THE HSWAGATA BUDDHA TOOTH RELIC PRESERVATION MUSEUM
FOR INTERNAL USE ONLY
Template No.: T188
Template Title: Local Leader & Elder Consultation Record
Related Research Case IDs / Cluster: Cluster D (Everyday Faith & Lay Donations), Cases 36–45 (add F if conflict risk)
Linked Templates / Policies: T180 (Community Event Proposal), T181 (Village Stupa Project Tracking), T183 (Community Feedback/Complaint), T158 (Stakeholder Mapping), T163 (Risk Register Entry), T173 (Records Classification), Safeguarding & Respect Guidelines
Date of form: ____ / ____ / ______
Prepared by / Role: _______________________
Office / Unit: ____________________________
Country / Location: _______________________
Confidentiality Level:
Internal only [ ] Restricted [ ] Sacred-Restricted / Sensitive [ ]
Use of this form (tick):
New case / action [ ] Follow-up [ ] Annual review [ ] Archive only [ ]
1) Purpose (why we use this record)
This record shows respectful consultation with local leaders and elders.
It keeps clear notes on topics, agreements, and concerns.
2) Consultation details (date and place)
Consultation date: ____ / ____ / ______
Time: __________ to __________
Place (village/temple/home/office): ________________________________
Method (tick): In-person [ ] Phone [ ] Online [ ] Community meeting [ ] Other: ______
Language(s) used: _______________________________________________
Facilitator (name/role): _________________________________________
Note taker (name/role): __________________________________________
3) Person consulted (leader / elder details)
Name (as preferred): _____________________________________________
Role/title (tick): Village elder [ ] Community leader [ ] Temple elder [ ] Local official [ ] Women’s group leader [ ] Youth leader [ ] Other: ______
Community / village: _____________________________________________
Contact (phone) (optional): _______________________________________
Consent to record notes (tick): Yes [ ] No [ ]
If No: write only general points, no names.
Consent to share summary with partners/community (tick): Yes [ ] No [ ]
If Yes, what can be shared (short): _________________________________
4) Participants (who attended)
HSWAGATA participants (name/role):
Community participants (name/role) (if allowed):
Observers/guests (optional): ________________________________________
5) Topics discussed (topics)
Tick and add notes.
Community needs and local context [ ] Notes: ________________________
Museum visit rules and respect guidance [ ] Notes: ___________________
Village stupa plan / repair / maintenance [ ] Notes: __________________
Event planning (festival, dāna day, school visit) [ ] Notes: ___________
Donations and fair handling (no pressure, clear receipts) [ ] Notes: ____
Youth learning and heritage education [ ] Notes: ____________________
Safety and crowd control [ ] Notes: ________________________________
Concerns about rumours/misinformation [ ] Notes: ___________________
Conflict risks between groups (if any) [ ] Notes: ____________________
Other topic: ______________________ [ ] Notes: _____________________
Key points said by the elder/leader (short, respectful):
6) Agreements reached (agreements)
Write clear agreements. Each should have an owner and a date.
Agreement 1: ______________________________________________________
Owner (HSWAGATA/community): _________________________________
Deadline / date: ____ / ____ / ______
Agreement 2: ______________________________________________________
Owner: _________________________________
Deadline / date: ____ / ____ / ______
Agreement 3: ______________________________________________________
Owner: _________________________________
Deadline / date: ____ / ____ / ______
7) Concerns raised (concerns)
List concerns clearly and calmly (facts, not blame).
Concern 1: ________________________________________________________
Type (tick): Trust/faith [ ] Donation ethics [ ] Safety [ ] Conflict [ ] Land/permission [ ] Reputation/rumours [ ] Other: ____
Urgency: Low [ ] Medium [ ] High [ ]
Suggested response: _____________________________________________
Concern 2: ________________________________________________________
Type: Trust/faith [ ] Donation ethics [ ] Safety [ ] Conflict [ ] Land/permission [ ] Reputation/rumours [ ] Other: ____
Urgency: Low [ ] Medium [ ] High [ ]
Suggested response: _____________________________________________
Sensitive note: If concerns include security or relic-access details, mark Restricted/Sacred-Restricted and keep details minimal.
8) Actions and follow-up plan
Action 1
Task: _________________________________________________
Owner: __________________________
Deadline: ____ / ____ / ______
Link to template (if needed): T180 [ ] T181 [ ] T183 [ ] T163 [ ] Other: ____
Action 2
Task: _________________________________________________
Owner: __________________________
Deadline: ____ / ____ / ______
Follow-up meeting needed? Yes [ ] No [ ]
If Yes, proposed date: ____ / ____ / ______ Place: ____________________
9) Record classification and filing
Recommended classification (T173): Public [ ] Internal [ ] Restricted [ ] Sacred-Restricted [ ]
Reason (if Restricted/Sacred-Restricted): _____________________________
File code / reference ID: ____________________
File location (cabinet/folder + digital path): __________________________
Retention period: 1 year [ ] 3 years [ ] 5 years [ ] 10 years [ ] Other: ____
10) Signatures (optional but recommended)
Elder/Leader name: __________________________ Signature/thumbprint: __________ Date: //____
(If they prefer not to sign, tick here: No signature requested [ ])
Prepared by (name/role): _______________________ Signature: __________ Date: //____
Reviewed by (Unit Head / Community Engagement): _ Signature: __________ Date: //____
