THE HSWAGATA BUDDHA TOOTH RELIC PRESERVATION MUSEUM
FOR INTERNAL USE ONLY
Template No.: T206
Template Title: Lab Result Receipt & Verification Form
Related Research Case IDs / Cluster: Cluster E – Science, Testing, Misinformation (E46–E65)
Linked Templates / Policies: T203 MoU & Data Governance, T204 Chain-of-Custody, T207 Internal Scientific Briefing Note, T208 Public Communication Plan
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 (record receipt of lab results)
1) Receipt Details
Relic ID: ______________________________
Sample ID(s) (if any): ______________________________
Lab / partner name: __________________________________________
Lab contact person (name/role): _______________________________
Email / phone: ______________________________________________
Date results received: ____ / ____ / ______
Time received (24h): ______ : ______
Received by (name/role): _____________________________________
Delivery method (tick): Email [ ] Secure portal [ ] USB/Drive [ ] Printed [ ] Other: _______
2) File Names Received (attach list if long)
File 1
File name: _________________________________________________
File type: PDF [ ] CSV [ ] Image [ ] RAW [ ] Other: ________
Size (if known): ___________________ Version/date: ___________
File 2
File name: _________________________________________________
File type: PDF [ ] CSV [ ] Image [ ] RAW [ ] Other: ________
Size (if known): ___________________ Version/date: ___________
File 3
File name: _________________________________________________
File type: PDF [ ] CSV [ ] Image [ ] RAW [ ] Other: ________
Size (if known): ___________________ Version/date: ___________
(Continue on extra page if needed.)
3) Basic Check (Quick Verification)
Tick each item after checking:
Files open and are readable [ ]
Files match correct Relic ID / Sample ID [ ]
Report includes test methods used [ ]
Report includes date(s) of testing [ ]
Report includes limits / uncertainty (not over-claiming) [ ]
No extra tests beyond agreed scope (T203) [ ]
Any images are labeled clearly (what/where/scale) [ ]
Any raw data is included if promised [ ]
Notes (short): __________________________________________________
4) Integrity and Security (if applicable)
Received through secure method? Yes [ ] No [ ]
Password provided separately? Yes [ ] No [ ] Not needed [ ]
Checksums / hashes provided? Yes [ ] No [ ]
If Yes, recorded where (folder/log): __________________________
Any sign of file change/corruption? Yes [ ] No [ ]
If Yes, explain: _______________________________________________
5) Internal Reviewer Assignment
Internal scientific reviewer (name/role): ________________________
Date sent to reviewer: ____ / ____ / ______
Review due date: ____ / ____ / ______
Secondary reviewer needed (conservation/ethics)? Yes [ ] No [ ]
If Yes, name/role: _________________________________________
6) Initial Internal Summary (1–3 lines only)
What the lab claims in simple words (no final decision here):
7) Storage Record (Where we saved it)
Stored location (secure folder / archive code): ___________________
Access level set: Internal [ ] Restricted [ ] Sacred-Restricted [ ]
Access list updated (names/roles): Yes [ ] No [ ]
Backup saved: Yes [ ] No [ ]
8) Next Steps (tick)
Prepare Internal Scientific Briefing Note (T207) [ ]
Prepare Public Communication Plan (T208) [ ]
Request clarification from lab [ ]
Start misinformation monitoring (T209) [ ]
Other: _________________________________________________
9) Signatures
Received by (name/sign): _________________________ Date: //____
Internal reviewer (name/sign): ____________________ Date: //____
Department head (if required) (name/sign): ________ Date: //____
