TAMILNADU NURSES AND MIDWIVES COUNCIL (CONSTITUTED UNDER TAMILNADU NURSES AND MIDWIVES ACT III OF 1926) JAYAPRAKASH NARAYANAN MALIGAI Old No: 140, New No: 56, Santhome High Road, Chennai – 600 004 Tel.No:044-24934792, Fax No:044-24620547 Academic Year: ……………………… Date of Inspection …………………….. INSPECTION PROFORMA Rule No: 37 of Tamil Nadu Nurses & Midwives Act : Yes /No Please Tick the Appropriate Boxes Type of Inspection : Sl No Type of Inspection H.V. ANM GNM Basic B.Sc(N) PBB.Sc (N) M.Sc (N) P.B Diploma Program 1 Primary Inspection 2 Annual Inspection 3 Re-Inspection 4 Enhancement of Seats 5 Surprise Inspection 6 Bi-annual Inspection I. GENERAL INFORMATION 1. Name of the Institution : …………………………………………….. ……………………………………………. 2. Full Address with Pin Code (as given in G.O) District : ……………………………………………. ……………………………………………. ……………………………………………. ……………………………………………. 3. If there is any address change, specify the new Address (enclose the Govt. Order for change of Address) : ……………………………………………. ……………………………………………. ……………………………………………. ……………………………………………. 4. Name of the Principal a)Telephone Number of the Principal : ……………………………………………. (O)…………………….(R)………………… (M)……………………………………. 5. Name of the Vice Principal a)Telephone Number of the Vice- Principal : …………………………………… (O)…………………….(R)………………… (M)……………………………………. 6. Telephone Number of the Institution : ………………………. Fax No:…………… 7. E-Mail of the Institution : ……………………………………………. 8. Name of the Trust/Society/Missionary/ Company (enclose a copy of the Registered trust Deed only if any name change of the trust or trust members,trust address) : ……………………………………………. ……………………………………………. ……………………………………………. …………………………………………… Encl:……….. 9. Administrative Control : 1.Government 2.University 3.Corporation 4.Private 5.Autonomous 6.Voluntary 7.Missionary/Trust/Society 8.Company 10. Does the institution has Minority status (If yes, enclose the minority status G.O. issued in recent years) : Yes / No Encl:……….. Is the institution willing to submit itself for the inspection under (to be filled by the Principal)
Transcript
TAMILNADU NURSES AND MIDWIVES COUNCIL
(CONSTITUTED UNDER TAMILNADU NURSES AND MIDWIVES ACT III OF 1926) JAYAPRAKASH NARAYANAN MALIGAI
Old No: 140, New No: 56, Santhome High Road, Chennai – 600 004 Tel.No:044-24934792, Fax No:044-24620547
Academic Year: ……………………… Date of Inspection ……………………..
INSPECTION PROFORMA
Rule No: 37 of Tamil Nadu Nurses & Midwives Act : Yes /No Please Tick the Appropriate Boxes Type of Inspection :
8. Name of the Trust/Society/Missionary/ Company (enclose a copy of the Registered trust Deed only if any name change of the trust or trust members,trust address)
Does the institution has Minority status (If yes, enclose the minority status G.O. issued in recent years)
:
Yes / No Encl:………..
Is the institution willing to submit itself for the inspection under
(to be filled by the Principal)
-2- 11. First Batch admitted for School/College :
* G.O, INC, TNC , University & Board Orders to be enclosed; *If G.O is exempted, kindly mention those courses (Both for New / Enhancement) Encl:………
12. a)Do you have parent Medical College : 1. Yes 2. No b)Do you have own Hospital : 1. Yes 2. No
If Yes, Name & Address of the Medical College Hospital( Proof of the same to be enclosed):-- Encl:……... 13) Is the INC/TNC/University affiliation Orders for the Previous academic year is available for each program : 1. Yes 2. No
If Yes, Mention the date of last inspection for each programme (Latest orders to be enclosed) Encl:……...
Council/University H.V. ANM GNM Basic B.Sc. (N)
PBBSc(N) M.Sc. (N) Post Basic Diploma
Programmes
Remarks
Tamilnadu Nursing Council
Indian Nursing Council University
Board (Govt/CMAI)
Programme
G.O No & Date
Year of Programme
Started
No. of Seats Sanctioned in Original G.O No. & Date
Enhancement of Seats (No.of seats sanctioned)
Remarks
G.O INC TNC University Board GO INC TNC University Board H.V. ANM GNM Basic B.Sc(N) Post Basic B.Sc (N) M.Sc.,(N) a. Med.Surg,Nsg b.Com. Health Nsg c. Paediatric Nsg d. Psychiatric Nsg e. OBG Nsg
M.Phil (N) Ph.D Post Basic Diploma Programmess
-3- II.TEACHING FACULTY
STAFFING PATTERN AS PER INC NORMS School Of Nursing
For School of nursing with 60 students (i.e., an annual intake of 20 students):
Note:
Teacher student ratio should be 1:10 for student sanctioned strength.
STAFFING PATTERN AS PER INC NORMS Collegiate Programme
Sl.No. Designation B.Sc.(N) 40-60
(Students Intake)
B.Sc.(N) 61-100
(Students Intake) 1 Professor cum PRINCIPAL 1 1 2 Professor cum
VICE- PRINCIPAL 1 1
3 Professor 0 1 4 Associate Professor 2 4 5 Assistant Professor 3 6 6 Tutor 10-18 19-28
Principal is excluded for 1:10 teacher student ratio norms
Tutor student ratio will be 1:10 (For 40 students intake minimum teacher required is 17 (including Principal).
The strength of tutors will be 10, and 6 will be as per sl. No.1 to 4)
3 Professor 0 4 Associate Professor 2 5 Assistant Professor 3 2 6 Tutor 10-18 2- 10
Teaching Faculty No. Required Principal 1 Vice-Principal 1 Tutor 4 Additional Tutor for interns 1 Total 7
-4- Sl.No. Designation B.Sc.(N)
40-60) (Students Intake)
P.B.B.Sc.(N) 20-60
(Students intake)
M.Sc.(N) 10-25
(Students intake)
1 Professor cum PRINCIPAL
1
2 Professor cum VICE- PRINCIPAL
1
3 Professor 0 1 4 Associate Professor 2 1 5 Assistant Professor 3 2 3* 6 Tutor 10-18 2-10
Sl.No. Designation GNM
20-60 B.Sc.(N) 40-60)
P.B.B.Sc.(N) 20-60
M.Sc.(N) 10-25
1 Professor cum PRINCIPAL
1
2 Professor cum VICE- PRINCIPAL
1
3 Professor 0 1*
4 Associate Professor /Reader
2 1*
5 Assistant Professor /Lecturer
3 2 3*
6 Tutor 6-18 10-18 2-10
*1:10 teacher student ratio for M.Sc.(N)
Sl.No. Designation ANM 20-60
GNM 20-60
B.Sc.(N) 40-60)
P.B.B.Sc.(N) 20-60
M.Sc.(N) 10-25
1 Professor cum PRINCIPAL
1
2 Professor cum VICE- PRINCIPAL
1
3 Professor 0 1* 4 Associate Professor 2 1* 5 Assistant Professor 3 2 3* 6 Tutor 4-12 6-18 10-18 2-10
*1:10 teacher student ratio for M.Sc(N)
1. Prof-Cum-Principal
:
5 years after M.Sc.,(N) with Total experience of 10 years after U.G.
2.Prof.-Cum Vice-Principal
3.Reader/Associate Professor : 3 years after M.Sc.,(N) with a total experience of 7 years after U.G.
4.Lecturer/Asst.Professor : M.Sc.,(N) with a total experience of 3 years after B.Sc.,(N)
5.Clinical Instructor : Basic B.Sc.,(N)/Post Basic B.Sc.,(N) with one year experience
-5- II. FACULTY DETAILS
A).Teaching Faculty Profile ( Full – Time) of all the Nursing programme offered by this institution( H.V., M, Basic B.Sc,(N), Post Basic B.Sc.,(N), M.Sc,(N) & any other (Nursing Faculty of all the nursing programme details to be given irrespective of the
program being inspected)
Sl No
Designation Name Age RN RM No
Pay scale
Name of the institution Year of passing from where and when qualified.(Enclose Photos with
self-attestation of all teaching faculty individually in the affidavit –Form II) Specialty
Experience in years & months* Date of Joining
Date of Leaving Previous
Employment** & Institution Name
Remarks
Basic BSc (N)
Post Basic BSc (N)
M.Sc (N) M Phil PhD Clinical
Teaching
Before PG`
After PG Total
1. Professor-cum-Principal
2. Professor-cum- Vice Principal
3. Professor
4. Reader/ Asso. Professor
5. Lecturer 6. Tutor/
CIinical Instructor
Enclose the colour photograph duly signed by the faculty,copies of appointment order, a copy of relieving order of Last institution, UG & PG Certificate, RN, RM & Addl. Qualn. Registration Certificates & Experience Certificates Encl -------------- ** Check the Relieving order & enclose the same; if joined within 6 months
-6- B) External Teachers Details (Part Time) (whichever subject applicable for the programme)
Sl. No
Subject Name Qualification Number of Hrs/ Year Remarks
As per norms prescribed
Allotted
1. Anatomy
2. Physiology
3. Bio –Chemistry
4. Nutrition
5. Micro – Biology
6. English
7. Computer Science
8 Psychology
9 Sociology
10 Pharmacology
11 Pathology
12 Genetics
13 Bio-Statistics
14 Bio-Physics
15 Community Medicine
16 Others
**(The above teachers should have post graduate qualification with teaching experience in respective area) C) COLLEGE OFFICE STAFF:
SL. No
Designation No. Required
No. in Position
Vacant Since When
Remarks
1. P.A to Principal 1 2. Sr.Assistant 1
3. Jr.Assistant 1
4. Accountant-cum-Cashier
1
5. Librarian 2 6. Computer
Programmer 1
7. Peon/Office Attendant
2
8. Security 2 9. Driver( As per the
No. of Vehicles)
10. Cleaner(Bus) ( As per the No. of Vehicles)
11. House Keeping Staff 4 12. Maintenance Staff 2
-7- D )HOSTEL STAFF:
S.No Designation No. Required No.in Position Vacant Since When
* Enclose the list of articles for all the labs Enclosures :……. Enclose copy of latest purchase bills:…………
*Proportionately the size of the built up area will increase according to the number of students admitted ( 10sq.ft for each student to be calculated for every additional seats)
-9-
E.LIBRARY Minimum Required Available Remarks Library Area Seating capacity
2400 sq.ft. Min. 60
Staff reading room
10 persons
Room for librarian Furniture
Should be Adequate
No. of cupboards
Should be Adequate
No. of racks Total No. of Books (For DGNM program total books=1500)
For Collegiate Programme 3000
Year Min. Books
Professional Journals
I 1000 National Inter National
Total
II 1500 3 2 5 III 2500 5 2 7 IV 3000 2 1 3
10 5 15 * For PG programme Departmental library with additional 1000 books and
journals (National & international)specialitywise should be available (i) General Books/Fictions :
(ii) No of latest edition Nursing books (since 2000) : ………………………………. (iii)Photocopying facility :
Yes
No
(iv)Internet facility :
Yes
No
(v)Separate section for staff/PG :
Yes
No
(vi) Ventilation :
Yes
No
(vii) Lighting :
Yes
No
(viii) Registers maintained Accession Register :
Yes
No
Journal Register :
Yes
No
Issue Register :
Yes
No
-10-
Administrative Facilities
Size (Sq. ft) Storage Facility
No. of Tables
No. of Chairs / Stools
Tel. Facility
Computer Facility
Venti -lation
Lighting Remarks
1.V.Good 2.Good 3.Fair 4.Poor
1.V.Good 2.Good 3.Fair 4.Poor
As per Norms sq.ft
Actually Available
Principal Office 300. Vice Principal Office 200 . Professor Offices 100x5 Lecturer’s Offices 600x3 Tutors/ Clinical Instr. Offices
600 x2
Offices of Administrative , Clerical staff and PA(s)
300
Accountants Office 100 Store Room 100 Record Room 100 Room for maintenance staff
100
Duplicating/Xeroxing Room
75
Common Room for Boys, Girls separately
300
Guidance/ Counselling room
Principal & Vice –Principal office should be attached with toilet. B] Hostel Facilities
1.Whether the College is having a Separate Hostel?
: 1. Yes
2.No
2.Built- up area of the Hostel
: ……………………Sq.ft.
3.Is the Hostel If owned, proof of ownership to be enclosed; (sale deed/Building completion certificate) If leased, Registered Lease Deed for 5yrs to be attached. If rented mention in the report
: 1.Own 2.Leased 3.Rented Encl: -----------
4. Is there a separate provision of Hostel for Male and Female Students
-11- 5. Whether the Hostel has provision for a. Water Supply b. Electricity c. Safe Disposal of Wastes
: : :
Yes
Yes
Yes
No No No
d. Laundry : Yes No
e. Hot water supply : Yes No
6. Is there a Recreation room available with : Yes No If yes area ……….sq.ft
T.V./Radio
7. i) Is there facilities available for outdoor and : Yes No Play ground area …..…. sq.ft. indoor games?
ii)If play ground is not available within the campus specify the address : ……………………………………….. iii) Distance from the college campus : ………………………………..kms iv) List of the sports articles available : …………………………………….
8. Is there a Sick Room available : Yes No If yes area .……….sq.ft
9. Whether the hostel mess is available : Yes No If yes area .……….sq.ft
10. Dining Facilities:
a. Dining room well maintained : Yes No
b Size : ……………….. Seating Capacity ………
c. Hand washing facility : Yes No
d. Safe Drinking water facility : Yes No
e Hygienic kitchen : Yes No
IV TRANSPORT DETAILS.
a)Vehicles available are : Own/ contract/ If both ………………. b)Vehicles available are : ……………………………. i)Number of Vehicles available : ……………………… ii)No. of own vehicles available : ……… ……………… iii) No. of vehicles available on contract basis : …………….………….. (vehicles should be allotted exclusively for Nursing College)
Sl.No Vehicle Capacity Registration No.
c)Who is the controlling authority of the vehicle : …………………………………………………..
-12- (d) Enclose the copy of Vehicle Registration
Certificate in the Name of the Institution, : Insurance copy, Drivers’ License & Latest FC (FC should be checked for yearly renewal) Encl:………………………. (e)Mention the availability for Enhancement of seats : Adequate/Inadequate
V.BUDGET 1. a) Is there a separate budget for the school/college : Yes No 1.Amount per annum : ………………………………………. 2.What was the last year’s budget Allocation : ………………………………………. Furnish the following details:
S.NO PARTICULARS EXPENDITURE (Rs.,) 1. CAPITAL EXPENDITURE
Land Building Furniture Transport Equipment AV Aids, computer Library books & journals
2. SALARY Nursing Staff Non Nursing Staff Part Time
3. Stipend 4. MAINTENANCE
Electricity Building : Lease/Rental Furniture AV Aids, Computer Lab Equipments Sports Articles Transport Stationeries Postal Telephone Contingencies Books & Journals House Keeping
5. INSPECTION & ANNUAL FEES: TNNMC
INC BOARD
UNIVERSITY 6. MISCELLANEOUS TOTAL * Enclose the Balance Sheet & Previous year audited income and expenditure statement of the Institution / Trust / Society Encl:………………..
-13-
VI. CLINICAL FACILITIES a) Hospital Details: 1.Is the Institution has parent Hospital
If Yes, No. of Beds
:
Yes
No
2.Is the Institution having parent Medical College Hospital
: Yes
No
If Yes, No. of Colleges affiliated
: ……………………………….
3.No. of Affiliated Hospitals ( Inspectors should visit, verify and enclose the consent letters, bills and payment receipts)
: ……………………………….
Sl.No
Name of the Hospitals
Distance No. of Beds
Bed Occupancy Rate on the day of Inspection
No. of Schools affiliated (Mention the name)
No. of Colleges Affiliated (Mention the name)
No. of Registered
Nurses
Last month On the day of inspection
1
2
3
4
5
6
7
-14-
4.Bed Distribution: (IP – No. of beds and OP – No. of patients per day) Specialty
(Minimum Required Beds) Parent
Hospital Affiliated Hospital Total
Beds Total OP/ day
1 2 3 4 5 6
Medical–Surgical – 40 IP OP IP OP IP OP IP OP IP OP IP OP IP OP IP OP Cardio Thoracic Respiratory Orthopedic -10 Neurology Nephro & Urology – 10 Dermatology 5-10 Communicable&STD ENT- 5 Eye – 5 Burns & Reconstructive 5-10
Oncology 5-10 Gynecology ICU/CCU - 10 Geriatrics Any other–Emergency -10 Pediatric Nursing – 50 beds Medical Surgical Communicable NICU PICU Nursery Any Other OBG & Gynaec – 40 beds Antenatal Postnatal High Risk& Emergency No. of Deliveries No. of Caesarians Any other Psychiatric Nursing – 60 beds Acute Ward Chronic Ward De-addiction Intensive Ward Family Therapy Ward Halfway Home Any Other
-15-
5. Statistics of Operation/Deliveries performed in the last month: MA - Major Surgeries & MI -- Minor surgeries Particulars Parent Hospital Affiliated Hospital - 1 Affiliated Hospital - 2 Affiliated Hospital - 3
General Surgery
MA MI Total MA MI Total MA MI Total MA MI Total
Ortho ENT Ophthalmic Gynec Obstetrics Pediatrics Super Specialties
Bed Occupancy Rate (BOR) at Parent Hospital on the day OF INSPECTION
: ……………
Bed Occupancy Rate (BOR) at Affiliated Hospital on the day of inspection
: 1.…………………2. ……………3…………….
Average BOR for the last 6 months(own Hospital) : ……………………………………………… Average BOR for the last 6 months(Affiliated Hospitals) : 1………………2 …………3………………. 6. Staffing Pattern of the Hospitals:
*Furnish the detailed list of Nurses with RN * RM Nos. working in the parent & affiliated Hospitals.* Encl:…………
7. Brief description of the hospital :……………………………………………………
8. Hospitals Records & Registers
IP Register OP Register Day / Night Report Discharge Register Census Register Any other (Specify)
: : : : : :
Yes / No Yes / No Yes / No Yes / No Yes / No
9. Clinical Supervision of students by (a) Hospital Nursing Staff : Yes No b) College Teaching Faculty : Yes No c) On the day of Inspection, was College teaching faculty : Yes No supervising the Students d) Teacher student ratio in Clinical Area : _________________
-16- (b) Community Health Facilities (1)
Type Name & Address Distance Population Covered
Area Coverage
No. of Villages covered
Urban
Rural (PHC)
Own / Adopted
(2) Service Rendered a) Health & Family Welfare Programme : Yes / No b) National Health Programme : Yes / No Supervision of Students: 1. Field Staff only 2.College Teaching Faculty 3.Both (Enclose copy of the letter of agreement for affiliation & bills paid to the Hospital and Health Centers to be attached. Inspectors to Visit the Hospital and Community Health Field and record their observation)
Encl:………………….. VII ADMISSION DETAILS.
(i) Admission of students in current session : INC Norms / University Norms
(ii) Percentage of Admission : Management / Government
(Attach the copy of admission criteria) Encl:…………………….
Total No. of Students under Training in the current Programme:
Programme I year II year III Year IV year Total
ANM
Male
Female
GNM Male
Female
B.Sc(N)
Male
Female
Post Basic B.Sc (N)* Male
Female
M.Sc (N)* Male
Female
M.Phil (N) Male
Female
Post Basic Diploma
Programme
Male
Female
Any other Male
Female
Total
* I & II Year Post Basic B.Sc (N) & M.Sc (N) Students details to be enclosed as per table given below & the inspectors
should verify whether these students are present in the institute on the day of inspection.
-17-
Sl.
No.
Name of the
Student
State Nursing Council Registration No.
Residence Address
Place & Address of Work at the
time of admission
Board/University from where last exam qualified
Duration of Course
With Dates From……
…….To
Does this
details updated In the nurses data bank
GNM B.Sc(N)
c) Year of passing out of first batch of students :
ANM GNM Basic B.Sc (N) Post Basic B.Sc.,(N)
M.Sc.,(N) P.B. Diploma Programmes
-18-
VIII. CURRICULAM PLANNING & EXAMINATION
a) COURSES OF INSTRUCTION & SUPERVISED PRACTICE (Kindly attach the enclosure as per the column given below for each program conducted at your institution)
N
ame
of th
e Pr
ogra
mm
e
Yea
r –w
ise
Pape
r No. of Hours Theory
No. of Hours
Practical
Theory Marks
Practical Marks
D
urat
ion
Syst
em o
f sup
ple.
ex
am
Eligibility for admission to Examination In
tern
al
Exte
rnal
Tota
l
Inte
rnal
Exte
rnal
Tota
l
Atte
ndan
ce %
Int.
Ass
. Mar
ks
Com
plet
ion
of
Prac
tical
R
ecor
ds
Con
duct
Rep
ort f
rom
th
e pr
inci
pal
Pres
crib
ed
Allo
tted
Pres
crib
ed
Allo
tted
Yes
/No
Freq
Theo
ry
Prac
tical
-19- b] I Teaching Plan
Sl. No
Program
Master Plan
Unit Plan
Lesson Plan
Learning Objectives
Learning Experiences
Plan of Evaluation
Time Table
Yes/ No Yes/ No Yes/ No Yes/No Yes/ No Yes/ No Yes/ No
1 H.V.
2 ANM
3 GNM
4 Basic B.Sc N
5 P.B.B.Sc N
6 M.Sc N
7 P.B. Diploma Programmes a. b. c. d. e. f. g. h. i. j. k.
c) .Does Clinical Teaching takes place? : Yes No
(N.B : Inspector to make observation of plan of different clinical experiences
d). Teaching Plan: i) Which syllabus is followed by the teachers in the college?
a) University Syllabus b) Indian Nursing Council Syllabus
(ii) Whether University syllabus fulfills the requirements of
Indian Nursing Council syllabus ; Yes No
a) If yes, what is the gap ____________________________________________
-20- e) CLINICAL PLAN : 1. Is Rotation based on the needs of clinical learning experience Yes No (Rotation plan to be enclosed) Encl …………………….. H.V.
I Year II Year
i. Number and size of student Groups
ii. Number of Rotation
iii. Duration of each Rotation
iv. Graphic rotation plan (attach copy) 1.Yes Appendix no. 2.No
ANM
I Year II Year
i. Number and size of student Groups
ii. Number of Rotation
iii. Duration of each Rotation
iv. Graphic rotation plan (attach copy) 1.Yes Appendix no. 2.No
GNM
I Year II Year III Year IV Year
i. Number and size of student Groups
ii. Number of Rotation
iii. Duration of each Rotation
iv. Graphic rotation plan (attach copy) 1.Yes Appendix no. 2.No
Basic B.Sc.(N)
I Year II Year III Year IV Year
i. Number and size of student Groups
ii. Number of Rotation
iii. Duration of each Rotation
iv. Graphic rotation plan (attach copy) 1.Yes Appendix no. 2.No
P.B. B.Sc.(N)
I Year II Year
i. Number and size of student Groups
ii. Number of Rotation
iii. Duration of each Rotation
iv. Graphic rotation plan (attach copy) 1.Yes Appendix no. 2.No
-21- M.Sc.(N)
I Year II Year
i. Number and size of student Groups
ii. Number of Rotation
iii. Duration of each Rotation
iv. Graphic rotation plan (attach copy) 1.Yes Appendix no. 2.No
P. B. Diploma in:
I Year
i. Number and size of student Groups
ii. Number of Rotation
iii. Duration of each Rotation
iv. Graphic rotation plan (attach copy) 1.Yes Appendix no. 2.No
(N.B. : Inspector to make observation of the rotation plan discuss the adequacy and inadequacy and record their observation)
2. Planning of Specific Clinical Experience a. Who prepares the Clinical Rotation Plan? School /college Faculty 2.Hospital nursing service personnel 3.Both b. Who are all involved in planning the Clinical Rotation Plan? ( Please indicate designation) …………………………………………………………………………………..
f) System of Examination:
1. Name and Address of Affiliated Examining Body / Board ……………………………………………………………………………….
…………………………………………………………………………………..
Tel…………………………………Fax………………………………….....
E Mail ID …………………………………………………………………………………..
Website …………………………………………………………………………........
-22-
2. Name and Address of affiliated University to …………………………………………………………………………
Which affiliated/ Deemed ……………………………………………………………………….
Telephone and Fax Number Tel……………………………….Fax………………………………………..
E Mail ID ………………………………………………………………………………..
Website ………………………………………………………………………........ g) (1) Eligibility for admission in Examination :
(a) Attendance percentage : 1.Theory …………………….. 2.Clinical practice
(b)Internal assessment marks : minimum requirement …………………………
(c)Completion of assignments & practical record : Yes / No
(2)Practical Examination conducted in : Parent hospital/Affiliated hospital
(3)Faculty eligible to be appointed as examiner is available in each speciality : Yes / No
(4)No. of students examined per day ………………..
(5)University / Board publishes results in time : Yes / No (If no kindly state the reason)
(6)Weak points on examination : …………………….
(7)Strong points on examination: ……………………
(8) Pass percentage of students in University examination(Current Academic Year)
Sl.No. Programme I year II year III year IV year Remarks on achievments
-23- IX RECORDS & REGISTERS
1. Are the following Registers maintained well? (Check depending on programme implemented)
S.No Registers * Yes No 1 Admission Register
2 Cumulative Register
3 Attendance Registers a) Daily b) Subject c) Clinical d) Faculty e) Ministerial Staff
4 Leave Record a) Student’s b) Faculty c) Ministerial Staff
5 Practical Records a)Nursing Foundation b)Medical Surgical Nursing c)Midwifery Case Book d)Log Book e)Drug Files
6 Daily Diary
7 Health Record
8 Clinical and Field Experience Record
9 Clinical Evaluation
10 Internal Assessment – Practical & Theory
11 Curricular & Co – Curricular Record
12 Family Folders
13 Any Other
Which type of Records used? TNC Records / other 2. Maintenance of Records:
Course planning of each subject : Yes No
Rotation Plans (Master & Clinical) : Yes No
Mark Register : Yes No
Minutes of Committee Meetings : Yes No
College Development Committee : Yes No
Curriculum : Yes No
Anti-ragging : Yes No
Selection Committee : Yes No
Library Committee : Yes No
-24- Any other – specify ……………………………………………………………………………….
Affiliation records : Yes No
Stocks Register : Yes No
Inventory Register : Yes No
Budget plan : Yes No
Annual report of activities and achievements : Yes No
Staff development Program : Yes No
Records signed by Teachers with dates : Yes No [Note: verify
Physically (a) & (b) ]
X WELFARE ACTIVITIES A.STUDENT: 1.Professional Association / Activities N.S.S. / SNA/ TNAI/any other – specify 2.Is the students of all basic nursing programmes been enrolled in SNA . : Yes No 3. Health services are provided when students are sick: : Yes No
If yes name of the hospital Address : : : Pin : Tel : fax Email : Web site : a). Do students have Health Insurance : Yes No If yes, is the Health Insurance : Group Individual
b) Name of the Health Insurance Company :
Address : :
: Pin : Tel : fax ___________ Email : Web site :
4.Eligible leave for students (*should adhere to INC norms) : 1. As per INC : 2. As per University :
3.As per Institutional Policy :
-25-
B] FACULTY
1. Is there any Professional Organization for Faculty? : Yes No If yes, name the Organization
S.No NAME OF THE ORGANIZATION 1. 2. 3. 4.
2. Establish Faculty Committee,
If yes , Name of the Committees
S.No NAME OF THE COMMITTEES 1. 2. 3. 4.
3. Any other welfare activities
S.No ACTIVITIES 1. 2. 3. 4.
4. Eligible leave for faculty
S.No NATURE OF LEAVE NO.OF.DAYS / year As per norms
(Days) No. of days given by the institution
1. Casual leave 12 2. Sick/medical leave 10 3. Vacation/annual leave 30 4. Public holidays All govt.gazette holidays 5. Maternity leave As per policy of
institution
6. On duty 15
-26- 5.Provides health services for the faculty when sick : Yes No If yes, name the Hospital
Address : :
Tel : Email :
Web site :
a) Will the faculty have Health Insurance : Yes No If yes, is the Health Insurance : Group Individual
b) Name of the Health Insurance Company
Address :
Pin : Tel : _____________ Fax _________________ Email : Web site :
6. Are the faculty eligible for Provident Fund : Yes No
7..Are the faculy deputed for the conference/workshops/seminars : Yes No If yes list the criteria
XI. LAST TNNMC INSPECTION DETAILS
a) Is there any Deficiencies notified in the previous/ recent Inspection : Yes /No Date of last inspection:---------------- b) If Yes, enclose Rectification/ Compliance Report sent to the Council : Yes/No c) Inspectors to verify the rectification of the past deficiencies & write the report ……………..
I have received the inspection Performa & have filled the same Yes No
Whether the Inspection report is completely filled after verification Yes No
Enclosures 1. Certified copy of the Registered Trust Deed : Yes No 2. G.O – Each Program : Yes No 3. INC – Each Program : Yes No 3. TNC – Each Program : Yes No 4. University/Board Orders – Each Program 5. Proof of documents for change of address & trust 6. Proof of the Own & Affiliated Hospitals &Health Centres 7. Admission Criteria – Each Program 8. List of Post Basic B.Sc (N) & M.Sc (N) Students 9. Latest orders of TNC,INC, Board/ University & Also for enhancement of seats if any. 10. Nursing faculty Details – UG,PG Certificates, RN, RM, Addl. Qualification, Experience Certificates, relieving order of
Last institution if DOJ within 3 months, Appointment Order & Self Attested Color Photo 11. Land Deed of the college & Hostel with Building completion certificate 12. If Leased, Registered Lease Deeds of College & Hostel 13. Vehicle Registration Certificate in the Name of the Institution ,Insurance, Drivers’ License & Latest FC 14. The balance Sheet & Previous year audited income and expenditure statement of the institution / Trust / Society 15. The list of Articles for all the Labs (Enclose the recent/ Last year purchase Bills) 16. List of Library Books & Journals (Enclose the recent/ Last year purchase Bills 17. List of Nurses with RN & RM No. working in the Parent & Affiliated Hospitals 18. Master & Clinical Rotation plan for respective years – Each Program 19. Eligibility for admission to examination : for all Nursing Programmes 20. List of Sports Articles 21. Report from the principal on course of instruction etc 22. Whether the institution has submitted details for the Website Updation; If not, CD containing details to be enclosed 23. Furnish all the above mentioned annexure in the CD in the jpg and Word format accordingly. 24. Furnish the evidences for the Latest annual recognition fees & web page renewal fees paid. 25. Minority status GO 26. Past Rectification report
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AFFIDAVIT
FORM - II
Particulars of the Faculty
1. Name (as in Degree Certificate : Photowith Signature
2. S/o./D/o./W/o :
3. Date of Birth and Age : ------/ -------- / ------- --------- Years
As on Date Date / Month / Year
4. (a) Year of UG Qualification : -----------------------------------( attach Certificate ) (b) Year of PG Qualification : ----------------------------------- (attach Certificate) (c) Specialty in M.Sc (Nursing) :------------------------------------
5. Council Registration No :------------------------------------
7. Teaching Experience: (Teaching Experience in various Institutions must be filled up& Copies should be enclosed) S.No Name of the Institution Designation From To Experience
From To
Total Experience
-29- 8. Residential Address : _____________________________________ _____________________________________ _____________________________________ _____________________________________ Phone No : _____________ Mobile No.------------------
Office Phone No : _____________
9. Voter card Number : _____________ Place of issue ___________
Date of issue ____________
10. Driving License Number : ______________________ Place of issue _____________
(Enclose photocopy of the relevant page) Date of issue _____________
11. PAN Card Number :__________________________
12. T.D.S for the last three years &Place of filing income, Tax Return (attach photocopy) :___________________________________________________________________
I declare that (i) the above information provided by me is true and correct to the best of my knowledge. (ii) I also understand that if any information given by me, is found incorrect, I will be debarred from teaching; (iii) if any information found incorrect, my case will be given over to the law authorities for furtherance in the matter. Place : Date : Signature of the Teacher
Signature of the Inspection Team 1.
2.
3.
Signature of the principal of the college With seal & date
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XV. REMARKS OF THE INSPECTORS S.NO PARTICULARS REMARKS 1. Physical Infrastructure a. Institution
