MADHYA PRADESH NURSES REGISTRATION COUNCIL

(to be filled by the Inspector)

Academic Year: ……………………… Date of Inspection ……………………..
INSPECTION PROFORMA
Is the institution willing to submit itself for the inspection under Madhya Pradesh Nursing Sikshan
Sansthan rules : Yes /No
Please Tick the Appropriate Boxes
Type of Inspection:
Sl Basic NPCC
Type of Inspection ANM GNM
B.Sc (N)
PBB.Sc (N) M.Sc (N)
No
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 : …………………………………………….
…………………………………………….
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 : Yes / No

Encl:………..
 -2-
11. First Batch admitted for School/College :
Year of No. of Seats Sanctioned in Original Enhancement of Seats Remarks
Programme Programme (No.of seats sanctioned)
Started
INC MPNRC University Board INC MPNRC University Board
ANM
GNM
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
NPCC (N)
Ph.D
Post Basic
Diploma
Programmess
* INC, MPNRC, University & Board Orders to be enclosed; Encl:………
12. a)Do you have parent Medical : 1. Yes 2. No
College/ Hospital : 1. Yes 2. No
b)Do you have own Hospital
If Yes, Name & Address of the Medical College /Hospital( Proof of the same to be enclosed):-- Encl:……...
13) Is the INC/MPNRC/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 ANM GNM Basic PBBSc(N) M.Sc. (N) NPCC Remarks
B.Sc. (N)

Madhya Pradesh Nursing Council

Indian Nursing Council
University
II. TEACHING FACULTY
STAFFING PATTERN AS PER INC/MPNRC NORMS
School Of Nursing
For School of nursing with 60 students (i.e., an annual intake of 20 students):

Teaching Faculty No. Required

Principal 1
Vice-Principal 1
Tutor 4
Additional Tutor for interns 1
Total 7

Note:
Teacher student ratio should be 1:10 for student sanctioned strength.
STAFFING PATTERN AS PER INC/MPNRC NORMS
Collegiate Programme
Sl.No. Designation B.Sc.(N) B.Sc.(N)
40-60 61-100
(Students Intake) (Students Intake)
1 Professor cum PRINCIPAL 1 1
2 Professor cum 1 1
VICE- PRINCIPAL
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)
Sl.No. Designation B.Sc.(N) P.B.B.Sc.(N)
40-60 20-60
(Students Intake) (Students Intake)
1 Professor cum 1
PRINCIPAL
2 Professor cum 1
VICE- PRINCIPAL
3 Professor 0
4 Associate Professor 2
5 Assistant Professor 3 2
6 Tutor 10-18 2- 10

Designation B.Sc.(N) P.B.B.Sc.(N) M.Sc.(N)

S.No. 40-60) 20-60 10-25
(Students (Students intake) (Students intake)
Intake)
1 Professor cum 1
PRINCIPAL
2 Professor cum 1
VICE- PRINCIPAL
3 Professor 0 1
4 Associate Professor 2 1
5 Assistant Professor 3 2 3*
6 Tutor 10-18 2-10

S.No. Designation GNM B.Sc.(N) P.B.B.Sc.(N) M.Sc.(N)

20-60 40-60) 20-60 10-25
1 Professor cum 1
PRINCIPAL

2 Professor cum 1
VICE- PRINCIPAL

3 Professor 0 1*

4 Associate Professor 2 1*
/Reader
5 Assistant Professor 3 2 3*
/Lecturer
6 Tutor 6-18 10-18 2-10

*1:10 teacher student ratio for M.Sc.(N)

 Sl.No. Designation ANM GNM B.Sc.(N) P.B.B.Sc.(N) M.Sc.(N)
20-60 20-60 40-60) 20-60 10-25
1 Professor cum 1
PRINCIPAL
2 Professor cum 1
VICE- PRINCIPAL
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)

-5-
II. FACULTY DETAILS
A).Teaching Faculty Profile ( Full – Time) of all the Nursing programme offered by this institution(GNM, 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)
Name of the institution Year of passing from
where and when qualified.(Enclose Photos with Date of Leaving
Experience in years & months* Date of Previous
self-attestation of all teaching faculty Remarks
Sl RN Joining Employment** &
Pay individually in the affidavit –Form II)
No Designation Name Age RM Specialty Institution Name
scale Post Teaching
No
Basic Basic M.Sc
NPCC PhD Clinical Before After
BSc (N) BSc (N) Total
(N) PG` PG
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. Qual. Registration Certificates & Experience Certificates Encl --------
------
** Check the Relieving order & enclose the same; if joined within 6 months
 -6-
B) External Teachers Details (whichever subject applicable for the programme)
Sl. Subject Name Qualification Number of hrs/ Year Remarks
No
As per norms Allotted
prescribed
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. Designation No. No. in Vacant Since Remarks
No Required Position When
1. P.A to Principal 1
2. Sr. Assistant 1
3. Jr. Assistant 1
4. Accountant-cum- 1
Cashier
5. Librarian 2
6. Computer 1
Programmer
7. Peon/Office 2
Attendant
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.N Designation No. No.in Vacant Since Remarks
o Required Position When
1. Warden 1
2. Asst. Warden 1
3. Cooks (1:20) 4
4. Bearer 4
5. House Keeping staff 4
6. Security 2
* HOSTEL SHOULD BE UNDER THE CONTROL OF THE PRINCIPAL

* SEPARATE HOSTEL FOR NURSING STUDENTS IS A MANDATE

III. PHYSICAL INFRASTRUCTURE DETAILS

A) ACADEMIC BLOCK : Own / Leased / Rented

1. Total Land Area :................................. Acres

2. Ready Built Area :................................ Sq.ft.

3. Details about ownership of the Building : 1.Own 2.Leased 3.Rented

If own, proof to be enclosed Encl:………………..

If leased, copy of the Registered lease
deed to be enclosed
*If leased building make sure it is registered for 5 yrs
lease, if not mention the same in the report. Make a
special note in the report if the building is rented

4. Building Completion Certificate by the : 1.Date of Completion -------------------

State Authority (proof to be enclosed) 2.Approved by Nazul /
Municipality / Panchayat
Encl:………………..
i) Does all the courses are imparted in the : Yes/No
same building
ii) If no, where the other courses are imparted …………………………………………..

5. Number of Toilets in the College for all : …………………………………………..

Nursing programs
Total No. of students : …………………………………………..
Total No. of Toilets : …………………………………………..
Student Toilet Ratio : …………………………………………..

Facilities Minimum requirement as per Available Remarks

INC norms
A. Teaching Block:
a. Lecturer Halls No. 4 for B.Sc.,(N) & extra/batch
Area /Size 1080 Sq.ft.
No. of Tables Should be adequate for Intake
No. of Chairs
B. Multipurpose Hall/
Auditorium 3000 sq.ft.
1. Area
2. Seating capacity }Exam purpose
3.Confidential Room }
4.CCTV facility Adequate for capacity
5.Furniture settings
 -8-
Facilities Minimum requirement as per Available Remarks
INC norms
C. Laboratories 1500 sq.ft.
a)Nursing Foundation Lab

1.No. of beds 1:3 students

2.No. of articles 10-12 sets in each item
3.Equipment & supplies Adequate for lab practice
4.No. of dummies
Adult manikin -3
Child/Neonate - 1
CPR manikin - 1
I.V.Arm Simulator - 1
5.Hand washing facilities Elbow/Leg operated system

b)Nutrition Lab – Area 900 sq.ft

1.Equipment & supplies Adequate for practice

2.Charts/Models Adequate for practice

c.MCH Lab – Area 900 Sq.ft

Simulators/charts/models/play Adequate for practice
materials/specimens/ Delivery Manikin -1
charts/models/specimens Neonatal Manikin -1

d.CHN Lab - Area. 900 sq.ft.

Charts/models etc
Community Health Bags 1:2 students

e. Computer Lab –Area 1500 sq.ft

No. of computer }
Internet facilities } 1:5

D.A.V.Aids Room - Area. 900 sq.ft.

OHP 1 for each class room
LCD 2 (minimum)
Slide projector 1
TV/Video 1
Charts/models/specimen Adequate for each student
Other T.L.aids specify

* 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 2400 sq.ft.
Seating Min. 60
capacity
Staff reading 10 persons
room
Room for
librarian Should be Adequate
Furniture
No. of
cupboards Should be Adequate
No. of racks
Total No. of For Collegiate Programme
Books 3000
(For DGNM Year Min. Professional Journals
program total Books
books=1500) I 1000 National Inter Total
National
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) specialty wise 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-
Size (Sq. ft) Storage No. of No. of Tel. Computer Venti Lighting Remarks
Administrative Facility Tables Chairs Facility Facility -lation
Facilities / Stools 1.V.Good 1.V.Good
As per Actually 2.Good 2.Good
3.Fair 3.Fair
Norms Available
4.Poor 4.Poor
sq.ft
Principal Office 300.
Vice Principal Office 200 .
Professor Offices 100x5
Lecturer’s Offices 600x3
Tutors/ 600 x2
Clinical Instr. Offices
Offices of 300
Administrative ,
Clerical staff and
PA(s)
Accountants Office 100
Store Room 100
Record Room 100
Room for 100
maintenance staff
Duplicating/Xeroxing 75
Room
Common Room for 300
Boys, Girls
separately
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 : 1.Own 2.Leased 3.Rented

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 Encl: -----------
4. Is there a separate provision of Hostel for : Yes No
Male and Female Students
a. Total number of Day Scholars : Girls Boys

b. Total number Students in the hostel : Girls Boys

c. Number of Rooms : Girls Boys

d. No. of students living in each room : Girls Boys

e. Size of each Rooms : Girls Boys

f. Total number of Toilets : Girls Boys

g. Total number of Bathrooms : Girls Boys

h. Furniture allotted to each student : Bed Table

: Chair Cupboard

Remarks
 -11-
5. Whether the Hostel has provision for
a. Water Supply : Yes No

b. Electricity : Yes No
c. Safe Disposal of Wastes : Yes No

d. Laundry : Yes No

e. Hot water supply : Yes No

6. Is there a Recreation room available with : Yes No If yes …….sq.ft

T.V./Radio ar ea
…
7. i) Is there facilities available for outdoor and : Yes No und area ............... sq.ft.
indoor games? Play gro

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:
MPNRC
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/Own Yes No
Hospital

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. Name of the Distance No. of Bed Occupancy Rate on the No. of No. of No. of
No Hospitals Beds day of Inspection Schools Colleges Registered
affiliated Affiliated Nurses
(Mention (Mention
the name) the name)
Last month On the day
of inspection
1

7
 -14-

4. Bed Distribution: (IP – No. of beds and OP – No. of patients per day)
Specialty Parent Affiliated Hospital Total Total
(Minimum Required Beds) Hospital Beds 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
Intensive Ward
Any Other

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
MA MI Total MA MI Total MA MI Total MA MI Total
General Surgery
Ortho
ENT
Ophthalmic
Gynec
Obstetrics
Pediatrics
Super
Specialties
 -15-

Bed Occupancy Rate (BOR) at Parent Hospital : ……………

on the day OF INSPECTION
Bed Occupancy Rate (BOR) at Affiliated Hospital on the day : 1.…………………2. ……………3…………….
of inspection
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:

S. Designation Qualification Parent Affiliated Hospital
No 1 2 3 4 5 6 7
1 Nursing Superintendent
2 Asst. Nursing Superintendent
3 Ward Sisters/ Ward In charges
4. Staff Nurses 1.ANM
2.Hospital trained
3.GNM
4.B.Sc.,(N)
5. M.Sc.,(N)
*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 : Yes / No
OP Register : Yes / No
Day / Night Report : Yes / No
Discharge Register : Yes / No
Census Register : Yes / No
Any other (Specify) :

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 Area No. of Villages
Covered Coverage 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
NPCC Male
Female
Post Basic Male
Diploma Female
Programme
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. Name of State Nursing Council Residence Place & Address Board/University Duration of Does
the Registration No. Address of Work at the from where last Course this
No.
Student GNM B.Sc(N) time of exam qualified With Dates details
admission From…… updated
…….To In the
nurses
data
bank

c) Year of passing out of first batch of students :

ANM GNM Basic B.Sc (N) Post Basic M.Sc.,(N) P.B. Diploma Programmes
B.Sc.,(N)
 -19-
8
-
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)

No. of No. of Theory Practical

Eligibility for admission to

System of supple.
Year –wise Paper

Hours Hours Marks Marks

Name of the
Programme

Theory Practical

Int. Ass. Marks

Duration

Completion of
Attendance %
exam

Practical
External
External
Internal

Internal
Prescribed

Prescribed

Total

Total
Allotted

Allotted

Practical
Yes/No

Theory
Freq
b] I Teaching Plan
Sl Program Master Unit Plan Lesso Learnin Learning Plan of Time
. Plan n g Experienc Evaluatio Tabl
N Plan Objectiv es n e
o es
Yes/ No Yes/ No Yes/ No Yes/No Yes/ No Yes/ No Yes/ No

1 ANM
2 GNM
3 Basic B.Sc N
4 P.B.B.Sc N
5 M.Sc N
6 P.B.
Diploma
Programm
es a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
7
 -20-
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) MPNRC / 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

 -22-
e) CLINICAL PLAN :
1. Is Rotation based on the needs of clinical learning experience Yes
No (Rotation plan to be enclosed)
Encl ……………………..
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
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
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?
 -23-
School /college Faculty 2.Hos tal nursing service personnel 3.Both
b. Who are all involved in planning
pi 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 …………………………………………………………………………........
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
 -24-
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? MPNRC 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
 -25-
 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/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 :
 -26-

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 No. of days
(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
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 : No
Yes Individual
If yes, is the Health Insurance : Group
b) Name of the Health Insurance Company
 -27-
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 MPNRC 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 ……………..
………………………………………………………………………………………………………………………………
………………………………………………………
……………………………………………
 -28-
-27-

XII CHECK LIST

 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. MPNRC – 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 B.Sc (N) & M.Sc (N) Students
9. Latest orders of MPNRC,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. Hospital PUC Certificate.
15. The balance Sheet & Previous year audited income and expenditure statement of the institution / Trust / Society
16. The list of Articles for all the Labs (Enclose the recent/ Last year purchase Bills)
17. List of Library Books & Journals (Enclose the recent/ Last year purchase Bills
18. List of Nurses with RN & RM No. working in the Parent & Affiliated Hospitals
19. Master & Clinical Rotation plan for respective years – Each Program
20. Eligibility for admission to examination : for all Nursing Programmes
21. List of Sports Articles
22. Report from the principal on course of instruction etc
23. Whether the institution has submitted details for the Website Updation; If not, CD containing details to be enclosed
24. Furnish all the above mentioned annexure in the CD in the jpg and Word format accordingly.
25. Furnish the evidences for the Latest annual recognition fees & web page renewal fees paid.
 -29-

MADHYA PRADESH NURSES REGISTRATION COUNCIL, BHOPAL

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 :------------------------------------

6. Additional Qualification Registration ------------------------------------- ( attach Certificate)

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
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
 -30-

XV. REMARKS OF THE INSPECTORS

S.NO PARTICULARS REMARKS

1. Physical Infrastructure
a. Institution
(Land, Building, Library, Lab,
Equipments, Furniture, etc,)

b.Hostel
(Land, Building, Furniture, etc,)

2. Transport

3. Clinical Facilities
a. Hospital

b. Community

4. Staffing
a. Nursing

5. Admission of Students

6. (a) Curriculum Planning and

Implementation

(b) Examination

7 Records & Registers

8 Welfare Activities for Students

9. Welfare Activities for Faculty

10 Performance indictors

11 Miscellaneous

EXECUTIVE SUMMARY

Please tick the appropriate:

DEFICIENT (time bound) /SUITABLE/ UNSUITABLE

Name of the Inspectors (in Capital Letters)with Designation and

Address Signature

1)

2)

3)