Maharashtra Nursing Council, · PDF fileCumulative record Students Enrolment ... (ANM, GNM,...
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1 Maharashtra Nursing Council, Mumbai Inspection Form from 20/07/2016 1. General Information Name of the Institution Full Address with Pin Code Date of Inspection Contact details Head of the Institution Telephone No Mobile No. E-mail id Contact details of the Principal Telephone No Mobile No. E-mail id Skype Account No Name of Courses inspected ANM GNM B. Sc. (N) P. B. Sc.(N) M. Sc. (N) Other Intake sanctioned Purpose of inspection State Government Feasibility Indian Nursing Council Periodical Maharashtra Nursing Council Enhancement of seats MUHS, Nashik Surprise Deemed University Final Approval Name and Signature of Principal with designation rubber stamp Place: Date: Name and Signature of Inspection (1) ___________________________ (2) ___________________________
Transcript of Maharashtra Nursing Council, · PDF fileCumulative record Students Enrolment ... (ANM, GNM,...
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Maharashtra Nursing Council, Mumbai Inspection Form from 20/07/2016
1. General Information
Name of the Institution
Full Address with Pin Code
Date of Inspection
Contact details
Head of the Institution
Telephone No
Mobile No.
E-mail id
Contact details of the Principal Telephone No
Mobile No.
E-mail id
Skype Account No
Name of Courses inspected
ANM GNM
B. Sc. (N) P. B. Sc.(N)
M. Sc. (N) Other
Intake sanctioned Purpose of inspection
State Government Feasibility
Indian Nursing Council Periodical
Maharashtra Nursing Council Enhancement of seats
MUHS, Nashik Surprise
Deemed University Final Approval
Name and Signature of Principal with designation
rubber stamp
Place: Date:
Name and Signature of Inspection
(1) ___________________________
(2) ___________________________
2
PARTICULARS
(For 40-60 admission capacity)
Standard Area
as per INC
specified
(in sq.ft)
YES NO REMARKS
2. Physical Infrastructure
A. Teaching Block 20,000
Class Rooms as per programme (Total No.) 900 each
Laboratories as per programme
Nursing foundation Lab
CHN and Nutrition Lab
Advance Nursing Skill Lab
M.Ch.Lab
Pre-clinical science Lab
Computer Lab
1500
900
900
900
900
900
Multipurpose Hall 3000
Library
Nursing Books (minimum 500)
Kinds of Nursing Journals
Kinds of Newspapers
Kinds of Magazines
1800
A.V. Aid room 600
Principal Office 300
Vice-Principal office 200
Faculty Room 1800
Administrative office 1000
Common room
Male
Female
1000
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Signature of Principal with designation rubber stamp
Name and Signature of Inspection
(1)____________________
(2)________________________
Toilets for Gents
Toilets for Ladies 1000
Fire extinguisher
Play ground Spacious
Transport Facilities
Garage
25 and 50 seater
bus as per
student strength
B. Hostel Block :- 17500
Number of Hostel females
Hostel Rooms (Single and double rooms) 9000(50 sq. ft.
for each
Student)
Toilet /Bath 1 Latrine and 1
bathroom 600 X
3= 18000
Pantry 1 on each floor
Dining Hall 3000
Recreation Room 500
Store Room 500
Visitor Room 500
Reading Room 250
Wardens Room 450
Kitchen and Store 1500
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CLINICAL FACILITIES Name of Parent Hospital - _________________________
Type of Hospital: -__________________________ No. of San. Bed:- _____________
Sr.
No.
Name and Add. of Hospital
Parent / Affiliated
No of
beds
No of
Nsg. staff
No. of Nsg
programme
affiliated
No of
OPD
patients
Annual
deliveries
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Signature of Principal with
designation rubber stamp
Name and Signature of Inspection
(1)______________________________
(2)_____________________________
5
Affiliated Bed Occupancy of Affiliated Hospitals
* Name of Hospital Medicine Surgery Orthopaedic Pead. Ob/gyn EYE/ENT Oncology Iccu Psychiatric Emergency
1
Beds
Occupancy
2
Beds
Occupancy
3
Beds
Occupancy
4
Beds
Occupancy
5
Beds
Occupancy
6
Beds
Occupancy
Signature of Principal with designation rubber stamp
Name and Signature of Inspection
(1) _________________ (2) ______________________
* Please note affiliated Hospital should not be more than 3 hospitals as per INC norms.
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F COMMUNITY HEALTH FACILITES
I RURAL FIELD
Name of CHC/PHC/SC
(i) Adopted Affiliated Dist. From the Nsg.
Institute
(ii) Administrator by 1. State Government Y/N
2. Municipal Corporation
3. Private
II. URBAN FIELD
a. Name of the MCH & F.W. Center
(1) Adopted (2) Affiliated
b. Distance from MCH and F. W.
Centre
Distance from the Institute
(iii) Administrator by 1. State Government Y/N
2. Municipal Corporation
3. Private
c. Supervision of Students 1. Field Staff Only
2. College Teaching Faculty
3. Both
Signature of Principal with
designation rubber stamp
Name and Signature of Inspection
(1) ___________________________
(2) ___________________________
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TEACHERS RECORDS: -
Teachers Record Yes No Remarks
A. CLASS COORDINATOR’S RECORD
Internal assessment Records
Ward Procedure evaluation format
Case Study evaluation format
Case presentation evaluation format
Family care plan evaluation format
Community procedure evaluation format
B. ADMINISTRATIVE RECORDS
Students Admission Records
Cumulative record
Students Enrolment
Hospital affiliation letter from competent authority
Rural & Urban Experience affiliation letter from
competent authority
Plan for Staff Development Programme
Students Health Record
Year Wise Students Result
Record of Counselling Guidance
Students Leave Record
Teachers Attendance Record
Clinical Experience Correspondence
Plan for Staff Development Programme
Any Other
Signature of Principal with designation rubber stamp
Name and Signature of Inspectors
(1)________________________
(2)________________________
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IMPLEMENTATION OF SYLLABUS
Implementation of Syllabus Yes No Remarks
Clinical Experience as per Syllabus
Theory Class as per syllabus
A – Students Records :
Procedure Book
Midwifery Case Book
Nursing Care Plan
Family Care plan
Case Presentation
Case Studies
Daily Diary
Field Visit Report
Master File
Drug Book
Signature of Principal with designation
rubber stamp
Name and Signature of Inspectors
(1)_______________________ (2)________________________
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HOSTEL STAFF :-
Sr.
no. Designation
No.
Sanctioned
No. in
Position
Vacant
since when Remarks
1. Warden Female (for
150 students)
03
2. House Keeper 01
3. Cooks (for 20 students
each shift)
01
4. Peon/Ayah 02
5. Sweeper 02
6. Gardner 02
7. Chowkidar 03
Signature of Principal with designation
rubber stamp
Signature of Inspectors
(1)__________________________
(2)___________________________
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TEACHING STAFF INFORMATION: -
Total No. Yes No Remarks
1. Total No. of Teachers
2. Principal
3. Vice Principal
4. Appointment letter( of each)
5. Previous Relieving order
6. Registration with parent Council
7. Registration with Maharashtra
Nursing Council
8. Renewal Done
9. Smart card
10. Verified 16th No form and professional
Tax payment / Bank Statement
11. Teacher Student ratio 1:10 maintained
Signature of Principal with designation rubber
stamp
Signature of Inspectors
(1)___________________________
(2)___________________________
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* Teaching Faculty Profile (Full-Time) of all the nursing programmes offered by this institution
(ANM, GNM, B.Sc., P.B. B.Sc., M. Sc. and any other) All nursing teachers of all the nursing
programmes details to be given irrespective of the program being inspected. (Attach extra sheet
as needed )
Sr
no
Designation Name Reg.no Mobile
no.
Email-
id
Experience Subject
Taught
Subject
hrs
allotted
Subject
hrs taken
Remarks
Clinical Teaching
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
12
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Signature of Principal with designation
rubber stamp
Name and Signature of the Inspectors
1)____________________________
2) ___________________________
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MNC AFFILIATION RECORDS: -
Sr.
No. MNC Affiliation records Yes No Remark
1. Inspection fees paid
2. Bed affiliation Fees paid
3. INC validity Fees paid
4. Examination Fees paid
5.
Compliance of last
inspection submitted
6. Obtained INC Validity
7.
Obtained University
Affiliation
8. Any court matter
Signature of Principal with designation rubber
stamp
Name and Signature of the Inspectors
1)____________________________
2) ____________________________
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CHECK LIST
1. I have received the inspection Performa & have filled the same Yes No
2. Whether the Inspection report is completely filled after verification. Yes No
3. MNC Consent /affiliation letter (relevant year) verified and annexed. Yes No
4. University Consent /affiliation permission letter verified &
annexed Yes No
5. Land deed document verified & annexed. Yes No
6. Teaching Faculty Original Certificate, photos (self-
attested)Verified & annexed Yes No
7. Smart card obtaining Yes No
8. Documents with Respect to Parent hospital verified &
annexed Yes No
9. Affiliated Hospital Permission letter verified from Hospital &
annexed Yes No
10. Relieving order of teachers verified & annexed Yes No
11. Permission letter of CHC/PHC verified & annexed. Yes No
12. Transportation (Registration Certificate)verified & annexed Yes No
Signature of Principal with designation rubber
stamp
Name and Signature of the Inspectors
1)___________________________
2) ___________________________
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RECOMMENDATIONS
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Name and Signature of the Inspectors
1)__________________________
2) __________________________
