Form 49116 - Condition Report - Indiana Commission On Public Records Conservation Division
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1
2CONDITION REPORT
INDIANA COMMISSION ON PUBLIC RECORDS
Log #
CONSERVATION DIVISION
State Form 49116 (9-98)
Patron name
Work
Address (street)
Telephone number
Home
(
)
Facsimile number
E-mail address
Address (city, state, ZIP code)
(
)
Record group #
Record Series number
Agency
Record Series name
Location
Box no.
CONTENTS
Letters
Parchment
Oversized materials
Books
Non-archival copies
Video recordings (size)
___________________
Photographs
Thermal Fax
Audio recordings (size)
___________________
Maps
Carbon copies
Microform (size)
___________________
Printed Material
Letterpress
Motion picture film (size) ___________________
Newsprint
Original Copies
Archival copies
File cards
Other __________________________________
PRESERVATION
Do items need conservation treatment?: Before processing:
Yes
No
Before public use:
Yes
No
Anticipated use of items:
High
Medium
Low
Conservation treatment required:
Extensive
Moderate
Minimal
None
Yes
No
May patron use original?
Yes
No
If yes, should patron be required to use gloves?
Should items be duplicated before use by patrons?
Yes
No
Should Patron be required to use copy only?
Yes
No
May this item be photocopied?
May it be made available for exhibit?
Yes
No
Yes
No
What is the best preservation option?
Maintain original
Microfilm
Photocopy
Encapsulated binding
Phase box
Defer preservation
What is intrinsic (most significant) about these items?
Charts
Binding
Multicolored
Letterhead
Signature
Artworks
Other
Inks
Graphs
Handwritten
Paper
Oversized
HOUSING
Box type :
.060 Blue/White
.060 Lig free
.060 Gray / Kraft
SRC box
Acid free cube
Replace box
Yes
No
Box load:
Overload
Underload
Correct
Are folders used?
Yes
No
If no, are they needed?
Yes
No
Yes
No
Should folders be replaced?
Other_________________
Type of binding:
Library
Ledger
Unique / Historic
Post
Covering material:
Cloth
Paper
Leather
Vellum
Vinyl
Other_________________
CONDITION
Rubber bands
Water damage
Mold damage
Fire damage
Adhesive tape
Active
Smoke damage
Adhesive stain
Insect damage
Staples
Torn
Active
Fragile
Paper clips
Surface dirt
Broken
Other fasteners
Folded
Other _____________________________
Fading
Rolled
PREVIOUS TREATMENTS
Fumigation
Deacidification
Heat set tissue
Mending
Phase box
Backing / Support
Disbound
Stain Reduction / Bleached
Rebound
Photocopied
Surface cleaned
Hardware removed
Encapsulation
Paste & paper
Other _____________________________
Microfilmed
Lamination
Conducted by / Signature
Conducted by / Printed name
Original survey date (month, day, year)
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