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INSPECTION PROFORMA FOR GENERAL NURSES & MIDWIVES

Date of inspection: - _____/___/ 20___

Type of inspection _________________ Preliminary/ Inspection/ Annual Report of Preliminary Inspection

conducted on _______/_____/20____by the committee constituted by Govt. On 20.03.2007 for opening of
General Nursing Training institutions for grant of no objection certificate/ Essentiality Certificate to
__________________________ to the session _____________ for students.

Name and Designation of the committee Members:-

1. Deputy Director Nursing:-

2. Asst. Director Nursing :-
3. Secretary O.N. & M.E. Board.

(To be furnished by the Principal/Head of the Trust Society and placed before the Inspectors/Committee
members for verification.

1) GENERAL INFORMATIONS
A) Name of the Institution :
b) Revenue Address :

Name of the Village Town where the ANMTC

Situated: - _______________________________
Police Station (Distance from T.C):
Tahasil :-_________________ Sub Division:_________________ District:- ______________
Postal Address with Pin Code:-
________________________________________________________________________________________
________________________________PIN_________________________
Telephone No. with STD Code Fax No.:-

2. E-Mail of the Institution:- _______________________________________________________________

1. When was the School Opened:-___________________________________________________________

2. Administrative Control: - Govt. Trust/Society/ Any Other (Tick Any One)
3. Name and Address of the Examination Board which affiliated:- _________________________________
4. Do you have a permanent hospital? Yes/No
Where the student gets their practical experience:-
5. Applied for affiliation of D.M.E.T. but not received:- Yes/No
6. Year & Date of Admission of Students:-
7. Date of last Inspection :-
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CATEGORY No. of students Sanctioned TOTAL STUDENTS UNDER TRAINING

State Govt. Nursing Council

ANM/GNM

B. Staff

1. Teaching Staff (Full Time)

Post Name Salary RNRM Professional Teaching Date of Remarks

number qualification experience joining in
with year of teaching at
passing present
institute
PT
Tutor
to
Tutor

Tutor

Tutor

Tutor

Tutor

2. Part time teachers:-

SI.No. Name Qualification Subject Numbers of Remarks

hours per year
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3. Supportive Staff (For School & Hostel)

SI.No Post Number Remarks

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Leave Register:-
Warden accommodation inside Hostel:-

C. Physical Facilities
Infrastructure
1. Class Room Number of class room: __________________________________
2. Library Yes/No
3. Practical Laboratory: Fundamentals/ Nutrition/ MCH/ Community Health/ Computer lab.
Give Comments.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
________________________________________________________________
4. Number of Toilets:-

a) For Staff: - ________________________

b) For Students: - _______________________

5. Is there a Vehicle for the School:- Yes/NO

a) If Yes, specify:- ________________________________________________________
b) If No, what arrangement is made:- ________________________________________

D. Administrative Facilities:-
Office
i) Principal Tutor Yes/No
ii) Teachers Common Room Yes/No
iii) Office of Administrative/Clerical Assistant Yes/No
iv) Record Room Yes/No

Library Facilities
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1) Is Computer Facilities available for students Yes/No

2) Number of Books available Yes/No
3) Number of Journals subscribed Yes/No
4) Is Internet Facility available for Students Yes/No
5) Audiovisual Aids available Yes/No

TV/ VCR/OHP/Black Board/ Monitor Board/

Through Computers/Others

Teaching Block

Built up area of the building _________________________

Is the Institution 1) Owned 2) Rented 3) Leased

Hostel

1. Whether safe drinking water supply available. Yes/No (Source)_______________

2. Provision for hand washing facilities available Yes/No (Source)_______________
3. Number of Toilets in the hostels and type _________ & _______bathroom _______

Administration
Who is controlling the school? Government/Private/NGO/Trust/Missionary
Is there a separate budget for the School? Yes/No
Who is controlling authority of the budget? _____________________________
What is the last year budget? _________________________________________

1. Hospital Facilities

Name of the Number of Average Distance from Number of RNRM Are the staff of Remarks
hospital attached other Occupancy the School Working in the the hospital
for students Schools/ per month hospital with involved in
practice Colleges their positions teaching students
affiliated

Distance from the School _______________________________________________________

Service rendered _______________________________________________________
Does the staff of PHC/CHC staff involve in teaching programme of students: - Yes/No
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Supervisor of students: - By School staff/by PHC Staff/by both. Specify __________________

Clinical Rotation Plan:-

Number & size of each group ________________________________________________________
(Enclosed copies of Rotation plan)

F. Teaching Plan:-
Syllabus followed?________________________________________________________________
Copy of Syllabus available Yes/No
Master Plan for Theory & Practice made Yes/No
Time Table made Yes/No

MCH Experience
How many delivers conducted by each student __________________________________________
How many of the following have been conducted:-

- ANC Exam _________________________________________

- Post natal care _________________________________________
- P.V. Exam. _________________________________________
- Motivation for F.P. _________________________________________
- Health Education _________________________________________
- Family Education _________________________________________
- Conducting Survey _________________________________________

Home Visiting Bags:-

- Number of Visiting Bags ____________________________________

- Number of Students for each if sharing ____________________________________

G. System of Examination:-
Eligibility of admission of Examinations
a.) Percentage of attendance :- Theory hours ______________Practical hours ________________
b.) Internal assessment marks maintained properly Yes/No
c.) Completion of practical Record Yes/No
d.) Conduct Yes/No

H. Records of Students:-
A. Are the following records maintained well? Yes/No
1) Admission Record Yes/No
2) Daily Attendance Registers Yes/No
3) Health Record Yes/No
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4) Clinical & Field Experience Record Yes/No

5) Practical Record Books/Midwifery Case Book Yes/No
6) Leave Record Yes/No
7) Cumulative Record each students progress Yes/No
8) Extracurricular activities record Yes/No
9) SNA activities record Yes/No

B. Is the following school records maintained?

1. Course planning of each subject Yes/No
2. Rotation Plan Yes/No
3. Committee Meetings Yes/N0
4. Affiliation Records Yes/No
5. Record of Stock Yes/No
6. Budget Plan Yes/No
7. Annual report of activities & achievements Yes/No
8. Staff Development programmed Yes/No

1. Hostel Facilities
1. Build up area ________________________
2. Is hostel Owned/Rental/Leased
3. Number of Rooms and number of students in each room: _____________________
4. Number of Toilets:- _______________________
2. Whether hostel has provision for:-
i. Electricity Yes/No
ii. Water Supply Yes/No
iii. Toilets /Bath Yes/No
iv. Safe disposal of wastes Yes/No
v. Visiting Room Yes/No
vi. Mess Yes/No
vii. Dining Room Yes/No
viii. Hand washing facilities Yes/No
ix. Kitchen Hygienic Yes/No
x. General condition of Hostel Good? Yes/No
xi. Furniture likes bed/table/chair available for all students Yes/No
xii. Facilities for Indoor games Yes/No
xiii. Is a TV/VCER available? Yes/No
xiv. Outdoor games available? Yes/NO
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Comments of Inspectors:-

1. Strong Points:-

2. Weak points:-

3. Executive Summary:-

Name of the Inspectors with Address:-

1. Signature & Date

2. Signature & Date

3. Signature & Date