Template No.: T242 Template Title: Mediation Session Record (Non-Escalation + Right Speech Focus)

 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 [ ]

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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):

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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):

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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:

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Needs/concerns (what they want / fear):

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G2) Party B statement (5–10 lines)

Facts as stated by Party B:

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Needs/concerns (what they want / fear):

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G3) Key notes from mediator (neutral)

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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)

1. ---

2. ---

3. ---

J) Points still not agreed (write clearly)

1. ---

2. ---

3. ---

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):

1. ---

2. ---

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):

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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: //____