A simple hemispherical phantom has been designed and prepared for the EURADOS intercomparison exercise on (241)Am activity determination in the skull (2011-13). The phantom consists of three parts that substitute bone and soft tissues. (241)Am is deposited on the surfaces of the bone-substituting part. The design and assumed composition of phantom parts are discussed. A preparation of the voxel representation of the phantom is described. The spectrum of a real measurement of the physical phantom agrees well with the simulation. The physical phantom, and its voxel representation, is provided to the participants of the intercomparison exercise.