RELIC SCIENTIFIC TESTING REQUEST & ETHICS FORM Form Code: HSW-F15

 HSWAGATA BUDDHA TOOTH RELICS PRESERVATION MUSEUM

RELIC SCIENTIFIC TESTING REQUEST & ETHICS FORM

Form Code: HSW-F15

Request Number: ____________________________

Date: ____ / ____ / ______

1. RELIC DETAILS

   1.1 Relic ID Code: ________________________

   1.2 Relic Name / Title: ___________________

   1.3 Short Description:

       ______________________________________

2. REQUESTING PARTY

   2.1 Name: ________________________________

   2.2 Institution / Organization: ___________

   2.3 Role / Position: _____________________

   2.4 Contact (phone / email):

       ______________________________________

3. TYPE OF TEST REQUESTED

   (tick as appropriate)

   [ ] Visual / microscopic examination

   [ ] X-ray / imaging (non-invasive)

   [ ] Material analysis (non-destructive)

   [ ] Material sampling (destructive / micro sample)

   [ ] Other: _______________________________

4. PURPOSE OF TESTING

   4.1 Main Aim (education, research, authenticity debate, etc.):

       ______________________________________

       ______________________________________

   4.2 Expected Benefits:

       ______________________________________

   4.3 Possible Risks (to relic, to faith, to community trust):

       ______________________________________

5. ALTERNATIVE METHODS

   5.1 Have non-harmful alternatives been considered?

       [ ] Yes   [ ] No

       If yes, please describe:

       ______________________________________

       ______________________________________

6. ETHICAL REVIEW (INTERNAL USE)

   6.1 Internal Reviewer Name(s):

       ______________________________________

   6.2 Discussion Points (short summary):

       ______________________________________

       ______________________________________

   6.3 Decision:

       [ ] Approved

       [ ] Not approved

       [ ] Approved with conditions:

           __________________________________

7. CONDITIONS (IF APPROVED)

   7.1 Ritual / Respect Requirements:

       ______________________________________

   7.2 Handling and Security Rules:

       ______________________________________

   7.3 Storage and Use of Test Results:

       ______________________________________

   7.4 Communication Plan (how results will be shared, if at all):

       ______________________________________

8. SIGNATURES

   Requesting Party:

   Name: __________________________

   Signature: _____________________   Date: ____/____/____

   For HSWAGATA (Ethics / Custodian / Director):

   Name: __________________________

   Role: __________________________

   Signature: _____________________   Date: ____/____/____