THE HSWAGATA BUDDHA TOOTH RELIC PRESERVATION MUSEUM
FOR INTERNAL USE ONLY
Template No.: T216
Template Title: Ethics & Consent Review Form for Testing (Custodians / Owners / Community)
Related Research Case IDs / Cluster: Cluster E (Science, Testing, Misinformation), Cases 46–65 (also link F if conflict risk; H for ethics model)
Linked Templates / Policies: T214 (Risk Assessment for Testing Proposal), Scientific Verification SOP, Relic Respect & Safeguarding Rules, T215 (Multi-Lab Dossier Summary), T156 / T24 (MoU templates), T190 (Media Approval), T183 (Feedback/Complaint), T163 (Risk Register), T173 (Records Classification)
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 form)
This form checks ethics and consent before any testing of a relic or sacred object.
It confirms consent from custodians, legal owners, and community, and records any conditions.
2) Testing proposal link (reference)
Proposal title / ID: ____________________________________________
Link to T214 risk assessment ID: _________________________________
Dossier ID (if multi-lab, T215): _________________________________
Reason for testing (tick): Conservation care [ ] Rumour response [ ] Education [ ] Research [ ] Other: ____
Short summary (2–4 lines, non-sensitive):
3) Object / relic details (non-sensitive)
Item name / museum ID: __________________________________________
Item type (tick): Relic-related [ ] Sacred object [ ] Reliquary/container [ ] Other: ____
Current status (tick): On display [ ] In storage [ ] Offsite (approved) [ ]
Sensitivity level (tick): Low [ ] Medium [ ] High [ ] Sacred-Restricted [ ]
Important note: Do not write security routines or exact storage locations here.
4) Stakeholder map (who must be respected)
Tick all groups that may be affected.
Primary custodian(s) / monastic authority [ ]
Legal owner(s) / trustee(s) [ ]
Local temple / sangha community [ ]
Lay community near the site [ ]
Donors connected to the object/site [ ]
Government heritage office (if required) [ ]
Partner labs/institutions (if any) [ ]
Other: __________________________ [ ]
Stakeholder notes (short): ___________________________________________
5) Consent checklist (who agreed, and how)
A) Custodian consent (custodians)
Custodian/monastic authority name/role: ______________________________
Consent given? Yes [ ] No [ ] Pending [ ] Not applicable [ ]
Type of consent (tick): Written [ ] Recorded meeting minutes [ ] Email [ ] Other: ____
Date of consent: ____ / ____ / ______
Proof filed (path / ref): ____________________________________________
Custodian notes / limits (short):
B) Legal owner consent (legal owners)
Legal owner/trustee name/role: ______________________________________
Consent given? Yes [ ] No [ ] Pending [ ] Not applicable [ ]
Proof of ownership checked? Yes [ ] No [ ] Pending [ ]
Type of consent (tick): Written [ ] Contract/MoU [ ] Email [ ] Other: ____
Date: ____ / ____ / ______
Proof filed (path / ref): ____________________________________________
Owner notes / limits (short):
C) Community consent (community)
Community consulted? Yes [ ] No [ ] Pending [ ] Not applicable [ ]
Method (tick): Elder/leader consultation (T188) [ ] Community meeting [ ] Temple committee [ ] Survey (T189) [ ] Other: ____
Date(s): ____ / ____ / ______
Who was consulted (roles/groups only): _______________________________
Community main view (short):
Support [ ] Mixed [ ] Concern [ ] Strong objection [ ]
Notes: _____________________________________________________________
D) Government/authority consent (if required)
Permission required by law/policy? Yes [ ] No [ ] Not sure [ ]
If Yes: authority name: _____________________________________________
Permission received? Yes [ ] No [ ] Pending [ ]
Reference number (if any): _________________________________________
6) Conditions and “strings attached” (conditions)
Any conditions placed by any party? Yes [ ] No [ ]
If Yes, list them clearly:
Condition 1: _______________________________________________________
Condition 2: _______________________________________________________
Condition 3: _______________________________________________________
Are any conditions not acceptable (control, special access, public claims)?
Yes [ ] No [ ] Not sure [ ]
If Yes, explain and propose changes: _________________________________
If conditions are risky, link to: T179 (Gift with Conditions Risk Review) or internal ethics note.
7) Ethics check (faith, heritage, peace)
Tick Yes/No and add short notes.
A) Faith and respect
The purpose is respectful and not insulting to faith. Yes [ ] No [ ]
Notes: _____________________________________________________________Words like “prove/disprove” will be avoided in public talk. Yes [ ] No [ ]
Notes: _____________________________________________________________
B) Heritage care (non-harm)
The plan uses minimal handling and avoids harm. Yes [ ] No [ ]
Notes: _____________________________________________________________No sampling/destructive action is planned (unless separately approved). Yes [ ] No [ ]
If No: sampling approval attached? Yes [ ] No [ ] Ref: ________________
C) Peace and harmony
Testing will not increase conflict in the community. Yes [ ] No [ ] Not sure [ ]
Notes: _____________________________________________________________A calm communication plan exists for rumours or disagreement. Yes [ ] No [ ]
Link (T212/T213/T190 as needed): ___________________________________
8) Consent quality check (is it informed and free?)
Tick Yes/No.
Consent was informed (people understood purpose and limits). Yes [ ] No [ ]
Consent was voluntary (no pressure, no fear, no payment for consent). Yes [ ] No [ ]
Consent scope matches the plan (site/lab/time). Yes [ ] No [ ]
People understand that results may be uncertain. Yes [ ] No [ ]
People understand we may not publish details publicly. Yes [ ] No [ ]
If any “No”, explain what must be fixed: _______________________________
9) Confidentiality and data rules
Classification (T173) for this case: Internal [ ] Restricted [ ] Sacred-Restricted [ ]
Who may access the dossier (roles): ________________________________
Any photos/data shared with labs? Yes [ ] No [ ]
If Yes: data-sharing rule agreed (MoU/T24)? Yes [ ] No [ ] Ref: _________
Media rule: No media statement without T190 and approved spokespeople.
10) Decision (proceed, hold, or refuse)
Decision (tick one):
Proceed (consent complete) [ ]
Proceed with conditions/changes [ ]
Hold (needs more consent/info) [ ]
Do not proceed (ethics/consent not acceptable) [ ]
Reasons (short, factual):
Actions needed if “Hold” or “Do not proceed”:
Action 1: ______________________________ Owner: __________ Date: //____
Action 2: ______________________________ Owner: __________ Date: //____
11) Signatures and approvals
Prepared by (name/role): _______________________ Signature: __________ Date: //____
Reviewed by (Science/Verification): _____________ Signature: __________ Date: //____
Reviewed by (Conservation): ____________________ Signature: __________ Date: //____
Reviewed by (Doctrinal/Ethics): ________________ Signature: __________ Date: //____
Reviewed by (Security/Chain-of-custody): _______ Signature: __________ Date: //____
Approved by (Director/Authority/Board): _________ Signature: __________ Date: //____
12) Attachments and filing
Attachments (tick):
T214 risk assessment [ ] Custodian consent proof [ ] Owner consent proof [ ] Community notes [ ] Government permit [ ] Draft public FAQ line (T212) [ ] MoU/T24 [ ] Other: ____
File code / reference ID: ____________________
File location (cabinet/folder + digital path): __________________________
Retention period: 3 years [ ] 5 years [ ] 10 years [ ] Permanent [ ] Other: ____
