THE HSWAGATA BUDDHA TOOTH RELIC PRESERVATION MUSEUM
FOR INTERNAL USE ONLY
Template No.: T281
Template Title: Annual Indicator Scorecard Summary (Short T97)
Related Research Case IDs / Cluster: H97 / Cluster H – Indicator Framework & Scorecard (annual review)
Linked Templates / Policies: T97 (full Indicator Framework & Scorecard); H96/H97 learning; Annual review cycle (apply yearly, share results)
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 [ ]
T281 – Annual Indicator Scorecard Summary (Short T97)
Purpose:
Use this short form to summarise key indicators once per year, based on the T97 indicator list and scoring scale.
This supports the yearly indicator review cycle.
A) Assessment details
Assessment year (this scorecard): ________
Period covered: ____ / ____ / ______ to ____ / ____ / ______
Unit assessed (site / department / project): ________________________________
Location(s): ___________________________________________________________
Baseline year (first measurement): ________
Baseline source (file code / report / T97 reference): _________________________
Domains included (tick): (use the same domains as T97)
A. Doctrine & Ethics [ ] B. Peace & Conflict Sensitivity [ ] C. Heritage/Technical Safeguards [ ]
D. Governance & SDGs [ ] E. Equity & Inclusion [ ] F. Partnerships [ ] G. Inner Qualities [ ]
B) Scoring scale used
(Choose one, as in T97.)
0–4 [ ] 1–5 [ ] Traffic light (R/A/G) [ ] Mixed (score + short narrative) [ ]
Scale note (1 line): ______________________________________________________
Trend key (tick one per indicator): Up [ ] Down [ ] Stable [ ] New (no baseline) [ ]
C) Key data sources used (tick)
Policy / constitution / MoUs [ ] Minutes / decisions [ ] Incident reports [ ] Interviews [ ]
Observation of relic rooms [ ] External audit/legal documents [ ] Community/donor feedback [ ]
Short method note (2–3 lines): _____________________________________________
D) Annual indicator summary table (main fields)
Fields required: indicator list, baseline, current score, trend, comments.
| Indicator code & short name | Baseline (year + score) | Current score (this year) | Trend (Up/Down/Stable/New) | Comments / evidence (file codes, 2–4 lines max) |
|---|---|---|---|---|
| 1) _______________________ | ________ / ____ | ____ | ________ | __________________________________________ |
| 2) _______________________ | ________ / ____ | ____ | ________ | __________________________________________ |
| 3) _______________________ | ________ / ____ | ____ | ________ | __________________________________________ |
| 4) _______________________ | ________ / ____ | ____ | ________ | __________________________________________ |
| 5) _______________________ | ________ / ____ | ____ | ________ | __________________________________________ |
| 6) _______________________ | ________ / ____ | ____ | ________ | __________________________________________ |
| 7) _______________________ | ________ / ____ | ____ | ________ | __________________________________________ |
| 8) _______________________ | ________ / ____ | ____ | ________ | __________________________________________ |
| 9) _______________________ | ________ / ____ | ____ | ________ | __________________________________________ |
| 10) ______________________ | ________ / ____ | ____ | ________ | __________________________________________ |
(Add rows as needed.)
E) Short summary (optional but recommended)
Top 3 strengths this year:
____________________ 2) ____________________ 3) ____________________
Top 3 weaknesses / gaps this year:
____________________ 2) ____________________ 3) ____________________
One key risk if we do nothing (1 line): ___________________________________
F) Actions for next year (short)
(Write only 3–5 actions. Link each action to an indicator code.)
| Action | Linked indicator code(s) | Owner (role/unit) | Deadline | Proof (report/minutes/photo/log) |
|---|---|---|---|---|
G) Sign-off and archive
Prepared by / Role: __________________________ Signature: ______________ Date: ____ / ____ / ______
Reviewed by (committee/lead): __________________ Signature: ______________ Date: ____ / ____ / ______
Approved by (ED/Board, if needed): _____________ Signature: ______________ Date: ____ / ____ / ______
Archive file code (T281): __________________________
Digital folder path: ________________________________
Next annual review due (date): ____ / ____ / ______
