THE HSWAGATA BUDDHA TOOTH RELIC PRESERVATION MUSEUM
FOR INTERNAL USE ONLY
Template No.: T219
Template Title: Scientific Equipment Loan / Borrow Form
Related Research Case IDs / Cluster: Cluster E (Science, Testing, Misinformation), Cases 46–65 (also link C for partnerships; G for maintenance care)
Linked Templates / Policies: Asset Management Policy, Lab Safety SOP, Chain-of-Custody SOP (for sensitive tools), T218 (Partner Reputation & COI Check), T163 (Risk Register Entry), 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 records any scientific equipment that is borrowed or loaned.
It tracks the item, condition, who has it, dates, and return condition.
2) Loan type and reference
Loan type (tick):
HSWAGATA borrows from partner [ ]
HSWAGATA loans to partner [ ]
Internal loan (between departments) [ ]
Loan reference / ID: _______________________________
Related project/dossier ID (if any): _______________________________
Related partner check (T218 ID, if external): _______________________
3) Item details (item)
Item name: _______________________________________________
Item category (tick): Measuring device [ ] Imaging tool [ ] Storage/packing tool [ ] PPE/safety [ ] Computer/drive [ ] Other: ____
Brand/model (if any): ______________________________________
Serial number / asset tag: _________________________________
Quantity: ________
Accessories included (tick): Case [ ] Charger [ ] Cable [ ] Batteries [ ] Manual [ ] Calibration certificate [ ] Other: ____
List accessories (if needed): _______________________________________
4) Condition at handover (condition)
Date checked: ____ / ____ / ______
Checked by (name/role): __________________________________________
Condition (tick): New [ ] Good [ ] Fair [ ] Poor [ ] Not working [ ]
Condition notes (write clearly):
Photos taken at handover? Yes [ ] No [ ]
If Yes, photo file/path: ____________________________________________
Calibration status (if relevant)
Calibration needed? Yes [ ] No [ ]
Last calibration date (if known): ____ / ____ / ______
Calibration proof attached? Yes [ ] No [ ] NA [ ]
5) From / To (from/to)
A) Lender (from)
Organisation/unit: ________________________________________________
Person name/role: ________________________________________________
Phone/email: _________________________________________________
Address/location (optional): ______________________________________
B) Borrower (to)
Organisation/unit: ________________________________________________
Person name/role: ________________________________________________
Phone/email: _________________________________________________
Use location (general): ____________________________________________
6) Loan dates and return plan (dates)
Date issued / handed over: ____ / ____ / ______
Time issued: ________
Expected return date: ____ / ____ / ______
Expected return time (optional): ________
Actual return date (complete later): ____ / ____ / ______
Actual return time (complete later): ________
Reason for loan (short):
Approved use only (tick):
Conservation care [ ] Documentation [ ] Education demo (approved) [ ] Lab testing support (approved) [ ] Other: ____
7) Handling and safety rules (must tick)
Borrower received basic use instructions. Yes [ ] No [ ]
Borrower will use PPE if needed. Yes [ ] No [ ] NA [ ]
Item will be kept dry, clean, and secure. Yes [ ] No [ ]
Item will not be shared to another person without approval. Yes [ ] No [ ]
No use in restricted/sacred areas unless authorised. Yes [ ] No [ ]
Data devices (USB/drives/laptops) follow data security rules. Yes [ ] No [ ] NA [ ]
Special handling notes (if fragile/sensitive):
8) Responsibility and liability (simple)
Responsible borrower (name/role): _________________________________
If lost/damaged, borrower must report within: 24 hours [ ] 48 hours [ ] Other: ____
Repair/replacement rule (tick): Borrower pays [ ] Shared cost [ ] Case-by-case [ ] Not stated [ ]
Insurance / liability document attached (if external loan)? Yes [ ] No [ ] NA [ ]
9) Return condition check (return condition)
(Complete when item is returned.)
Returned to (name/role): _________________________________________
Return condition (tick): Same as issued [ ] Minor wear [ ] Damaged [ ] Missing parts [ ] Not working [ ]
Condition notes: _________________________________________________
Accessories returned fully? Yes [ ] No [ ] List missing: _______________
Photos taken at return? Yes [ ] No [ ]
If Yes, photo file/path: ____________________________________________
Action needed (tick):
Clean [ ] Repair [ ] Re-calibrate [ ] Replace [ ] No action [ ]
Work order / maintenance note (if any): ______________________________
10) Signatures (handover and return)
Handover signatures
Lender name/role: __________________________ Signature: __________ Date: //____
Borrower name/role: ________________________ Signature: __________ Date: //____
HSWAGATA witness (if needed): ______________ Signature: __________ Date: //____
Return signatures (complete later)
Returned by (name/role): ____________________ Signature: __________ Date: //____
Received by (name/role): ____________________ Signature: __________ Date: //____
11) Filing
File code / reference ID: ____________________
Classification recommended (T173): Internal [ ] Restricted [ ]
File location (cabinet/folder + digital path): __________________________
Retention period: 1 year [ ] 3 years [ ] 5 years [ ] Other: ____
