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CENTRAL COUNCIL OF INDIAN MEDICINE


NEW DELHIVISITATION PROFORMA FOR ASSESSMENT OF AVAILABLE FACILITIES OF TEACHING AND PRACTICAL TRAINING OF UNANI COLLEGE Section A-General Information Name of the College with Complete Address (mentioning taluka, distt. and other details)

Information of communication Contact No. of College

Contact No. of Hospital

Fax

Email

Information of Principal Name

Office Tel No.

Resident Tel No.

Mobile No.

Information of President of Society of College (For private college)

Name & Address

Office Tel No.

Residence Tel No.

Mobile No.

Information of Secretary of Society of College

(For private college)

Name & Address

Office Tel. No.

Residence Tel No.

Mobile No.

Information of concerned Health Secretary/Ayush Secretary dealing with the education of Unani Name & Address

Office Tel No.

Residence Tel No.

Mobile No.

Information of the State Govt. Director/Commissioner of Unani / Ayush Name & Address

Office Tel No.

Residence Tel No.

Mobile No.

Important information of connectivity Name of Nearest Airport & Distance (km)

Name of Nearest Railway station & Distance (km)

1.

2.

3.

Fee Structure For Management seats

For Government seats

Name of the fee fixation authority

Name of competent authority conducting entrance examination for Govt. seats Name & Address

Telephone Number

Name of competent authority conducting entrance examination for Management seats Name & Address

Telephone Number

Name of the other Unani Colleges within radius of 50 km 1.

2.

3.

Name and year of 1st affiliation of University Name

Year of 1st affiliation

Year of 1st permission of State Govt.

DETAILS OF LAND

To be filled up by college

Verification by Visitors as Correct/Not correct

Total area of land with Society/Trust (in acres)

Ownership of land (Own/Lease/Rented)

In the name of the Society/Trust

In the name of President/Secretary

Whether entire land is in one plot or more than one. If more than one, then size and distance between these plots

Whether the land available with the Society/Trust is entirely for Unani College and attached Hospital or for any other Institute also, if so, details thereof.

Information regarding other institutions/colleges runs by the same society/trust. Whether they are in same campus or anywhere else.

Total area of land allotted to the Unani college (in acres)

Total area of land allotted to the Unani hospital (in acres)

Total area of land allotted to the hostels (in acres)

Name of other institutions running in the campus of Unani College

TOTAL CONSTRUCTED AREA OF COLLEGE

Note: Please furnish details in Annexure-I

TOTAL CONSTRUCTED AREA OF HOSPITAL

Note: Please furnish details in Annexure-I

TOTAL CONSTRUCTED AREA OF HOSTEL (Sq.ft.)

Area for Girls Hostel

Area for Boys Hostel

Number of Staff Quarters available

INFORMATION OF ADMITTED STUDENTS

Name of the Course

Admission Capacity

Student admitted in the year 2009-10

Date of last admission of the student

Verification by Visitors as correct/Not correct

Govt. quota

Management quota

UG

PG (Subj. Wise)

*Detail information of total number of subject wise Post Graduate students passed from college till date be furnished as per annexure -II

*List of students admitted in the Year 2009-10 be furnished as per Annexure-III

SECTION B

FINANCIAL INFORMATION

Total income of college

TOTAL EXPENDITURE IN THE YEAR 2008 FROM JAN. TO DEC.

Total Salary of teaching staff

Total Salary of non teaching staff

Total Salary of hospital staff

Total Expenditures on purchase of new books

Total Expenditures on furniture & fixtures

Total Expenditure on equipments & instruments

Total Purchase of raw drugs

Total Purchase of prepared medicines

Total Purchase of Lab Chemicals

others

Total

Verification by Visitors as correct / Not correct

Year 2008

MONTH WISE EXPENDITURE IN THE YEAR Jan. to Dec. 2009

S. No.

Month

Total Salary of teaching staff

Total Salary of non teaching staff

Total Salary of hospital staff

Total Expenditures on purchase of new books

Total Expenditures on furniture & fixtures

Total Expenditure on equipments & instruments

Total Purchase of raw drugs

Total Purchase of prepared medicines

Total Purchase of Lab Chemicals

Others


1

January

2

February

3

March

4

April

5

May

6

June

7

July

8

August

9

September

10

October

11

November

12

December

13

Total

14

Grand Total expenditure of the year 2009

15

TOTAL INCOME OF THE YEAR 2009

DETAILS OF MUSEUM

Name of the Department

Number of Charts, Models & Specimens Available (To be filled up by college)

Verification by Visitors as correct / Not

Correct

Charts

Models

Specimens

Charts

Models

Specimens

1. Kulliyat

2. Tashreehul Badan

3. Ilmul Advia wa-Saidla

4. Tahaffuzi wa Samaji Tib

5. Niswan wa Atfal

6. Moalajat

7. Jarahat

INFORMATION ABOUT VARIOUS SECTIONS IN COLLEGE



LIBRARY

-

-

1. Number of books available

Unani -

Modern -

Others -

Total -

2. Seating arrangement in reading room

3. Number of computers with internet facility

HOSTEL

-

-

1. Total number of room available for Boys

2. Total number of rooms available for Girls

3. Seats available for Boys

4. Seats available for Girls

5. Mess facility for Boys available/not available

6. Mess facility for Girls available/not available

HERBAL GARDEN

-

-

Number of Plants

Number of species

Irrigation facility- Available/Not available

NAME & DETAILS OF SPORTS AND GAMES FACILITY

TRANSPORT FACILITY Exists /Not

PHARMACY- Functioning/Non Functioning

*If, Yes, details of Pharmacy be furnished as per

Annexure-IV

SECTION CINFORMATION OF TEACHING & PRACTICAL TRAINING (Jan. to Dec. 2009) FOR UG S.No.SubjectNumber of Classes held (to be filled up by college)Verification by Visitors as correct / Not correct

Theory

Practical/

Clinical

Theory

Practical

1. Tashreehul Badan

2. Munafeul Aza

3. Umoore Tabiya

4. Mantiq, Falsafa & Haiyat

5. Arabic

6. Tarikhe Tib

7.

Ilmul Advia I

(Kulliyat & Mufradat)

8.

Ilmul Advia II

(Murakkabat & Saidala)

9.

Ilmul Amraz & Sareeriyat

10.

Ilmus Samoom & Tibbe Qanooni

11.

Tahaffuzi wa Smamji Tib

12.

Moalajat- I

13.

Moalajat- II

14.

Jarahiyat

15.

Amraz Ain, Uzn, Anf wa Halaq

16.

Qabalat, Niswan wa Atfal

17.

Number of educational tours conducted for teaching & practical purpose in the year 2009

For PG S.No.SubjectNumber of classes & practical/clinical held (to be filled up by college)Verification by Visitors as correct / Not correct

Theory

Practical

Theory

Practical

1.Kulliyate Umoore Tabiya

2.Munafeul Aza

3.Ilmul Advia

4.

Ilmus Saidla

5.

Tahaffuzi wa Samaji Tib

6.

Ilmul Atfal

7.

Moalajat

8.

Ilmul Amraz

9.

Ilaj Bit Tadbeer

10

Amraze Jild o Zohrawiya

11.

Tashreehul Badan

12.

Ilmul Jarahat

13.

Amraze Uzn, Anf wa Halaq

14.

Qabalat wa Amraze Niswan

NUMBER OF EXISTING TEACHING STAFF (where seven Deptt. exists)

S.

No.

Department

Number of Teachers as per CCIM Norms (to be filled up by college)

No. of Existing Teachers


P

R

L

P

R

L

P

R

L

1.

Deptt. of Kulliyat

For UG

1

1

1

Additional for PG course

1

or 1

2

2.

Deptt. of

Tashreeh-ul-Badan

For UG

1

2

2


1

or 1

2

3.

Deptt. of Ilmul Advia wa-Saidla

For UG

1

1

2 one in each subj.


1

or 1

2

4.

Deptt. of Tahaffuzi-wa Samaji Tib

For UG

1

1

2


1

or 1

2

5.

Deptt. of Moalajat

For UG

1

2

2


1

or 1

2

6.

Deptt. of Niswan-wa- Atfal

For UG

1

2

2


1

or 1

2

7.

Deptt. of Jarahat

For UG

1

1

2


1

or 1

2

Total Number of teachers

Professor-

Readers-

Lecturers -

NUMBER OF EXISTING TEACHING STAFF (where fourteen Deptt. exists)

S.

No.

Department

Number of Teachers as per CCIM Norms (to be filled up by college)

No. of Existing Teachers


P

R

L

P

R

L

P

R

L

1.

Kulliyat

For UG

1

1

1


1

or 1

2

2.

Tashreehul Badan

For UG

1

1

1


1

or 1

2

3.

Munafeul Aza

For UG

1

1

1


1

or 1

2

4.

Ilmul Advia wa-Saidla

For UG

1

1

1


1

or 1

2

5.

Ilmul Amraz-

For UG

1

1

2


1

or 1

2

6.

Tibbe Qanooni wa Ilmus Samoom

For UG

1

1

1


1

or 1

2

7.

Tahaffuzi-wa Samaji Tib

For UG

1

1

2


1

or 1

2

8.

Moalajat

For UG

1

1

2

Additional for PG

1

or 1

2

9.

Niswa wa Atfal

For UG

1

1

1

Additional for PG

1

or 1

2

10.

Ilmul Qabalat

For UG

1

1

1

Additional for PG

1

or 1

2

11.

Jarahiyat

For UG

1

1

1

Additional for PG

1

or 1

2

12.

Ain, Uzn, Anf, Halaque

For UG

1

1

1

Additional for PG

1

or 1

2

13.

Amraze Jild wa Amraz Zohrawiya

For UG

1

1

1

Additional for PG

1

or 1

2

14.

Ilaj Bid Tadbeer

For UG

1

1

1

Additional for PG

1

or 1

2

Total Number of teachers

Professor-

Readers-

Lecturers -

SALARY INFORMATION*


Verification of information by Visitors as correct / Not correct

Pay Scale of teachers

As per State Govt./UGC

(If none of these please mention reason thereof )

1. Mode of payment through BankYes/No (If none please mention reason thereof )

2. GPF & CPF is deducted from the salaryYes/No (If none please mention reason thereof)

3. Teachers promotion policy as per norms of CCIM/Govt./UGC.Yes/No (If none please mention reason thereof)

4. Existing pay scale of teaching staff ( State Govt./UGC/others)

[Pl. tick whichever applicable]Pay Scale of Professor

Pay Scale of Reader

Pay Scale of Lecturer

INFORMATION OF NON TEACHING STAFF OF VARIOUS DEPARTMENTS

S.No.

Department

No. of Existing Non-Teaching Staff

( To be filled up by college)


Lab. Tech.

Lab Asstt.

Muse. Keeper

Peon

Lab Tech.

Lab Asstt.

M. Keeper

Peon

1.

Kulliyat

-

1

-

1

2.

Tashreeh- ul-Badan

2 Tec

1

1

1

3.

Ilmul Advia wa-Saidla

1 lab

Attnd

-

1

4.

Tahaffuzi-wa Samaji Tib

-

1

1

1

5.

Moalajat

1

--

--

1

6.

Niswa-wa- Atfal

--

--

--

1

7.

Jarahat

--

--

--

1

Note: Housekeeping may be from out sources with minimum three sweepers

NOTE: DETAIL INFORMATION OF TEACHING STAFF BE FURNISHED AS PER ANNEXURE-V

NOTE: DETAIL INFORMATION OF NON TEACHING STAFF ALONG WITH SALARY DETAILS BE FURNISHED AS PER ANNEXURE-VI

STAFF REQUIRED FOR HOSPITAL & VARIOUS DEPARTMENTS

HOSPITAL STAFF

Name of Post

Staff Required as Per Norms of CCIM

Number of Existing Staff

Verification by Visitors as Correct /Not correct

Superintendent (Principal or Dean of the college may also be ex-officio)

1

Deputy Superintendent

1

Hakeem (for OPD for clinical subjects)

Professors, Readers and Lectures of Tibbi College

Medical Specialist

1 Part time

Surgeon

1 Part time

Gynaecologist

1 Part time

Radiologist

1 Part time

Pathologist

1 Part time

Anesthetist

1 Part time/on call

X-ray technician

1

Clinical Registrar

1 for each clinical deptt.

RMO

1

House Officer/PG student

1 for 20 beds

Matron/Nursing Superintendent

1

Staff Nurse

1 for 10 beds (and 1 for general OPD and 1 for Gynae. OPD)

Ward boy/Ayah/ANM

1 for 20 beds ( and 2 for OPD)

Pharmacist

2

Store Keeper

1

Head Clerk

1

Cook

1

Kitchen Attendant/ Cook

1

Plumber

1 on contract basis

Watch Men

3 on contract basis

Lift men for multi-storeyed Building

3 on contract basis

Electrician

1 (part time)

Dark Room Attendant

1

Dressers(for OPD)

2

Operation Theatre

Attendant

1

Labour Room Attendant

2

Safaiwala

2 (outsourcing)

Statistician

part time

Photographer

part time

ILAJ BID TADBEER DEPARTMENT STAFF

-

-

Ilaj bit tadbeer hakeem

1 Male

1 Female

Ilaj bit tadbeer Technician

2

Ilaj bit tadbeer Assistant

1 Male

1 Female

Physiotherapist

1

Safaiwala

1 (outsourcing)

LIBRARY STAFF

-

-

Librarian

1

Asst. Librarian

1

Library Attendant/Peon

1

PHARMACY STAFF

-

-

Deputy Superintendent (M.D. Ilmul Advia/ Saidla)

Machine Operator

Labour (Number)

HERBAL GARDEN STAFF

-

-

1.

2.

NOTE:- DETAIL INFORMATION OF HOSPITAL STAFF ALONG WITH SALARY DETAILS BE FURNISHED AS PER ANNEXURE -VII

SECTION D

FACILITIES AVAILABLE IN THE HOSPITAL

OPD FACILITIES

S. no.

Name of Department

Equipment, Instrument, Furniture etc required as per norms of CCIM

Departmental Equipment, Instrument, Furniture Available or Not (To be filled up by college)


1

Moalajat

View Box

BP Instrument

Stethoscope

Examination Table

Thermometer

Tongue depressor

Weighing machine

Torch

Measuring tape

Weight and height measuring stand

Hammer

2.

Ilmul Jarahat

Autoclave/sterilization facilities

Minor OT

Instruments for anorectal examination

Examination Table

BP instrument

Surgical Blades

Suturing material

Rubber catheter

View Box

Stethoscope

Cheetles forceps

Torch

3

Ain, Uzn, Anaf wa Halaq

Sterilization facilities

Tuning fork

Ophthalmoscope/ fundoscope

Auroscope

Tongue depressor

Examination Table

View Box

BP Instrument

Stethoscope

ENT kit

Torch

Bull`s lamp

4


Sterilization facilities

Weighing machine

Sims speculum

Cuscos speculum

Examination Table

Lamp stand

Torch

View Box

BP Instrument

Stethoscope

Measuring tape

Washbasin

5

Amraze Atfal

Scale

Weighing machine

Torch

View Box

BP Instrument

Stethoscope

6

Ilaj bit tadbeer

As per Moalajat

7

Emergency

Facilities available (Equipment, Instrument, Furniture etc)

8

Minor OT

Facilities available (Equipment, Instrument, Furniture etc)

Note: Every Deptt. shall have proper seating arrangements for internees/students

NUMBER OF PATIENTS ATTENDED OPD (Jan. to Dec. 2009)

S.No.

Month

Moalajat

including

Ilaj bit tadbeer

Jarahat

including Ain, Uzn, Anaf wa Halaq


Amraze Atfal

Tahaffuzi wa Samaji Tibb


1.

Jan.

2.

Feb.

3.

March.

4.

April

5.

May

6.

June

7.

July

8.

August

9.

Sept.

10.

Oct.

11.

Nov.

12.

Dec

Total

Grand total

DETAILS OF IPD PATIENTS (Jan. to Dec. 2009)

1. Total Number of Patients Admitted in the Year 2009

S .No.

Month

Moalajat

Jarahat



Amraze Atfal

Ilaj bit tadbeer


1.

Jan.

2.

Feb.

3.

March.

4.

April

5.

May

6.

June

7.

July

8.

August

9.

Sept.

10.

Oct.

11.

Nov.

12.

Dec

Total

Grand Total

2. Total Number of Bed Days Occupied

S.No.

Month

Moalajat

Jarahat



Amraze Atfal

Ilaj bit tadbeer


1.

Jan.

2.

Feb.

3.

March.

4.

April

5.

May

6.

June

7.

July

8.

August

9.

Sept.

10.

Oct.

11.

Nov.

12.

Dec

Total

Grand total

Note: To calculate the total number of bed days occupied of the months, please calculate the date wise total number of patients, remained on bed at midnight.

IPD SECTIONS WITH BED STRENGTH

Name of the Department

% of Bed Distribution as per CCIM norms

Number of Existing Bed strength (To be filled up by college)


(i) Moalajat and Ilaj bit tadbeer

40%

(ii) Jarahat

10%

(iii) Ain, Uzn, Anaf wa Halaq

10%

(iv) Qabalat wa Amraze Niswan

20%

(v) Amraze Atfal

05%

(vi) Others

15%

Total Number of Beds

DETAILS OF DRUG DISTRIBUTION IN OPD & IPD (Jan. to Dec.2009)

Note:-Detail Information be furnished as per Annexure-VIII

INFORMATION ABOUT VARIOUS SECTIONS IN THE HOSPITAL



LABOUR ROOM- Functional/Non Functional

Antenatal Room with attached Toilet-Functional/Non Functional

Facilities for Neonatal care - Available/Not Available

Other Available Facilities, Equipments, Instruments

Note:- Details be furnish as per annexure-IX

Number of Deliveries performed during the year 2009

OPERATION THEATRE- Functional/Non Functional

Air conditioning- Exist/Not

Pre Operative Room with attached toilet- Exist/Not

Sterilization room Exist/Not

Changing and wash room with attached toilet - Exist/Not

Total Number of operations done during the year 2009

Details of Available equipments, Instruments and other facilities in Operation theatre

Note:- Details be furnished as per annexure-X

Fumigation Details

AMBULANCE - Available/Not Available

OTHER FACILITIES AVAILABLE IN THE HOSPITAL

-

-

Pathological tests

Total number of Pathological tests/

investigations done in the year 2009

X-Ray

Total number of X-rays done in the year 2009

ECG

Total number of ECG done in the year 2009

USG

Total number of USG done in the year 2009

INFORMATION OF ILAJ BIL TADBEER DEPARTMENT

Name of the Instrument

Number of Instruments Available (To be filled up by college)


correct

Apparatus needed for -

Hajamat (Cupping Set)

Dalk Table

Riyazat

Taleeq (Aquarium for leeches)

Fasd (Venesection Set)

Hamam

Other

TADABEER BEING CARRIED OUT

TOTAL NUMBER OF REGIMENS CARRIED OUT IN THE YEAR 2009 (To be filled up by college)

VERIFICATION BY VISITORS AS CORRECT / NOT CORRECT

Fasad

Hajamat

Dalk

Riyazat

Taleeq

Hamam

Others

DETAILS OF MEDICAL CAMPS CONDUCTED BY COLLEGE IN THE YEAR 2009

S.No.

TO BE FILLED UP BY COLLEGE

VERIFICATION OF INFORMATION BY VISITORS AS CORRECT / NOT CORRECT

NATURE OF THE CAMP

DATE

PLACE

NUMBER OF PATIENTS

* If required additional sheet be attached in the prescribed format.

ANNEXURE -I

DETAILS OF AREA OF COLLEGE AND HOSPITAL

DETAILS OF AREA OF COLLEGE::

TOTAL CONSTRUCTED AREA

NAME OF DEPARTMENT & SECTIONS



1. Administrative wing

2. Kulliyate Tib

3. Munafeul Aza

4. Tashreeh-ul-Badan

5. Ilmul Advia wa saidla

6. Ilmul Amraz

7. Moalajat

8. Niswan wa Atfal

9. Ilmul Qabalat

10. Jarahat

11. Ain Uzn, Anaf wa Halaq

12. Ilaj Bil Tadber

13. Tahaffuzi wa Samaji Tib

14. Library+ reading room

15. Pharmacy

16. Herbal Garden

17. Auditorium

18. Staff Room

19. Common Room

20. Canteen

21. Class Rooms

22. Tutorial room for PG

23. Area of Dissection Hall

24. Munafeul Aza Lab.

25. Saidla lab

AREA OF MUSEUMS

1. Tashreehul badan

2. Munafeul Aza

3. Ilmul advia

4. Ilmul Amraz

5. Jarahat

6. Tahaffuzi wa Samaji tib

7. Kulliyate Tibb

OTHERS

1.

2.

Total Constructed Area

Cont..

AREA OF VARIOUS SECTIONS AVAILABLE IN THE HOSPITAL

TOTAL CONSTRUCTED AREA OF HOSPITAL

VARIOUS SECTIONS IN THE HOSPITAL

Sections If Exist please mention Area (To be filled up by college)


ADMINISTRATIVE BLOCK-

-

-

1. Reception

2. Registration counter

3. Office of Medical Superintendent/ Medical Deputy Superintendent

4. RMO Room

5. Store Room

6. Total area of IPD wards

OPD SECTIONS -

-

-

1. Moalajat including Ilaj Bit Tadbeer

2. Jarahat including Ain, Uzn, Anaf, Halaq-wa-Asnan

3. Qabalat-wa-Amaz-e-Niswan

4. Amraz-e-Atfal

5. Emergency

6. Tahaffuzi-wa-Samaji Tib

7. Minor OT

Clinical Pathology & Biochemistry Lab

Area of store room of Drugs

Dispensary

Record Room

Labour room

Operation Theater

Recovery Room

OTHERS

-

-

1.

2.

Total Constructed Area

ANNEXURE-II

NUMBER OF POST GRADUATE STUDENTS PASSED FROM COLLEGE FROM INCEPTION TO TILL DATE

S.No.

NAME OF PG SUBJECT

TOTAL NUMBER. OF PG STUDENTS PASSED OUT FROM COLLEGE FROM BEGINNING TO TILL DATE (To be filled up by College)

1. Kulliyat-Umoor-e-Tabiya

2. Munafeul Aza

3. Ilmul Advia

4.

Ilmus Saidla

5.

Tahaffuzi-wa-Samaji Tib

6.

Ilmul Atfal

7.

Moalajat

8.

Ilmul Amraz

9.

Ilaj Bil Tadbeer

10.

Amraze Jild o Zohrawiya

11.

Tashreehul Badan

12.

Ilmul Jarahat

13.

Amrazee Uzn, Anf wa Halaq

14.


GRAND TOTAL

LIST OF STUDENTS ADMITTED IN THE YEAR 2009-10

S.No.


Verification of information by Visitors as correct/Not correct

Name of the Students

Fathers Name

Date of Admission

Residential Address

Govt. Quota /Management Quota

* If required additional sheet be attached in the prescribed format.

ANNEXURE-IV

DETAILS OF SAIDLA (PHARMACY)

DETAILS OF EQUIPMENT & INSTRUMENTS

Essential Equipment and Instruments

Available Number of Equipment and Instruments (to be filled up by College)


1. Pulveriser

2. Grinder

3. Mixer

4. Filtering Machine

5. Tablet Making Machine

6. Pill making machine

7. Heating machine

8. Capsule Filling Machine

9. Air Tight Desiccators

10. Moisture absorbing machine etc.

11. Tablet coating pans & fitting press

12. Granulator drying chamber

13. Projector Overhead and Slide

14. Distillation apparatus/Qara Ambiq

15. Weighing Machine

16. Pestle and Mortar

17. Others

DETAILS OF PREPARED MEDICINES IN THE YEAR 2009

NAME OF PREPARED MEDICINE

QUANTITY OF PREPARED MEDICINE


1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

* IF REQUIRED ADDITIONAL SHEET BE ATTACHED

TOTAL EXPENDITURE ON PURCHASE OF RAW MATERIALS IN THE YEAR 2009

NAME OF THE COMPANY

DATE

VOUCHER NUMBER

AMOUNT

VERIFICATION BY VISITORS AS CORRECT/ NOT CORRECT

1.

2.

3.

4.

5.


TOTAL EXPENDITURE ON PURCHASE OF COMPOUND FORMULATION IN THE YEAR 2009

NAME OF THE COMPANY

DATE

VOUCHER NUMBER

AMOUNT

VERIFICATION BY VISITORS AS CORRECT/ NOT CORRECT

1.

2.

3.

4.

5.


ANNEXURE-V

PROFORMA TO FURNISH THE DETAILS OF TEACHING STAFF

Note: Information to be filled up by college as per proforma and be verified by Visitors

S. No.

Name of the Teacher

Father's Name

Date of Birth

UG Qualifi. (Univ. & year)

PGQualif.with subject (Univ. & year)

Nature

of appoin.

Date wise details of Experience in chronological order

Department (Subject)

Present Working Address

Permanent Address

State Board Registration No.

Bank Account Number


Duration

(d/m/y)

Designation

Name of the college

Sir Name

First Name

Second name

Note: Please attach the certified copies of Under-graduate and Post-graduate degree, Registration certificate, experience certificates and reliving order along with original affidavit as per prescribed format of all teaching staff. The provisional certificates will be considered only for two years after passing the examination.

ANNEXURE-VI

PROFORMA TO FURNISH THE DETAILS OF NON TEACHING STAFF

S.No.

Name of Employee

Fathers Name

Qualification

Date of Appointment

Nature of Appointment (regular/ contractual/

Part time)

Designation

Name of working department

Pay Scale

Verification of information by Visitors as correct / not correct

ANNEXURE-VII

PROFORMA TO FURNISH THE DETAILS OF HOSPITAL STAFF

S.NO.

NAME OF EMPLOYEE

FATHERS NAME

QUALIFICATION

DATE OF APPOINTMENT

DESIGNATION

NAME OF DEPARTMENT


PROFORMA TO FURNISH THE POST WISE EXPENDITURE ON SALARY OF HOSPITAL STAFF

S.NO.

NAME OF THE POST

NO. OF PERSONS

PAY SCALE

REGULAR/

CONTRACTUAL/

PART TIME

TOTAL EXPENDITURE INCURRED IN THE YEAR 2009


ANNEXURE-VIII

DETAILS OF DRUG DISTRIBUTION IN OPD & IPD (JAN. TO DEC. 2009)

S.No.

Name & Quantity of Drugs obtained from own Pharmacy

Name & Quantity of Drugs purchased from market

Name & Quantity of utilised Drugs along with balance


Unani Drugs

Modern Drugs

Unani Drugs

Modern Drugs

Utilised

Balance

Utilised

Balance

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

* If required additional sheets be attached in the prescribed format

ANNEXURE IX

DETAILS OF EQUIPMENT AND INSTRUMENTS REQUIRED FOR LABOUR ROOM

S.No.


Number of Instruments & Equipments available (to be filled up by college)

Verification of information by Visitors as correct/not correct

1.

Well equipped labour room with attached oxygen tent.

2.

Incubator

3.

Suction Machine - 1

4.

Oxygen Cylinder - 1

5.

Pulse Oxymeter

6.

Others

ANNEXURE X

DETAILS OF EQUIPMENT AND INSTRUMENTS REQUIRED FOR OPERATION THEATRE

S.No.




1.

Necessary Instruments relating to the subject be kept in hospital. Instruments used in Operation theatre Latest instrument for operation,

Leeching,

Cupping,

Venesection &

Autoclave

2.

Oxygen Cylinder

3.

Suction Machine

4.

Enema

5.

X-ray View Box

6.

Pulse oxymeter

7.

Anaesthesia machine

8.

Others

ANNEXURE XI

DETAILS OF EQUIPMENT AND INSTRUMENTS REQUIRED FOR DEPARTMENT OF TASHREEHUL BADAN (ANATOMY)

S. No.

DISSECTION HALL



1.

Nubmer of tables

2.

Preservative tank- Exists/Not

3.

No of cadavers available at the time of visitation

4.

No of cadavers dissected/demonstrated in the year 2009

ANNEXURE XII

DETAILS OF EQUIPMENT AND INSTRUMENTS REQUIRED FOR PHYSIOLOGY LABORATORY

S.NO.



Verification of information by Visitors as correct/not

correct

1.

Microscope

2.

Microtome

3.

Haemocytometer

4.

Haemoglobinometer

5.

Tissue Slide

6.

Refrigerator

7.

BMR Apparatus

8.

Spirometer

9.

BM Instruments

10.

Stethoscope

11.

Kymograph Instruments including electrometer

& accessories

12.

Albuminometer

13.

Urino meter

14.

Centrifugal machine

15.

Distillation apparatus

16.

Glassware for urine examination &

other necessary accessories

17.

Dissecting trays

18.

Necessary chemical etc.

19.

Sphygmomanometer

20.

Tonometer

ANNEXURE XIII

DETAILS OF EQUIPMENT AND INSTRUMENTS REQUIRED FOR MAHIYATUL AMRAZ LABORATORY

S.No.



Verification of information by Visitors as correct/not

correct

1.

Pathological and Biochemical laboratory well equipped for all types of routine and histological examination should be attached with hospital and necessary accommodation for this laboratory also be provided.

2.

Others

ANNEXURE XIV

PROGRESS MADE BY INSTITUTION IN LAST TWO YEARS ON SALIENT POINTS

S.No.

Important Information of College

Progress made by college (To be filled up by college)

1.

Construction of college & hospital building

2.

Appointment of Teaching staff

3.

Number of Seminar organized by the college/attended by teaching staff

4.

ROTP attended by the staff

5.

Research work carried out by teaching staff

6.

Publication of teachers

7.

Quality of work presented/published (National /International journals)

8.

Any contribution/ innovation made by the college/faculty for the System

9.

Conduct of examination in time ort not

10.

Appointment of Non-Teaching staff

11.

Appointment of Paramedical and other Hospital staff

12.

Expansion of Various

Departments of College

13.

Expansion of Herbal Garden, Plantation of New Plants

14.

Development of Pharmacy

15.

Progress in Hospital OPD

16.

Progress in Hospital IPD

17.

Progress of Ilaj Bil Tadbeer Department

ANNEXURE XV

NOTARISED AFFIDAVIT TO BE FILLED UP BY TEACHER IN THE GIVEN FORMAT.

S.No

Information of Teacher

To be filled up by Teacher

1.

Name of the Teacher (Sir Name- First Name- Second name)

2.

Date of Birth (d/m/y)

3.

UG Qualification (University & year)

4.

PG Qualification with subject (University & year)

5.

Post wise details of Experience in chronological order (* Date, Month and Year wise experience should be mentioned)

Duration

(d/m/y)

Designation

Name of the college

6.

Present working Department (Subject)

7.

Present Working Address

8.

Permanent Address

9.

State Board Registration No.

10.

Bank Account Number

11.

Contact Number a. Mobile-

b. Residence

c. Permanent Res.

Signature of Teacher

LIST OF ANNEXURES TO BE SUBMITTED BY COLLEGE

S.No.

Annexure Number

Name of the Annexure

1.

Annexure -I

Details of area of College and Hospital

2.

Annexure-II

Number of Post Graduate students passed out from college from beginning to till date

3.

Annexure-III

List of students (UG and PG) admitted in the year 2009-10

4.

Annexure-IV

Details of Saidla (Pharmacy)

5.

Annexure-V

Proforma to furnish the details of Teaching Staff

6.

Annexure-VI

Proforma to furnish the details of Non Teaching Staff

7.

Annexure-VII

Proforma to furnish the details of Hospital Staff

8.

Annexure-VIII

Details of Drug distribution in OPD & IPD (Jan. to Dec. 2009)

9.

Annexure IX

Details of Equipment and Instruments required for Labour Room

10.

Annexure X

Details of Equipment and Instruments required for Operation Theatre

11.

Annexure XI

Details of Equipment and Instruments required for Tashreehul Badan

12

Annexure XII

Details of Equipment and Instruments required for Munafeul Aza (physiology) Laboratory

13

Annexure XIII

Details of Equipment and Instruments required for Mahiyatul Amraz Laboratory

14

Annexure XIV

Progress made by Institution in last two years on salient points

15

Annexure XV

Notarised affidavit to be filled up by Teacher in given format. (in respect of all teaching staff)

Note: Teachers of Govt. colleges/University constituents colleges who have already submitted affidavits need not to submit again. However, these colleges should submit the affidavit of newly appointed teachers.

*****

***

*


NEW DELHI

Guidelines/Instructions to fill up the Visitation Proforma as well as regarding submission of annexures:-

1. Please read the proforma carefully before fill up.

2.Attested copy of UG & PG Certificates, Experience Certificates, Joining report, Relieving Certificate and Affidavit (as per annexure-XV) in respect of each teacher should be attached as per serial number of the list of teaching staff. (as per annexure V) Note: Teachers of Govt. colleges/University constituent colleges who have already submitted affidavits need not to submit again. However, these colleges should submit the affidavit of newly appointed teachers.

3. Copy of Form No. 16 issuing for purpose of income tax should be submitted in respect of all the teaching staff. (Not admissible for Govt./University constituent colleges)

4. In absence of complete documents the teacher will be treated as ineligible.

5. If any teacher found in duplicity the necessary action will be taken against the management, Principal of the college and concern teacher under IPC.

6. Attested copy of salary bills of Jan, June, Nov. & Dec., 2009 should be submitted in respect of Teaching, Non teaching & Paramedical staff along with Bank statements. (Not admissible for Govt./University constituent colleges)

7. Page-wise Index of all annexures should be provided.

8. Financial information should be filled up in prescribed format of proforma only. (Balance sheet should not be attached).

9. The column (namely Verification of information by visitors as Correct/Not correct) will be filled up only by visitors after verification at the time of visitation of the college.

10. The college should filled up the information strictly as per prescribed format. Any change in the prescribed format will not be accepted by CCIM.

11. Please mention constructed area in Sq. ft. only and land area in acres. Any other measurement strictly be avoided.

12. The information should be based on present facts and complete information should be provided in the prescribed format.

Pass Port Size Photograph (To be attested by Principal)

Proforma (U) 2010-11 4

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