THE HSWAGATA BUDDHA TOOTH RELIC PRESERVATION MUSEUM
FOR INTERNAL USE ONLY
Template No.: T204
Template Title: Chain-of-Custody Log for Relic Movements (Lab)
Related Research Case IDs / Cluster: Cluster E – Science, Testing, Misinformation (E46–E65)
Linked Templates / Policies: T201 Sample Request, T203 MoU & Data Governance, T205 Packaging & Transport Checklist
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 (use one line per handover; attach extra pages if needed)
A) Item Identification (complete once)
Relic ID / Container ID: ______________________________________
Sample ID (if any): ___________________________________________
Item description (short): ______________________________________
Start location (HSWAGATA): ___________________________________
Destination lab location (building/room): ________________________
Primary seal number (start): ___________________________________
Secondary seal number (if used): _______________________________
B) Chain-of-Custody Log Entries (repeat for every movement/handover)
Entry No.: ______
Date & time (24h): ____ / ____ / ______ ______ : ______
Location (exact place): ____________________________________
Handed from (name/role): __________________________________
Handed to (name/role): ____________________________________
Seal number(s) checked: ____________________________________
Seal status: Intact [ ] Not intact [ ] Replaced [ ]
Notes (short, factual):
Sign (from): ____________________ Sign (to): ____________________
Witness (name/sign, if required): _______________________________
C) Exception Notes (only if something is not normal)
Exception happened? Yes [ ] No [ ]
If Yes, write:Date/time: ______________________ Location: ____________________
What happened (short): ________________________________________
Immediate action taken: ________________________________________
Who was informed: ____________________________________________
Photos/evidence saved: Yes [ ] No [ ] File name(s): ______________
D) Close-Out (when chain ends)
End date/time: ____________________________
Final location (exact): ________________________________________
Final seal number(s): _________________________________________
Close-out confirmed by (name/role/sign): ________________________ Date: //____
