RELIC DAMAGE / LOSS INCIDENT REPORT Form Code: HSW-F13
HSWAGATA BUDDHA TOOTH RELICS PRESERVATION MUSEUM
RELIC DAMAGE / LOSS INCIDENT REPORT
Form Code: HSW-F13
Incident Number: ___________________________
Date of Report: ____ / ____ / ______
1. RELIC DETAILS
1.1 Relic ID Code: _________________________
1.2 Relic Name / Title: ____________________
2. INCIDENT DETAILS
2.1 Date of Incident: ____ / ____ / ______
2.2 Time: __________
2.3 Location (room, case, shelf):
_______________________________________
2.4 Type of Incident:
[ ] Damage
[ ] Suspected loss
[ ] Confirmed loss
[ ] Near-miss (almost happened)
2.5 Description of What Happened:
_______________________________________
_______________________________________
3. PERSONS INVOLVED / PRESENT
3.1 Names and Roles:
_______________________________________
_______________________________________
3.2 Who First Noticed the Problem?
Name: _________________________________
4. IMMEDIATE ACTIONS TAKEN
(e.g., moved relic, closed room, called security)
___________________________________________
___________________________________________
5. REPORTING
5.1 Reported To (name, role):
_______________________________________
5.2 Date / Time of Report:
____/____/____ __________
6. FOLLOW-UP PLAN
6.1 Suggested next steps (investigation, repair, etc.):
_______________________________________
_______________________________________
6.2 Person Responsible for Follow-Up:
_______________________________________
Reported By:
Name: __________________________ Role: _______________
Signature: ______________________ Date: ____/____/____
Reviewed By (Manager / Custodian):
Name: __________________________ Signature: __________
Date: ____/____/____