College code: ---------------------- Academic Year: -------------------- Date of Inspection:-----------------

1 KERALA NURSES AND MIDWIVES COUNCIL RED CROSS ROAD, THIRUVANANTHAPURAM - 35 INSPECTION PROORMA OR COLLEGIATE PROGRAMMES (TO BE ILLED BY THE PRINCIPAL) A GENERAL INORMATION College code: ---------------------- Academic Year: -------------------- Date of Inspection:----------------- 1. Name of the Institution : -------------------------------------------------------------- --------------------------------------------------------------- 2. ull Address with Pin Code : --------------------------------------------------------------- --------------------------------------------------------------- ---------------------------------------------------------------- 3. College Opened on D D M M Y Y Y Y 4. irst Batch Admitted on D D M M Y Y Y Y B.Sc.(N) Post Basic B.Sc.(N) Post Basic Diploma(N) M.Sc (N) 5. Telephone Number of the Institution : ----------------------- ax No. --------------------------- 6. E-mail of the Institution : -------------------------------------------------------------- 7. Name, Telephone Numbers & : (O) ------------------- (R) --------------- (M) ------------ Email id of the Principal :

2 8. Administrative Control : 1. Government 2. University 3. Missionary/Trust/Society 4. Autonomous 5. Any other - specify Name of the Trust/Society/Missionary/ Company: -------------------------------------------------------------------- (Certified copy of the Trust Registration Document) (ANX - I) 9. Philosophy Yes / No (ANX- II) (Attach copy) 10. Organization Chart Yes / No (ANX - III) (Attach copy) 11. University to which Affiliated with full address : --------------------------------------------------------- --------------------------------------------------------------------- --------------------------------------------------------------------- --------------------------------------------------------------------- Tel. No--------------------------------------- ax No. --------------------------------------------- Website ------------------------------------------ Email id ------------------------------------------------- Please Tick the Appropriate Boxes Type of Inspection : 1. irst Inspection 4. 4. Re- inspection 2. Periodical Inspection 5. Surprise Inspection 3. Seat Enhancement Nursing Programme under Inspection: 1. Basic B. Sc. (N) 2. Post Basic B.Sc. (N) 3. PB Diploma(N) 4. M.Sc. (N) NB: ANX.I, II &III to be submitted by the Principal/ Management during I inspection by the Council.

3 12. Nursing Education Programs and approved seats (current academic year) Programme I B. Sc. (N) II Post Basic B. Sc. (N) III M. Sc. (N) 1. Medical Surgical Nursing- Total Sub Speciality Seats: No. of seats sanctioned Govt. INC KNMC KUHS No. of students admitted/batch IV V VI a. Cardio Vascular & Thoracic Nursing b. Critical Care Nursing c. Oncology Nursing d. Neurosciences Nursing e. Nephro- Urology Nursing f. Orthopedic Nursing g. Gastro enterology Nursing 2. OBG Nursing 3. Paediatric Nursing 4. Psychiatric Nursing 5. Community Health Nursing VII VIII G.N.M Post Basic Diploma - Total Clinical Speciality Seats : a. Critical Care Nursing b. Emergency & Disaster Nursing c. Oncology Nursing d. Nurse - Midwifery Practitioner e. Neuro Sciences Nursing f. Cardio Thoracic Nursing g. Neonatal Nursing h. Psychiatric Nursing I. Operation Room (OR) Nursing ANM M. Phil (N) Ph. D Grand Total 13. Nursing Education Programs and Number of Students Under Training.

4 Sl. No Programme I B. Sc. (N) Male No. of students admitted Gender I year II year III year IV year Total emale II Post Basic B. Sc. (N) M III M. Sc. (N) Total M 1. Medical Surgical Nursing - Total Sub Speciality: a. Cardio Vascular & Thoracic Nursing b. Critical Care Nursing M c. Oncology Nursing M d. Neuro-Sciences Nursing M e. Nephro- Urology Nursing M f. Orthopedic Nursing M g. Gastro Enterology Nursing M 2. OBG Nursing M 3. Paediatric Nursing M 4. Psychiatric Nursing M 5. Community Health Nursing M IV G.N.M M M M

5 V VI VII VIII Post Basic Diploma -Total (Specify the clinical specialities) a. Critical Care Nursing M b. Emergency & Disaster Nursing M c. Oncology Nursing M d. Nurse - Midwifery Practitioner e. Neuro - Sciences Nursing M f. Cardio Thoracic Nursing M g. Neonatal Nursing M h. Psychiatric Nursing M i. Operation Room(OR) Nursing M ANM M. Phil (N) Ph. D Grand Total 14. Nursing Education Program and Date of last Inspection: Sl. No B. Sc. PB B. Sc. PB.Diploma M. Sc. M. Phil PhD 1 Government 2 INC 3 State Nursing Council 4 KUHS (Attach Copies of latest orders from each authority) (ANX IV) I. PHYSICAL ACILITIES

6 A. COLLEGE 1. Owned 2. Rented 3. Leased 4. Independent 5. Attached to Hospital 6. Any other Specify Copy of Land Deed with Ownership Certificates and Approved Building Plans for College and Hostel to be submitted by the Principal / Management during irst Inspection by the Council. (ANX- V & VI) acilities Minimum requirement as per INC norms Available Remarks A. Teaching block a. Area of land 3-4 Acres b. Built up area of the College 23720 Sq:ft building c. Lecture Halls No. 4 for B.Sc N & extra /batch Area/Size No. of Tables No. of chairs B. Multi purpose Hall /Auditorium 1. Area 2. Seating capacity 3. Confidential Room 4. CCTV facility 5. urniture & Settings 1080 Sq:ft Adequate for intake 3000 Sq:ft Exam. Purpose C. Laboratories ( 6 labs) a) Nursing oundation Lab 1500 Sq.ft Adequate for capacity 1. No. of beds 1:6 students 2. No. of articles 10-12 sets 3. Equipment & Supplies Adequate for lab practice 4. No. of dummies 4-5 Adult maniquin - 3 Child /Neonate -1 CPR maniquin - 1 5. Hand washing facilities Elbow /Leg operated system

7 b) Nutrition Lab - Area 1. Equipment & Supplies 2. Charts / models c) MCH Lab Area Simulators/charts/models/play materials /specimens. Charts / models/specimens d) CHN Lab - Area Charts / models etc Community Health Bags e) Computer Lab No. of Computer Internet facilities 900 Sq.ft Adequate for practice Adequate for practice 900 Sq.ft Adequate for practice 900 sq.ft 1:2 students 1500 sq.ft 1:5 e) Pre Clinical Science Lab 900 sq.ft D. A.V. AIDS Room OHP LCD/DLP Slide projector TV/video Charts /models /specimen Other T-L aids specify 600 sq.ft 1 for each class room 2 (minimum) 1 1 Adequate for each subject E. LIBRARY Minimum required Available Remarks Library Area Seating Capacity 2400 Sq.ft Min.60 Staff reading room 10 persons Room for librarian urniture adequate No. of cupboards Adequate No. of racks Total No. of Books- 3000 year Min. Professional Journals Books Nation Inter Total al national 1 1000 3 2 5 II 1500 5 3 8 III 2500 8 4 12 IV 3000 10 5 15 General books / fictions Attach list of journals (ANX VII)

8 Photocopying facility Yes No Internet facility Yes No Separate section for staff / PG Yes No Ventilation Adequate Inadequate Lighting Adequate Inadequate Registers maintained Accession Register Yes No Journal Register Yes No Issue Register Yes No Any other Specify:. Water supply and sanitation Safe drinking water facility Yes No Hand washing facility Yes No No. of toilets in the college Gents Ladies G. Office& aculty Rooms Administrative acilities Minimum Area in sq.ft Storage facility No. of urniture Telephone and intercom facility Computer with internet facility Ventilatio n/ Lighting Attached toilet facility Remarks Office of the 300 Principal with visitors room Vice Principal 200 Professor/Assoc. Prof./Reader s room(1 room for each Dept. Head) 6Nos 200 each

9 Asst. Professor/ Sr. Lecturer Lecture s room (2 teachers in one room) Offices of Admin. Clerical staff and PA(s) Accountant s office Store Room Record room Duplicating/Xero xing room Common room with all facilities Girls Boys Staff 200 200 1000 3 1100 H. Other facilities : Hall for indoor games, Playground, Garage, ire escape facility etc. II. TEACHING ACULTY (for annual intake- B.Sc. (N)- 60, M.Sc.(N) -25, PBB.Sc 30) Sl. No Designation Minimum requirement Available Remarks (Eligibility as Uty. examiner) 1 Principal cum Professor 1 2 Vice Principal cum Professor 1 3 Associate Professor 5 (one in each speciality ) 4 Assistant Professor 8 (1-2 in each speciality) 5 Lectures with PG 10 (1-2 in each speciality) 6 Tutor / Clinical instructors 10 Total 35 Teacher student ratio 1:10 Qualification & Experience of Teachers of College of Nursing is as per revised INC norms

10 Details of Regular Teaching aculty of all Nursing programmes offered by the Institution Sl. No Designation Name Age & Date of Birth 1. Principal Qualification/ Name of Institution/University/ Year passing B.Sc. (N) P. B B.Sc. (N) M.Sc. (N) & specialty Additional qualification Experience in years and months Clinical Teaching Before PG After PG Total KNMC Reg. No & date Date of joining the institutio n 2. Vice Principal 3. Asso.Professor/ Reader 1. 2. 3. 4.

11 5. 4. Asst. Professor 1. 2. 3. 4. 5.

12 6. 7. 8. 9. 10. 4 Lecturer with PG 1 2 3. 4. 5

13 6 7 8 9 10 5. Tutor /Clinical Instructor 1. 2. 3 4 5

14 6 7 8 9 10 11 12 13 14 15 Date College Seal Name &Signature of the Principal

15 OICE STA Sl. No. 1 Administrative Officer /Office Registrar Designation Minimum Required No. available Remarks 2 C A to Principal 1 3 U.D.C 1 4 L.D.C 2 5 Accountant-cum-cashier 1 6 Librarian grade IV 2 7 Computer Programmer 1 8 Attender 1 for Library 1,, Lab 1,, Office 9 Watchman 2 10 Driver 2 11 Peon 1 12 Cleaner (Bus) 1 13 Sweeper 2 1 III. CLINICAL ACILITES O PARENT AND AILIATED HOSPITALS. A. PARENT HOSPITAL Parent Medical College Yes No Parent Hospital Yes No Name &address of the Parent hospital Number of Beds Average occupancy per month No. of Schools affiliated No. of Colleges affiliated Distance from the College in kms No. of Registered Nurses

16 CLINICAL AREAS IN THE PARENT HOSPITAL ( Minimum Bed strength 200, Student patent ratio 1:3) CLINICAL AREAS Minimum Required No. available Last month occupancy Remarks Medical 40 Surgical 40 Paediatrics 30 Gyne & Obst. 40 Orthopaedic 10 Emergency /causality 10 ICU Specify available (Medical,Surgical and facilities Specialities) Other Clinical Specialities Clinical Specilities Required Parent Affiliated Affiliated Affiliated Remarks 1 2 3 Eye, ENT 10 Coronary /ICCU /ICU 5-10 Nephrology 10 Neurology 10 Trauma care Unit 10 Burns and Plastics 5-10 Oncology 5-10 Dermatology 5-10 Affiliation for Psychiatry Dialysis Cardio Thoracic Neuro ICU Neonatal ICU 50 beds Specify facility available

17 B. AILIATED HOSPITALS Total No. of Affiliated Hospital(s) : DETAILS O AILIATED HOSPITALS: Name &address of the Affiliated Hospitals Number of Beds Average occupancy per month No. of Schools affiliated No. of Colleges affiliated Distance from the College in kms No. of Registered Nurses Other Clinical Areas Sl. Areas Parent Affiliated Hospitals Remarks No. Hospital 1 2 3 1 No. of Operation Theatres Major OT No, of Tables Minor OT No, of Tables 2 Average No. of Operations per month Major Minor 3 Average No of deliveries per month 4 Average Attendance at OPD per day

18 UTILIZATION O CLINICAL ACILITIES O AILIATED HOSPITALS Sl. No Name & Address of Hospitals Clinical speciality for which affiliation is sought No. of beds in the respective speciality. Program for which affiliation is sought Year of study I,II, III, IV year Remarks NURSING SERVICE DEPARTMENT Sl. No 1 Nursing officer/ Nursing Superintendent 2 Deputy Nursing Superintendent 3 Asst. Nursing Superintendent 4 Head Nurse 5 Staff Nurse 6 ANMs Designation No. Available in Hospitals Remarks Parent Affiliated 1 2 3 Attach separate list of Nursing Staff of Parent and Affiliated Hospitals with Kerala Nurses and Midwives Council Registration Numbers in the enclosed proforma- II (ANX - IX) Supporting Staff Nursing Assistants - Class IV employees -

19 Hospital Records & Registers IP Register - Yes/No OP Register - Yes/No Day / Night Report - Yes/No Discharge Register - Yes/No Census - Yes/No Any other (specify) - C. COMMUNITY HEALTH ACILITIES 1. RURAL IELD a. Name of CHC / PHC / SC i) Adopted/Affiliated ---------------------------------------------------------------------- ii) Administered by 1. State Govt. 2. Private b. Residential Accommodation available for iii) Supervising Teacher 1. Yes 2. 2. No. iv) Students 1. Yes 2.No. Remarks : c. Details of CHC/PHC/SC i) Distance from the College ---------------------------------------------------------------------------- ii) Area Coverage (in Kms) ------------------------- Number of villages covered: ---------- iii) Population Coverage ---------------------------------------------------------------------- iv) Service Rendered a) Health and amily Welfare programmes: Yes / No ----------------------- b) National Health Programmes : Yes / No ----------------------- d. Supervision of students: 1. ield staff only 2. College teaching faculty 3. Both II. URBAN IELD a. Name of MCH &.W. Centre i) Adopted ii) Affiliated

20 b. Details of MCH and.w. Centre i) Distance from the College ------------------------------------------------------- ii) Administered by 1. State Govt. 2. Private iii) Area Coverage (in Kms) --------------------- Number of villages covered ----------- iv) Population Coverage ---------------------------------------------------------------------- v) Staff Pattern (specify) ------------------------------------------------------------- ------------------------------------------------------------- vi) Services Rendered: c. Supervision of Students: 1. ield staff only 2. College teaching faculty 3. Both N.B: Copies of Affiliation Orders from the Hospital and Health Centres to be submitted. Inspectors should visit the Hospitals and Community Health ield and record their observations. IV. TRANSPORTATION No. of vehicles available - Vehicle No. - Seating capacity - Staff car for Principal Yes No (ANX- X) (Copy of RC books to be submitted) (ANX-XI) V. TEACHING PLAN A. TEACHING PLAN OR EACH PROGRAM/ BATCH 1 Master Plan Yes /No 2. Time table Yes / No 3. Clinical Rotation Plans Yes / No 4. Clinical Rotation is based on the syllabi and Clinical Learning Needs Yes / No 5. Nursing Service is consulted before planning Yes / No Copies of Master and Clinical Rotation plans to be submitted (ANX-XII)

21 B. SYSTEM O EXAMINATION a) Eligibility for admission to Examination: i) Attendance percentage: 1)Theory ---- ------ 2) Clinical practice ------- ii) Internal assessment marks minimum requirement :------------------------------- iii) Completion of assignments & practical record : Yes /No b) Practical Examination conducted in : Parent hospital / Affiliated hospital c) aculty eligible to be appointed as internal examiner is available in each speciality : Yes / No d) No of students examined per day : ------------------------------------------------ e) University/ Council publishes results in time : Yes / No f) Weak points on examination -------------------------------------------------- g) Strong points on examination -------------------------------------------------- i) Pass percentage of students in University examination Sl. No Program I yr II yr IIIyr IVyr Remarks on achievements 1 B.Sc (N) 2 PBB.Sc(N) 3. PB Diploma(N) 4. M.Sc(N) VI. AVAILABILITY O RECORDS / REGISTERS / REPORTS A. Student Records a. Admission Register Yes No b. Attendance Register Yes No c. Health Record Yes No d. Clinical and ield Experience Record Yes No

22 e. Practical Records - Nursing oundations Yes No - Medical Surgical Nursing Yes No - Midwifery Case Book Yes No - Log Book Yes No - Drug iles Yes No f. Leave Record Yes No g. Extracurricular activities of students Yes No h. Cumulative Record of each student Yes No B. Maintenance of Documents a. Course Planning of each subject Yes No b. Rotation Plans (Master & Clinical) Yes No c. Mark Register Yes No d. Minutes of Committee meetings College Development Committee Yes No Curriculum Yes No Anti-ragging Yes No Selection Committee Yes No Library Committee Yes No PTA Meeting Yes No Any other specify ------------------------------------------------------------------------- e. Affiliation Records Yes No f. Stock Registers Yes No g. Budget Plan Yes No h. Annual Report of Activities and Achievements Yes No i. Staff Development Programs Yes No Attach copy of annual report of the college and report on CNE (ANX XIII and XIV) C. Professional Association / Activities N.S.S /SNA/TNAI /any other - specify

23 VI. HOSTEL ACILITIES 1. College has a separate Hostel: : Yes No 2. Built-up area of the hostel (30750Sq.ft) : -----------------------------------------sq. ft. 3, Ownership of the hostel : Own Rented Leased If owned proof of possession of hostel to be enclosed ANX V 4. Separate Hostel for Male and emale Students : Yes No. If yes a. Total Number of students in the hostel Girls--------------- Boys----------------- b. Number of rooms Girls--------------- Boys----------------- c. No. of students accommodated in each room Girls--------------- Boys----------------- d. Size of rooms Girls--------------- Boys----------------- e. urniture allotted to each student Bed----------------- Table ---------------- Chair----------------- Cupboard--------- 5. Hostel has provision for a. Water Supply Yes No. b. Electricity Yes No. c. Safe disposal of Waste Yes No. d. Laundry/washing Yes No. e. Hot water supply. Yes No. 6. Recreation room with TV/radio Yes No. 7. acilities for indoor & outdoor games Yes No. 8. Guest Room Yes No. 9. Sick Room for students Yes No. 10. Hostel mess Yes No. 11. Dining Hall facilities: a. Dining hall 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 12. General condition of the hostel 1, V Good 2. Good 3. 3. Average 4 Satisfactory 5. Poor

24 13. HOSTEL STA (or 150 inmates) Sl. Designation Posts Required Staff Appointed No. 1 Warden ()/Asst. warden 1 2 House Keeper () 3(3 shifts) 3 Cook(1: 20/shift) 3 for 60 students /shift 4 Watchman 3 5 Cleaning staff 3 VII. BUDGET 1. a. Separate budget for the College Yes No b. Amount per annum : -------------------------------------------- 2. Name and designation of Drawing and Disbursing Authority : -------------------------------------------- 3. Last year s budget allocation : ------------------------------------------- 4. Expenditure details Sl. Particulars No. 1 Salary - Teaching aculty - Non-teaching faculty 2 Stipend for students 3 New equipments and Machinery 4 Maintenance of vehicles and cost of petrol/diesel Expenditure (annual)

25 5 Purchase of urniture 6 Office supplies including stationery and postage 7 Contingency fund- educational tours, professional activities, prizes, entertainments, maintenance of the school premises and any other needed items 8 Library purchase of books, journals and daily news papers, binding of journals, stationary such as index card, label etc 9 Incidental teaching equipment charts, films, slides, transparencies, pen, chalk, etc 10 External Lectures- payment in accordance with the policy of the controlling authority Copy of Budget to be submitted ANX: XV 4. Salary Structure of Teachers Sl. Designation Basic Pay Allowances Total Remarks No 1 Principal 2 Vice-Principal 3 Asso. Professor/Reader 4 Asst. Professor 5 Lecturer with PG 6 Tutor/Clinical Instructor Remarks by the Principal, if any: ------------------------------------------------------------------------------------------------------------------------------------- Declaration by the Principal I. hereby declare that all the information and documents furnished are true and correct to the best of my knowledge. I will abide by the rules & regulations in force of the Govt. of Kerala, Indian Nursing Council, Kerala Nurses and Midwives Council and Kerala University of Health Sciences and as amended from time to time. Place: College Seal Name & Signature of the Principal Date: