THE HSWAGATA BUDDHA TOOTH RELIC PRESERVATION MUSEUM
FOR INTERNAL USE ONLY
Template No.: T284
Template Title: Staff & Volunteer Code of Conduct Acknowledgement Form
Related Research Case IDs / Cluster: _______
Linked Templates / Policies: _______________
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
T284 – Staff & Volunteer Code of Conduct Acknowledgement Form
Purpose:
This form confirms that a staff member or volunteer has read the HSWAGATA Code of Conduct and agrees to follow it.
A) Person details (to be completed by staff/volunteer)
Full name: _______________________________________________
ID / Staff No. (if any): ____________________________________
Role (tick): Staff [ ] Volunteer [ ] Intern [ ] Consultant [ ] Monk/Nun support role [ ] Other: ______
Department / Unit: ________________________________________
Supervisor / contact person: ________________________________
Phone / Email: ____________________________________________
B) Code of Conduct acknowledgement (tick all)
I confirm that I have received and read the HSWAGATA Code of Conduct (version: ________).
I understand and agree that I must:
Treat everyone with respect. No bullying, hate speech, or discrimination. [ ]
Protect confidentiality. I will not share internal or sensitive information without permission. [ ]
Protect sacred items and museum property. I will follow all safety and access rules. [ ]
Follow safeguarding rules. I will help keep children and vulnerable people safe. [ ]
Avoid conflicts of interest. I will declare gifts, money, or personal benefit that can influence my work. [ ]
Use honest speech and calm behaviour in disagreements. [ ]
Report concerns quickly (safety, misconduct, corruption, theft, damage, harassment). [ ]
Follow instructions on uniforms, ID badges, photos, social media, and visitor communication. [ ]
Where to report a concern (fill in by office):
Safeguarding / Ethics focal person: ______________________________
Phone / Email: _______________________________________________
Emergency contact (security / duty officer): ______________________
C) Optional notes (if any)
(Example: training needed, accessibility needs, language support.)
D) Signature
By signing below, I confirm the statements above are true.
Name (print): ____________________________________________
Signature: _______________________________________________
Date: ____ / ____ / ______
Witness / Supervisor (optional but recommended):
Name (print): ____________________________________________
Role: _________________________________________________
Signature: _______________________________________________
Date: ____ / ____ / ______
Office filing (for Office Use Only):
Form received by: ________________________ Date: //______
Stored in: Personnel file [ ] Volunteer file [ ] Training file [ ]
Next refresher / re-sign due date: ____ / ____ / ______
