THE HSWAGATA BUDDHA TOOTH RELIC PRESERVATION MUSEUM
FOR INTERNAL USE ONLY
Template No.: T242
Template Title: Mediation Session Record (Non-Escalation + Right Speech Focus)
Related Research Case IDs / Cluster: Cluster F – HGT Conflicts & Security (Cases 66–85)
Linked Templates / Policies: T226 (Overview), T227 (Chronology), T228 (Stakeholder Map), T231 (Actions Tracker), T232 (Risk Sheet), T229 (Evidence Index), T246 (Confidentiality Decision)
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 [ ]
A) Session identification
Case ID: ___________________________ Session No.: ______
Session date: //______ Start time: ______ End time: ______
Session type (tick): In-person [ ] Online [ ] Hybrid [ ]
Location / platform: ________________________________________________
Mediator / facilitator (role): _________________________________
Note-taker (role): ____________________________________________
B) Purpose of the mediation (simple)
Tick main purpose:
Reduce tension and stop conflict growth [ ]
Agree on facts and timeline [ ]
Agree on safe behaviour and access rules [ ]
Agree on relic protection steps [ ]
Agree on next steps (documents / MoU / legal) [ ]
Other: _______________________________
Purpose statement (2–4 lines):
C) Participants (use codes/roles, not full names)
Party A code/role: ____________________ Organization: ________________
Party B code/role: ____________________ Organization: ________________
Other party codes/roles (optional): ___________________________________
Observers (if any) (roles/codes): _____________________________________
Security present? Yes [ ] No [ ] If Yes, role: ________________________
Interpreter present? Yes [ ] No [ ] If Yes, role: ______________________
D) Ground rules (read aloud and tick)
Speak calmly. One person speaks at a time. [ ]
No insults, threats, or shouting. [ ]
Use facts. Say “I saw” or “I heard” clearly. [ ]
No recording unless all agree and it is approved. [ ]
Focus on safety and relic protection first. [ ]
Confidentiality: do not share details outside allowed roles. [ ]
If any rule was broken, note it (facts):
E) Safety check before discussion
Any risk today? People safety risk: Yes [ ] No [ ] Unsure [ ]
Relic/site safety risk: Yes [ ] No [ ] Unsure [ ]
If Yes/Unsure, control used (tick): Extra guard [ ] Shorter meeting [ ] Separate rooms [ ] Stop meeting [ ] Other: ______
F) Agenda (what topics were discussed)
Topic 1: ____________________________________________________________
Topic 2: ____________________________________________________________
Topic 3: ____________________________________________________________
G) Summary of each party’s statement (facts + needs)
G1) Party A statement (5–10 lines)
Facts as stated by Party A:
Needs/concerns (what they want / fear):
G2) Party B statement (5–10 lines)
Facts as stated by Party B:
Needs/concerns (what they want / fear):
G3) Key notes from mediator (neutral)
H) Evidence and documents mentioned (do not attach originals here)
Evidence ID(s) referenced (from T229): ________________________________
Timeline number(s) referenced (T227): _________________________________
Any claim needing verification (T233/T230)? Yes [ ] No [ ]
If Yes, list what must be verified: ___________________________________
I) Points of agreement (write clearly)
J) Points still not agreed (write clearly)
K) Options discussed (solutions considered)
Option A: ___________________________________________________________
Option B: ___________________________________________________________
Option C: ___________________________________________________________
L) Decisions made in this session
Decision made? Yes [ ] No [ ] Partial [ ]
If Yes, record decision(s) (simple, 1–3 lines each):
Decision level: Staff [ ] Head [ ] Board required [ ] Legal required [ ]
M) Action plan (add to T231)
(One owner per action, with due date.)
| Action | Owner (role) | Due date | Linked template (tick) | Notes |
|---|---|---|---|---|
| __________________________ | __________ | //____ | T231 [ ] T233 [ ] T230 [ ] T232 [ ] Other: ___ | ______ |
| __________________________ | __________ | //____ | T231 [ ] T233 [ ] T230 [ ] T232 [ ] Other: ___ | ______ |
| __________________________ | __________ | //____ | T231 [ ] T233 [ ] T230 [ ] T232 [ ] Other: ___ | ______ |
N) Communication control after mediation
Spokesperson (role): __________________________
Public statement allowed? Yes [ ] No [ ] Board only [ ]
Key message (internal, calm, factual) (1–2 lines):
O) Follow-up meeting
Next meeting needed? Yes [ ] No [ ]
Proposed date/time: //______ Time: ______
Place/platform: _________________________________________________
Main goal for next meeting (1–2 lines): _______________________________
P) Sign-off
Mediator/Facilitator (Name): __________________ Role: ________________
Signature: _________________________________ Date: //______
Note-taker (Name): __________________________ Role: ________________
Signature: _________________________________ Date: //______
Party A acknowledgement (code/role): __________________ Signature: __________ Date: //____
Party B acknowledgement (code/role): __________________ Signature: __________ Date: //____
