THE HSWAGATA BUDDHA TOOTH RELIC PRESERVATION MUSEUM
FOR INTERNAL USE ONLY
Template No.: T202
Template Title: Scientific Partner / Lab Pre-Screening Checklist
Related Research Case IDs / Cluster: Cluster E – Science, Testing, Misinformation (E46–E65)
Linked Templates / Policies: T201 Sample Request, T203 Testing MoU & Data Governance, T204 Chain-of-Custody, T205 Transport Checklist, Institutional Policies for Relic Stewardship
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
FIELDS (Pre-Screening Checklist)
1) Lab Name and Identity
Lab / Institution name: ______________________________________
Department / unit (if any): ___________________________________
Address (full): ______________________________________________
Country: _______________________ City: _______________________
Website / official registry (internal note): ______________________
Main contact person (name/role): ______________________________
Email / phone: ______________________________________________
Emergency contact (after hours): ______________________________
2) Experience With Heritage (Museums / Temples / Archives)
Tick evidence provided:
Has worked with cultural heritage objects before [ ]
Has worked with sacred / religious objects before [ ]
Can show examples or project list (attach) [ ]
Has safe handling SOPs for fragile items [ ]
Has clean workspace / contamination control for micro-samples [ ]
Notes (short): ________________________________________________
3) Ethics and Respect (Must Agree)
Lab confirms (tick each):
Will follow “minimal harm / smallest sample” rule [ ]
Will not do any extra tests outside the written scope [ ]
Will not share photos or stories on social media [ ]
Will keep all data confidential until HSWAGATA approves release [ ]
Will respect “Sacred-Restricted / Sensitive” rules [ ]
Ethics document attached? Yes [ ] No [ ] Title/ID: _______________
4) Quality and Trust (Basic Checks)
Tick what is verified:
Lab accreditation / certification (attach proof) [ ]
Clear method description (what, how, limits) [ ]
Reports include uncertainty / limits (not over-claiming) [ ]
Clear sample labeling system (ID control) [ ]
Secure file transfer (encrypted email/portal) [ ]
Notes: ________________________________________________________
5) Previous Issues (Red Flag Check)
Any past complaints, sanctions, lawsuits, or serious disputes? Yes [ ] No [ ]
Any retracted papers or proven data problems? Yes [ ] No [ ]
Any public scandal linked to this lab/team? Yes [ ] No [ ]
If “Yes”, describe briefly and attach evidence:
6) Reference Check (Minimum 2)
Reference 1
Organization / person: ________________________________________
Contact (email/phone): _______________________________________
What they tested (type of object): ______________________________
Result of reference check: Positive [ ] Mixed [ ] Negative [ ]
Notes: ________________________________________________________
Reference 2
Organization / person: ________________________________________
Contact (email/phone): _______________________________________
What they tested (type of object): ______________________________
Result of reference check: Positive [ ] Mixed [ ] Negative [ ]
Notes: ________________________________________________________
7) Decision (Pre-Screen Result)
Approved to proceed to T203 (MoU & data governance) [ ]
Approved with conditions [ ] Conditions: ________________________
Not approved [ ] Reason: _____________________________________
Reviewer name/role: ___________________________
Signature: ____________________ Date: ____ / ____ / ______
