Template No.: T220 Template Title: Incident Report: Breach of Testing Protocol
THE HSWAGATA BUDDHA TOOTH RELIC PRESERVATION MUSEUM
FOR INTERNAL USE ONLY
Template No.: T220
Template Title: Incident Report: Breach of Testing Protocol
Related Research Case IDs / Cluster: Cluster E (Science, Testing, Misinformation), Cases 46–65 (add F if conflict risk; add G if loss/neglect risk)
Linked Templates / Policies: Scientific Verification SOP, Chain-of-Custody SOP, T214 (Testing Risk Assessment), T216 (Ethics & Consent Review), T217 (Data Storage & Access Register), T218 (Partner Reputation & COI Check), T219 (Equipment Loan/Borrow), T213 (Media Interview Prep), T190 (Media Approval), T169 (Learning Workshop Note), T163 (Risk Register Entry), T173 (Records Classification), T183 (Feedback/Complaint)
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 breach of testing protocol (a mistake or rule break).
It helps protect faith, heritage, and peace. It also helps learning and prevention.
Important: Do not write exact security routines, exact storage locations, or other Sacred-Restricted details here.
2) Incident identification (basic details)
Incident ID / code: ______________________________
Date discovered: ____ / ____ / ______
Time discovered: __________
Date incident happened (if known): ____ / ____ / ______
Time incident happened (if known): __________
Location (general): On-site lab area [ ] Storage support area [ ] Display area [ ] Offsite lab [ ] Transport [ ] Digital system [ ] Other: ______
Reported by (name/role): _______________________________________
Incident owner (name/role): _____________________________________
Related project/dossier: ______________________________ (T215 ID if any: __________)
Related object/item case (internal ID): ___________________________
3) What happened (summary)
Write 3–8 lines. Use facts only.
4) What protocol was breached? (tick all that apply)
Testing process
Unapproved method used [ ]
Steps not followed / missing checklist [ ]
Sampling attempted without approval [ ]
Equipment not calibrated / wrong settings [ ]
Wrong labeling / mix-up risk [ ]
Poor environment control (heat/light/humidity) [ ]
Other: __________________________ [ ]
Chain-of-custody / access
Unauthorised person handled item [ ]
Access rules not followed [ ]
Transport/handling log incomplete [ ]
Item left unattended [ ]
Other: __________________________ [ ]
Data and confidentiality
File shared to wrong person [ ]
File stored in wrong place (personal device/USB) [ ]
Missing encryption/password [ ]
Public statement made too early [ ]
Other: __________________________ [ ]
Which SOP/policy section was breached (if known): _____________________________
5) People and organisations involved (roles only if sensitive)
HSWAGATA staff involved (name/role):
External lab/partner involved? Yes [ ] No [ ]
If Yes, organisation name: __________________________________________
Main contact (role/name): __________________________________________
Witnesses (optional): ______________________________________________
6) Immediate containment actions (what we did right away)
Tick what was done.
Work stopped immediately [ ] Time: ________
Item secured (authorised storage only) [ ]
Area secured / access limited [ ]
Supervisor informed [ ]
Security informed (if needed) [ ]
Conservation informed [ ]
Data access removed/locked [ ]
Incorrect file deleted/moved to correct secure folder [ ]
Equipment taken out of use [ ]
Other immediate action: __________________________ [ ]
Immediate actions details (short):
7) Impact assessment (impact)
A) Impact type (tick all that apply)
Faith/trust impact (community upset, disrespect concern) [ ]
Heritage impact (damage risk, contamination, loss) [ ]
Peace impact (conflict/rumours/media risk) [ ]
Legal/compliance impact [ ]
Data/privacy impact [ ]
Safety impact (people injured or near-miss) [ ]
B) Severity rating
Likelihood: 1 Rare [ ] 2 Unlikely [ ] 3 Possible [ ] 4 Likely [ ] 5 Almost certain [ ]
Impact: 1 Minor [ ] 2 Low [ ] 3 Medium [ ] 4 High [ ] 5 Severe [ ]
Overall severity (tick): Low [ ] Medium [ ] High [ ] Critical [ ]
C) Impact notes (facts only)
What was affected (item/data/people): _______________________________
Any physical damage suspected? Yes [ ] No [ ] Not sure [ ]
If Yes/Not sure, conservation check required.
Notes:
8) Notifications and escalation (who was informed)
Tick and fill dates.
Unit Head informed [ ] Date: //____
Director informed [ ] Date: //____
Board informed (if needed) [ ] Date: //____
Conservation lead informed [ ] Date: //____
Doctrinal/Ethics advisor informed [ ] Date: //____
Security lead informed [ ] Date: //____
IT/Data custodian informed [ ] Date: //____
Partner lab informed [ ] Date: //____
Government/authority informed (if required) [ ] Date: //____
Any public/media risk? Yes [ ] No [ ]
If Yes: use T213 for messages and T190 for approvals. No public talk until approved.
9) Root cause review (why it happened)
Tick main cause(s). Add short notes.
Lack of training/induction [ ]
Poor supervision / unclear roles [ ]
Time pressure / rushed work [ ]
Checklist not used [ ]
Wrong equipment / equipment failure [ ]
Poor communication with partner [ ]
Poor data control / wrong folder access [ ]
Human error (mistake) [ ]
Unclear consent/permission limits [ ]
Other cause: __________________________ [ ]
Root cause notes (2–6 lines):
10) Corrective actions (fix now)
List actions that correct the problem. Include owner and deadline.
Corrective action 1: _______________________________________________
Owner: __________________________ Deadline: //____
Status: Open [ ] In progress [ ] Done [ ]
Corrective action 2: _______________________________________________
Owner: __________________________ Deadline: //____
Status: Open [ ] In progress [ ] Done [ ]
Corrective action 3: _______________________________________________
Owner: __________________________ Deadline: //____
Status: Open [ ] In progress [ ] Done [ ]
If data was involved: update T217 entry? Yes [ ] No [ ] File code: __________
If equipment was involved: update T219? Yes [ ] No [ ] Loan ref: __________
11) Preventive actions (stop it happening again)
Tick and plan.
Update SOP/checklist [ ] Link to T162 (SOP cover) if needed: ________
New training for staff/partners [ ]
Stronger access controls (roles/permissions) [ ]
Two-person verification for key steps [ ]
Better labeling and documentation rules [ ]
Better pre-brief with partner labs [ ]
Update risk assessment (T214) [ ]
Other prevention: __________________________ [ ]
Prevention action plan (owner + deadline):
12) Learning and reflection (learning)
Write 3–7 lessons. Keep them practical and simple.
Learning workshop needed (T169)? Yes [ ] No [ ]
If Yes, planned date: //____ Facilitator: _____________________
Risk register entry needed (T163)? Yes [ ] No [ ] Risk ID: _____________
13) Closure (when the case is finished)
Case closed? Yes [ ] No [ ]
Closure date: ____ / ____ / ______
Closed by (name/role): ____________________________________________
Evidence attached (tick):
Photos (safe) [ ] Logs [ ] Email trail [ ] Lab note [ ] Data access log [ ] Training record [ ] Other: ____
14) Signatures and approvals
Prepared by (name/role): _______________________ Signature: __________ Date: //____
Reviewed by (Science/Verification lead): ________ Signature: __________ Date: //____
Reviewed by (Conservation, if item risk): _______ Signature: __________ Date: //____
Reviewed by (Security/Data, if needed): _________ Signature: __________ Date: //____
Reviewed by (Doctrinal/Ethics, if faith impact): _ Signature: __________ Date: //____
Approved by (Director/Authority/Board if needed): _____________________
Signature: __________ Date: //____
15) Filing
File code / reference ID: ____________________
Classification recommended (T173): Internal [ ] Restricted [ ] Sacred-Restricted [ ]
File location (cabinet/folder + digital path): __________________________
Retention period: 3 years [ ] 5 years [ ] 10 years [ ] Permanent [ ] Other: ____