Central Council of Indian Medicine:: Ministry of...

CENTRAL COUNCIL OF INDIAN MEDICINENEW DELHI

VISITATION PROFORMA FOR ASSESSMENT OF AVAILABLE FACILITIES OF TEACHING AND PRACTICAL TRAINING OF SIDDHA 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 State Govt. Heath Secretary/ AYUSH Secretary Dealing with the education of Ayurved, Unani and Siddha

Name & Address

Office Tel No.

Residence Tel No.

Mobile No.

Visitation Proforma ( Siddha) -1

Information of State Govt. Director of Ayurved / 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 Siddha 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 Verification of


by college information by Visitors as Correct/Not

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 plotsWhether the land available with the Society/Trust is entirely for Siddha 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 Siddha college (in acres)

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

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

Name of other institutions running in the campus of Siddha CollegeTOTAL CONSTRUCTED AREA OF COLLEGE (Sq. ft.)Note: Please furnish details in Annexure-ITOTAL CONSTRUCTED AREA OF HOSPITAL (Sq .ft.) Note: Please furnish details in Annexure-I

TOTAL CONSTRUCTED AREA OF HOSTEL (Sq. ft.)

Area for Girls Hostel

Area for Boys Hostel

Total Land for Herbal Garden

Number of Staff Quarters available

INFORMATION OF ADMITTED STUDENTS Name of the Course

To be filled up by college Verification by Visitors as correct/NotAdmission

CapacityNumber of Students admitted in the year 2009-10

Date of last admission of the student

Govt. quota Management quota

I. UG CourseII. PG Course (Subject Wise)

* If required additional sheet be attached in prescribed format regarding information of PG Course NOTE: - Detail Information of Total Number of Subject Wise Post Graduate Students Passed from College till date be furnished as per Annexure –IINOTE: - List of Students admitted in the Year 2009-10 be furnished as per Annexure-III


SECTION –B

FINANCIAL INFORMATION

Total income of college in the year 2008 (To be filled up by college)

TOTAL EXPENDITURE IN THE YEAR JAN. TO DEC.2008 (To be filled up by college) Verification of information by Visitors as correct / Not

Total Salary of teaching staff

Total Salary of non teaching staff

Total Salary of paramedical & other hospital staff

Total Expenditure on purchase of new books

Total Expenditure on furniture & fixtures

Total Expenditure on equipments & instruments

Total Purchase of raw drugs

Total Purchase of prepared medicines

Total Purchase of Lab Chemicals

Building construction & other expenditure

Total

MONTH WISE EXPENDITURE IN THE YEAR Jan. to Dec. 2009 (To be filled up by college) Verification of information by Visitors as correct / Not

S. No

Month Total Salary of teaching staff

Total Salary of non teaching staff

Total Salary of paramedical & other hospital staff

Total Expenditure on purchase of new books

Total Expenditure on furniture & fixtures

Total Expenditure on equipments & instruments

Total Purchase of raw drugs

Total Purchase of prepared medicines

Total Purchase of Lab Chemicals

Building construction & other expenditure

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 200915 TOTAL INCOME OF

THE YEAR 2009


DETAILS OF MUSEUMName of the Department Number of Charts, Models & Specimens Available

(To be filled up by college)Verification of information by Visitors as correct /

NotCharts Models Specimens Charts Models Specimens

1. Udal Koorugal (Anatomy)

2. Udal Thathuvam (Physiology)

3. Gunapadam4. Maruthuva Thavara Iyal5. Noi Anuga vidhi

Ozhukkam6. Sattam Sarntha

Maruthuvamum Nanju Noolum

7. Sirappu Maruthuvam including Yoga & Varmam

8. Othersa.b.

INFORMATION ABOUT VARIOUS SECTIONS IN COLLEGE To be filled up by college Verification of information by Visitors as correct / Not

DISSECTION HALL - -

No of Dissection tables

Cadaver preservative tank- Available/Not

No of cadavers available at the time of visitation

No of cadavers dissected in the year 2009

LIBRARY - -

1. Number of books available

Siddha -

Modern -

Others -

Total -

2. Seating arrangement in reading room

3. Number of computers with internet facility

HOSTEL

1. Seats available for Boys

2. Seats available for Girls

3. Total number of room available for Boys

4. Total number of rooms available for Girls

5. Mess facility for Boys – available/not

6. Mess facility for Girls – available/not

HERBAL GARDEN

Number of Plants

Number of species

Irrigation facility- Available/Not

NAME & DETAILS OF SPORTS AND GAMES FACILITY

TRANSPORT FACILITY – Available/Not

PHARMACY- Functioning/Non Functioning


*If, Yes Details of Pharmacy be furnished as per Annexure-IV


SECTION C

INFORMATION OF TEACHING & PRACTICAL TRAINING (Jan. to Dec. 2009)

FOR UG S.No Subject Number of classes held (to

be filled up by college)Verification of information by Visitors as correct / Not

Theory Practical Theory Practical1. Siddha Maruthuva Adipadai Thathuvangalum

Varalarum2. Tamil Language3. Uyir Vedhiyal4. Udal Koorugal I5. Udal Thathuvam I6. Udal Koorugal II7. Udal Thathuvam II8. Maruthuva Thavara Iyal9. Maruthiyal Adippadaihalum Marunthu Sei

Muraihalum10. Gunapadam-I11. Noi Nadal-I12. Gunapadam-II13. Noi Nadal-II14. Nunnuyiriyal15. Noi Anugavidhi Ozhukkam16. Sattam Sarntha Maruthuvamum Nanju Noolum

(Forensic medicine and Toxicology)17. Maruthuvam-Pothu (General Medicine)18. Sirappu Maruthuvam including Yoga &

Varmam (Special Medicine)19. Aruvai Maruthuvam including Enburnurivu and

Pal Maruthuvam (Surgery including Bone Setting and Dental Diseases)

20. Sool, Magalir Maruthuvam and Kuzhanthai Maruthuvam (Obstetrics Gynecology and Paediatric Medicine)

21. Number of educational tours conducted for teaching & practical purpose in the year 2008-09

For PG S.No. Subject Number of classes &

practicals held (to be filled up by college)

Verification of information by Visitors as correct / Not

Theory Practical Theory Practical1. Gunapadam 2. Maruthuvam 3. Sirappu Maruthuvam 4. Kuzhanthai Maruthuvam5. Nanju Noolum Maruthuva Neethi Noolum6. Noi Nadal7. Others

a)b)c)d)

8. Number of educational tours conducted for teaching & practical purpose in the year 2008-09


NUMBER OF EXISTING TEACHING STAFF

S.No. Department

Intake Capacity for UG Number of Teachers as per CCIM Norms

No. of Existing Teachers (to be filled up by college)

Verification of information by Visitors as Correct/Not

P R L P R L P R L

1.

Siddha Maruthuva Adippadai Thanthuvangalum Varalarum

50 1 or 1 160 1 or 1 180 1 or 1 1100 1 or 1 1

Additional for PG Dept.

2.Maruthuva Thavara Iyal (MedicinalBotany)

50 1 or 1 160 1 or 1 180 1 or 1 1100 1 or 1 2


3. Uyir Vedhiyal (Bio-Chemistry)

50 1 or 1 160 1 or 1 180 1 or 1 1100 1 or 1 1


4. Tamil (Language)

50 1 or 1 160 1 or 1 180 1 or 1 1100 1 or 1 1



50 1 or 1 1 60 1 or 1 180 1 or 1 2100 1 1 2



50 1 or 1 160 1 or 1 180 1 or 1 2100 1 1 2


7. Gunapadam (Materia Medica)

50 1 or 1 160 1 1 280 1 or 1 4100 1 1 4


8. Noi Anuga Vidhi Ozhukkam (Hygiene)

50 1 or 1 160 1 or 1 180 1 or 1 1100 1 1 1


9.Noi Nadal (Pathology) including Nunnuyiriyal (Microbiology)

50 1 or 1 160 1 or 1 180 1 or 1 2100 1 1 2


10.

Sattam Sarntha Maruthuvamum Nanju Noolum (Forensic medicine and Toxicology)

50 1 or 1 160 1 or 1 180 1 or 1 2100 1 1 2


11. Maruthuvam Pothu (General Medicine)

50 1 or 1 160 1 or 1 180 1 1 2100 1 1 2


12.

Sirappu Maruthuvam including Yoga & Varmam (Special Medicine)

50 1 or 1 160 1 or 1 180 1 or 1 2100 1 1 2


13.

Sool, Magalir and Kuzhanthai Maruthuvam(Obstetrics, Gynaecology & Paediatrics)

50 1 or 1 160 1 or 1 280 1 1 2100 1 1 2

Additional for PG Dept.14. 50 1


Aruvai Maruthuvam including Enbu Murivu & Pal Maruthuvam (Surgery including Bone Setting and Dental Diseases)

60 1 or 1 180 1 or 1 1100 1 1 2


INFORMATION OF TEACHERSTo be filled up by college Verification of

information by Visitors as correct / Not

Professor Reader Lecturer Total

1. Total number of teachers who have retired from the college (Jan. to Dec. 2009)

2. Total number of teachers transferred/left from the college (Jan. to Dec. 2009)

3. Total number of teachers newly appointed in the college (Jan. to Dec. 2009)

4. Total number of teachers reemployed after retirement from Govt. or Grant In Aid colleges (Jan. to Dec. 2009)

SALARY INFORMATION To be filled up by college


Pay Scale of teachers As per State Govt./UGC(If none of these please mention reason thereof )

1.Mode of payment through Bank Yes/No (If no please mention reason thereof )2.GPF & CPF is deducted from the

salaryYes/No (If no please mention reason thereof)

3.Teachers promotion policy as per norms of CCIM

Yes/No (If no please mention reason thereof)

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

[Pl. tick whichever applicable]

Pay Scale of ProfessorPay Scale of ReaderPay Scale of Lecturer

INFORMATION OF NON TEACHING STAFF OF VARIOUS DEPARTMENTS

S.No. DepartmentNo. of Existing Non-Teaching Staff

( To be filled up by college)

Verification of information by

Visitors as correct / Not

Lab Tech. Lab Asstt M. Keeper Clerk/typist Peon sweeper

1. Siddha Maruthuva Adippadai Thathuvangalum Varalarum

2. Maruthuva Thavara Iyal (MedicinalBotany)

3. Uyir Vedhiyal (Bio-Chemistry)

4. Tamil



7. Gunapadam (Materia Medica)8. Noi Anuga Vidhi Ozhukkam (Hygiene)

9. Noi Nadal (Pathology) including Nunnuyir Iyal (Microbiology)

10. Sattam Sarntha Maruthuvamum Nanju Noolum (Forensic medicine and Toxicology)

11. Maruthuvam - Pothu(General Medicine)

12. Sirappu Maruthuvam including Yoga & Varmam (Special Medicine)

13. Sool, Mahalir and Kuzhanthai Maruthuvam(Obstetrics, Gynecology & Paediatrics)

14. Aruvai Maruthuvam including Enburnurivu and Pal Maruthuvam (Surgery including Bone Setting and Dental Diseases)


NOTE:- DETAIL INFORMATION OF TEACHING STAFF BE FURNISHED AS PER ANNEXURE-VNOTE:- DETAIL INFORMATION OF NON TEACHING STAFF BE FURNISHED AS PER ANNEXURE-VI

STAFF REQUIRED FOR HOSPITAL & VARIOUS DEPARTMENTS

HOSPITAL STAFF Name of Post Staff Required as Per

Norms of CCIMDepartment wise Number of Existing Staff (To be filled up by college)

Verification of information by Visitors as Correct /Not

Superintendent (Principal or Dean of the college may also be ex-officio)Deputy SuperintendentPhysician(AllProfessors, Readers & Lecturers of Clinical Subjects)Doctors for OPD (6)Casualty Medical Officer (3)Physician Specialist 1 Part timeSurgeon 1 Part timeGynaecologist 1 Part timeRadiologist 1 Part timePathologist 1 Part timeAnesthetist 1 Part time/on callX-ray technician 1Clinical Registrar 1 for each clinical deptt.RMO 1House Officer/PG student 1 for 20 bedsMatron/Nursing Superintendent 1Asstt. Matron 1 for 100 bedsStaff Nurse 1 for 25 beds (and 2 for OPD

& 1 for Gynae OPD)Ward boy/Ayah/ANM 1 for 25 beds (and 2 for OPD)Pharmacist 4 (2 for OPD)Store Keeper 1Head Clerk 1Cook 1 for 50 bedsKitchen Attendant/Cook 1 for 25 bedsPlumber On contract basisWatch Men 3 or on contract basisLift men for multistoried building 2 or on contract basisElectrician 1 (part time)Dressers for OPD (2)Dark Room Attendant 1Operation Theatre Attendant 2Labour Room Attendent 2Sweeper cum Cleaner 1 for 25 beds or on contract

basis (and 2 for OPD)Statistician part timePhotographer part timeLIBRARY STAFF - -Librarian 1Asst. Librarian 1Library Attendant/Peon 2PHARMACY STAFF - -Pharmacy Superintendent (HOD Gunapadam)

1

Deputy Superintendent (MD Gunapadam)

1

Pharmacist 1Attender 1HERBAL GARDEN STAFF 1.

2. NOTE:- DETAIL INFORMATION OF HOSPITAL STAFF BE FURNISHED AS PER ANNEXURE -VII


SECTION DOPD FACILITIES DETAILS OF HOSPITAL

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 Maruthuvam - Pothu(General Medicine)

Hand Washing facility X-ray viewing Box BP Apparatus Stethoscope Sitting arrangement for internees/students Examination Table Thermometer Tongue depressor Cotton balls Torch Measuring tape Weight and height measuring stand Knee Hammer Washbasin

2 Sirappu Maruthuvam including Yoga & Varmam (Special Medicine)

X-ray viewing Box BP Apparatus Stethoscope Sitting arrangement for internees/students Examination Table Thermometer Tongue depressor Cotton balls Torch Measuring tape Weight and height measuring stand Knee Hammer Washbasin

3 Aruvai Maruthuvam including Enburnurivu and Pal Maruthuvam (Surgery including Bone Setting and Dental Diseases)

Hand washing facility Drainage facility Minor OT Instruments for anorectal examination Examination Table BP Apparatus Surgical Blades Cotton balls Gauze pieces X-ray viewing Box Stethoscope Sitting arrangement for internees/students Cheetle’s forceps Torch

4 Sool, Magalir Maruthuvam and Kuzhanthai Maruthuvam (Obstetrics Gynecology and Paediatric Medicine)

Weighing machine Sim’s speculum Cusco’s speculum Examination Table Lamp stand Torch X-ray viewing Box BP Apparatus Stethoscope Sitting arrangement for internees/students Examination Table Baby Weighing Machine Measuring tape Washbasin

5 Thokkanam and Varmam

As per requirement

6 Avasara Maruthuvam (Emergency)

Facilities available (Equipment, Instrument, Furniture etc)

7 Minor OT Facilities available (Equipment, Instrument, etc.)

Visitation proforma (Siddha)-11

NUMBER OF PATIENTS ATTENDED OPD (Jan. to Dec. 2009)(Note: - Patients of Medical Camps OPD should not be included)

S.No. Month Information to be filled up by college Verification of information by Visitors as correct / Not

Maruthuvam - Pothu

Sirappu Maruthuvam

Aruvai Maruthuvam Sool, Mahalir and Kuzhanthai Maruthuvam

Avasara Maruthuvam (Casualty)

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 2009S .No. Month Information to be filled up by college Verification of


Pothu -Maruthuvam

Sirappu Maruthuvam

Aruvai Maruthuvam

Sool, Mahalir and Kulanthai Maruthuvam

Avasara Maruthuvam

Thokkanam and Varmam

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 OccupiedS.No. Month Information to be filled up by college Verification of


Pothu -Maruthuvam

Sirappu Maruthuvam

Aruvai Maruthuvam

Sool, Mahalir and Kulanthai Maruthuvam

Avasara Maruthuvam

Thokkanam and Varmam

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 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 STRENGTHName of the Department % of Bed Distribution

as per CCIM normsNumber of Existing Bed strength (To be filled up by college)


(i) Maruthuvam - Pothu 40%

(ii) Sirappu Maruthuvam 15%

(iii) Aruvai Maruthuvam 10%

(iv) Sool, Mahalir and Kulanthai Maruthuvam

10%

(v) Avasara Maruthuvam 10%

(vi) Thokkanam and Varmam 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

To be filled up by college


LABOUR ROOM- Functional/Non FunctionalAntenatal Room with attached Toilet-Functional/Non Functional

Facilities for Neonatal care - Available/Not Available

Other Available Facilities, Equipments, InstrumentsNote:- Details be furnish as per annexure-XIIINumber of Deliveries performed during the year 2009

MINOR 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 theatreNote:- Details be furnish as per annexure-XIII Fumigation facility- Available/Not Available AMBULANCE - Available/Not Available

OTHER FACILITIES AVAILABLE IN THE HOSPITAL To be filled up by college


X-Ray Total number of X-rays done in the year 2009

ECG Total number of ECG done in the year 2009

DETAILS OF MEDICAL CAMPS CONDUCTED BY COLLEGE IN THE YEAR 2009S.No. TO BE FILLED UP BY COLLEGE VERIFICATION OF INFORMATION BY

VISITORS AS CORRECT / NOTNATURE OF THE CAMP DATE PLACE

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


ANNEXURE –IDETAILS OF AREA OF COLLEGE AND HOSPITAL

DETAILS OF AREA OF COLLEGE

TOTAL CONSTRUCTED AREA OF COLLEGE

NAME OF DEPARTMENT & SECTION To be filled up by college Verification of information by Visitors as correct / Not

1. Administrative wing

2. Thotrakirama Aarachiyum Siddha Maruthuva Varalarum

3. Maruthuva Thavara Iyal (Medicinal Botany)4. Uyir Vedhiyal (Bio-Chemistry)5. Tamil6. Udal Kooruhal (Anatomy)7. Udal Thathuvam (Physiology)8. Gunapadam-Moolihai, Thathu-Jeeva

Vahuppu (Materia Medica)9. Noi Anuga Vithi (Hygine)10. Noi Nadal and Noi Mudal Nadal

(Pathology)11. Nanju Noolum, Maruthuva Neethi Noolum

(Toxicology & Jurisprudents)12. Maruthuvam - Pothu (General Medicine)13. Sirappu Maruthuvam (Special Medicine)14. Sool, Mahalir and Kuzhendai Maruthuvam

(Obstetrics, Gynecology & Padiatrics)15. Aruvai Maruthuvam (Surgery)16. Library17. Pharmacy18. Auditorium19. Staff Room20. Boys Common Room21. Girls Common Room22. Canteen23. Class Rooms 24. Tutorial room for PG25. Area Of Dissection Hall26. Physiology Lab.27. Medicinal Botany Lab.28. Bio-Chemistry Lab. 29. Pathology Lab.AREA OF MUSEUMS1. Udal Koorugal (Anatomy)2. Udal Thathuvam (Physiology)3. Gunapadam4. Maruthuva Thavara Iyal5. Nanju NoolumOTHERS 1.2.3.

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) in Sq.ft.


ADMINISTRATIVE BLOCK- - -1. Reception 2. Registration counter3. Office of Medical Superintendent/ Medical

Deputy Superintendent4. RMO Room5. Store Room

OPD SECTIONS - - -1. Maruthuvam (Pothu & Sirappu)2. Aruvai Maruthuvam3. Sool, Mahalir and Kuzhanthai Maruthuvam4. Avasara Maruthuvam (Casualty)5. Minor OT

Total area of IPD wards Clinical Pathology & Biochemistry Lab Area of store room of Drugs Dispensary Record Room Labour room Operation Theater Recovery Room OTHERS - -

1.2.3.4.5.


ANNEXURE-II

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

S.No. NAME OF PG SUBJECT TOTAL NUMBER OF PG STUDENTS PASSED OUT FROM COLLEGE FROM INCEPTION TILL DATE (To be filled up by college)

1. Gunapadam (Materia Medica)2. Maruthuvam (General Medicine) 3. Sirappu Maruthuvam (Special Medicine)4. Kuzhanthai Maruthuvam (Paediatrics)5. Nanju Noolum (Toxicology) Maruthuva Neethi

Noolum6. Noi Nadal (Pathology)7. Others

a)b)c)d)

GRAND TOTAL

ANNEXURE-III

LIST OF STUDENTS ADMITTED IN THE YEAR 2009-10

S.No. To be filled up by college Verification of information by Visitors as correct / Not

Name of the Student

Father’s Name Date & Number of fee receipt

Residential Address

Govt. Quota /Management Quota

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


ANNEXURE-IV

DETAILS OF PHARMACY

DETAILS OF EQUIPMENT & INSTRUMENTSEssential Equipment and Instruments

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

Verification of information by Visitors as Correct/Not

1. Pulveriser2. Disintegrator3. Tablet Making Machine4. Hot air Oven/Dryer5. Muffled Furnace

(Horizontal & Vertical)6. Electric Khalva7. Soxhalet Apparatus8. Percolater9. PH Meter10. Tablet Disintegration

Time Testing Machine11. Tablet Hardness Testing

Machine12. Refractometer13. Melting Point Detector14. Audio-Visual equipments15. Khalva Yantra16. Metal-I(Taptakhalva)

Porcelain- 17. Hot plate18. Measuring Equipments19. Big Vessels & Containers

(Brass, Copper, Steel etc.)20. Balance (Different

Capacities)- Physical & Chemical

21. Sieves22. Wet Grinder23. Mixi24. Juice Extractor25. Pyrometer26. Pressure Cooker27. Moosha (Crucibles)28. Koshti with Blower29. Refrigerator30. Jars (Porcelain

Fermentation Purpose) 31. Yantras32. Distillation Apparatus33. Enamel Trays34. Spirit Lamp35. Earthen Vessels

36. Others


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

ANNEXURE-V

PROFORMA TO FURNISH THE DETAILS OF TEACHING STAFF

S. No.

Name of the Teacher Father's Name

Date of

Birth

UG Qualificatio

n (University

& year)

PGQualificatio

nwith subject (University

& year)

Date wise details of Experience in chronological order

Department

(Subject)

Nature of present

appointment (regular/

contractual)

Present Working Address

Permanent Address

State Board Registration

No.

Bank Account Number

Verification of

information by Visitors as correct /

NotDuration(d/m/y)

Designation

Name of the collegeSur

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 (Annexure-XVI) and Salary bills of all teaching staff.

ANNEXURE-VIPROFORMA TO FURNISH THE DETAILS OF NON TEACHING STAFF

S.No. Name of Employee

Father’s 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

ANNEXURE-VII

PROFORMA TO FURNISH THE DETAILS OF HOSPITAL STAFF

S.No. Name of Employee

Father’s 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


ANNEXURE-VIIIDETAILS 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 Verification of information by Visitors as correct / Not

Ayurvedic Drugs Modern Drugs Ayurvedic Drugs Modern DrugsUtilised Balance Utilised Balance

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

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


ANNEXURE IXDETAILS OF EQUIPMENT AND INSTRUMENTS REQUIRED FOR PHYSIOLOGY LABORATORY

S.NO. Essential Equipment and Instruments

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

Verification of information by Visitors as correct/not

1. Microscopes with oil immersion

2. Westergen’s pipette for ESR3. Haematocrit Tube4. Haemoglobinometer sahli’s5. Haemocytometer6. Sphygmomanometer7. Stethoscopes8. Clinical Thermometer9. Knee Hammer10. Tuning forks11. Electrocardiograph12. Stop watches13. Water Distillation still14. Thermometers, balances,

Microslides,15. Cover slips, glassware16. Centrifuge with speed

control17. Colorimeter (photoelectric)18. PH meter Electric19. PH comparator with disc20. Refrigerator21. Newton’s colour wheel

In a batch22. Spirometer23. Tonometer24. Hydrometer25. Viscometer26. Osmometer27. Stalagmometer28. Sterlizer


ANNEXURE X DETAILS OF EQUIPMENT AND INSTRUMENTS REQUIRED FOR GUNAPADAM LABORATORY

S.No. Essential Equipment and Instruments Number of Instruments & Equipments available (to be filled up by college)


1. Kalvama. Small b. Mediumc. Porcelain

2. Heating Device-a. Gas Stoveb. Electric stovec. Hot plated. Chulla (Charcoal)

3. Vessels-a. Frying Panb. Steel Vesselc. Spatulad. Ladles & Spoonse. Knifef. Platesg. Tongs

4. Measuring Equipments Different Size (Glass)

5. Big Vessels & Containers-a. Brassb. Copperc. Steel etc.

6. Balance (Different Capacities)a. Physicalb. Chemical

7. Ponding Apparatus 8. Sieves (Assorted Nos. & Size)9. Wet Grinder10. Mixi11. Juice Extractor12. Putas (Different kind)13. Pyrometer14. Thermo meter15. Pressure Cooker16. Moosha (Crucibles)17. Blower18. Refrigerator19. Jars(Porcelain) Fermentation

Purpose20. Yantras (Karuvigal)

a. Dula Yantrab. Valuka Yantrac. Others

21. Distillation Apparatus 22. Enamel Trays23. Spirit Lamp24. Microscope25. Earthen Vessels26. Kuppipuda Karuvi27. Almiras & Racks


ANNEXURE XI

DETAILS OF EQUIPMENT AND INSTRUMENTS REQUIREDFOR MEDICINAL BOTANY LABORATORY

S.No. Essential Equipment and Instruments



1. Field magnifier

2. Compound microscope

3. Dissecting Microscope

4. Microscope

5. Slides box with cover slips,

6. Blotting/filter papers

7. Electronic balance

8. Dissection Box

9. Enamel Trays


ANNEXURE XIIDETAILS OF EQUIPMENT AND INSTRUMENTS REQUIRED

FOR PATHOLOGY LABORATORYS.No. Essential Equipment and

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


1. Binocular microscope 2. X-ray view box 3. Sterile disposable lancet/needle4. Sahli’s Square tube5. Hb pipette6. Dropper7. Glass rod8. WBC Pipette9. Improved Neubauer chamber10. Cover slip11. Red cell pipette12. Cleaned slides13. Incubator14. Wintrobe’s tube15. Pasteur’s pipette16. Centrifuge machine17. Westregrens pipette18. Rubber teat19. Westergrens’s stand20. Litmis paper21. pH indicator paper strips22. Urinometer23. Multi stix24. Bomsen burner25. Test tube26. Test tube holder27. Filter paper28. Steel almirah29. Steel rack30. Glass Jars with lid of different

sizes31. Glass view rack32. Magnifying lens33. Autoclave34. Water bath35. Separating funnels of various

sizes36. Stop watch37. Ultraviolet lamp38. Monocular microscope with oil

emersion lens20(e)39. Capillary Tubes40. Hot air oven41. Microscope with oil immersion 42. Refrigetors43. Sterile vessels/bottle to collect

samples44. Sphigmomanometer45. Stethocope

Cont………………..





46. Thermometer47. Tongue depressor48. Torch49. Knee hammer50. Measuring Tape51. ENT set52. Reflectors(Mirrors)53. Weighing machine54. Tuning Forke55. Nasal speculum56. Laryngoscope57. Catheters58. Probes59. Disposable Gloves60. Physical balance61. Syringe needle destroyer62. HBs Ag kit63. HIV kit - Tridot (method by

T Mitra)64. CT & BT kit65. Cell counter

(haemoautoanalyser)66. Renal profile, LET kit, Lipid

profile, Blood Sugar kit


ANNEXURE XIII

DETAILS OF EQUIPMENT AND INSTRUMENTS REQUIRED FOR LABOUR ROOM




1. Shadowless Lamp 2. Suction Machine (Neonatal)3. Oxygen Cylinder & Mask4. Foetal Toco Cardiograph5. Radient Warner6. Photo therapy Unit7. Weighing Machine

(Paediatric)8. Patient trolley9. Anaesthesia trolley10. Infantometer11. Vacuum extractor12. Foetal Doppler13. Low cavity forceps14. Steriliser15. Machintosh rubber sheet16. Catguts & Thread17. Speculum – Sim’s

-Cuscos18. Instruments for labour &

Episiotony.(Scissors, forceps, needle holders etc.)

19. Baby tray20. Draw Sheets21. Plastic Aprons22. HIV kit for emergency

patients23. Plain & Hole towels24. Gloves25. Nebuliser26. Foetoscope27. Auto Clave28. Drums29. Instrumental Trolley30. OT tables & head Up &

headlow facility 31. Double dome Shadowless

lamp32. Pulse Oxymeter33. Oxygen Cylinder34. Resuccitation kit35. Boyle’s apparatus36. Electro Cautery37. MTP Suction Machine38. Anaesthesia Kit

Cont……………


39. Blunt & Sharp Currate40. Dilators set (Hegar’s,

Hawkins)41. Sims’s Speculum42. Anterior Vaginal Wall

retractor43. Cysco’s Speculum44. Uterine sound45. Volsellum46. MTP Suction Currate 47. Needles48. Needle holders49. Sponge holding forcep’s50. Towel Clips51. Retractors abdominal

(Doyne’s etc.)52. Green armytage forcep53. Uterus holding forcep54. Kocher’s forceps55. Artery forceps (Long,

short, Mosquito)56. Scissors57. Forceps obstetrics58. Tongue depressor59. Endotrachial tubes60. B.P. apparatus61. HSG Canula62. Cord Cutting appliences63. I.U.C.D. removing hook64. Bladder Sound


ANNEXURE XIV

DETAILS OF EQUIPMENTS AND INSTRUMENTS REQUIRED FOR MINOR OPERATION THEATRE S. No Essential Equipments and Instruments No. of Instruments and

Equipments availed (to be filled up by college)

Verification of information by visitors as correct/Not

1. Spot light2. Needle Holding Forceps3. Dressing Drums of assorted size4. I.V. Stand5. X-ray view fox6. Masks and caps7. Gauze, cotton and Bandage8. Gloves of different sizes9. Artery forceps (small, medium, big)10. Dissection forceps11. Sinus forceps12. Scissors – straight13. Scissors curved of different sizes14. Stich removal scissors15. Pointed scissors16. Probes assorted sizes17. Needle holders18. Suturing needle19. Surgical thread20. B.P. Handle of different size21. Surgical blades of different sizes22. Rubber catheters23. Generator24. Emergency light25. Refrigerator26. Autoclave27. Proctoscopes – various sizes28. Nasal speculum29. Ear speculum30. Eye wash glasses31. Aural syringe 32. Kidney trays33. Kaaranool – Medicated Thread34. Salaagai (silver)35. Operation Table36. Instrument trolly37. Revolving stools38. Electric sterilizers39. Vaporizer40. Nebulizer41. Gabriel syringe42. Piles holding Forceps43. Barron piles Gun44. Vertical BP Instrument


ANNEXURE XV PROGRESS MADE BY INSTITUTION IN LAST TWO YEARS IN RESPECT OF FOLLOWINGS 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. Appointment of Non-Teaching staff

4. Appointment of Paramedical and other Hospital staff

5. Expansion of Various Departments of College

6. Expansion of Herbal Garden, Plantation of New Plants

7. Development of Pharmacy

8. Progress in Hospital OPD

9. Progress in Hospital IPD

10. Progress of Thokkanam


ANNEXURE XVI 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 (Sur 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(dd/mm/yyyy)

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

Signature of Teacher


Pass Port Size Photograph (To be attested by Principal)

FOLLOWING DOCUMENTS BE ENCLOSED BY VISITORS WHILE SUBMITTING THE REPORT TO THE CCIM-

1. Copy of first & last page of OPD & IPD register duly signed by Visitors at the time of

visitation.

2. Name wise Salary bills of the teaching staff from 1st Jan. to 31st Dec. 2009.

3. Attendance register of teaching, non teaching & hospital staff from Jan. to Dec. 2009.

4. Certified copies of Under-graduate and Post-graduate degree, Registration certificate, experience certificates, reliving order along with original affidavits as per prescribed format in respect of all teaching staff.

5. Visitors should made the entry of eligible teachers only in the column of teaching staff after ensuring the following conditions-a. Qualification of teaching staff should be as per regulation prescribed by CCIM

including possession of PG qualification in concern subject or allied subject as case may be.

b. UG teachers appointed after 12.10.2006 should not be included.c. Experience of Professor and Reader should be as per norms of the CCIM in

promotion case.d. Teachers appointed after the submission of affidavits by the college for the year

2009 should be taken into consideration only after obtaining the affidavits. 6. Before receiving the report from college please ensure whether college has submitted

all the annexures (total 16) along with index.

*********

Page No. 21-33 Not send (includes Annexure IX to XIV)


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 Hospital2. Annexure-II Number of Post Graduate students passed out from college

from inception to till date3. Annexure-III List of students admitted in the year 2009-104. Annexure-IV Details of Pharmacy5. Annexure-V Proforma to furnish the details of Teaching Staff6. Annexure-VI Proforma to furnish the details of non Teaching Staff 7. Annexure-VII Proforma to furnish the details of Hospital Staff8. Annexure-VIII Details of drug distribution in OPD & IPD (Jan. to Dec. 2009)9. Annexure-IX Details of equipment and instruments required for Physiology

Laboratory 10. Annexure-X Details of equipment and instruments required for Gunapadam

Laboratory11. Annexure-XI Details of equipment and instruments required for Medicinal

Botany Laboratory12. Annexure-XII Details of equipment and instruments required for Pathology

Laboratory13. Annexure-XIII Details of equipment and instruments required for Labour

Room 14. Annexure-XIV Details of Equipment and Instruments Required For Minor

Operation Theatre15. Annexure-XV Progress made by institution in last two years on salient points16. Annexure-XVI Notarized affidavit to be filled up by teacher in the given

format

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