affiliation inspection proforma (upto 50 students)

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DATE OF VISIT: ________________________________

AFFILIATION INSPECTION PROFORMA (UPTO 50 STUDENTS)

Name, Contact details and address of the College / Institute: -_

____________________________________________________________________________

Name of the Owner / Person / Trust / Foundation / Partners _

__________________________________________________________________________________ Session Timing: _________________Morning/Evening Already Recognized / Not Recognized Since

Name of Technologies (No. of Seats) applied for:

. General Provisions:

1.1 Institution applying for affiliation shall submit the case on the prescribed

form at least 2 months before the beginning of the academic session. The

application shall be entertained up to 30th April and 31st October for July &

January session/semester respectively of the year.

1.2 The institution shall submit a written undertaking on a surety bond viz status of the Institute and to observe the rules and regulations of FPMA from time to time.

1.3 The Institution requesting for affiliation with FPMA will not seek affiliation with any other organization for the sake of Allied Health Science education.

1.4. Provisional affiliation shall be granted for a period of two years. The affiliation granted will automatically expire at the end of this period and the institution will be required to apply for renewal/continuation of affiliation for the next two years by at least 3 months before expiry is due.

1.5. The admissions will be done twice a year and in single shift only. The application

shall be entertained up to 30th October and 30th April for January & July

session/semester respectively of the year. Application shall not be entertained

after expiry of the deadline.

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1. BUILDING/PREMISES

Ownership Name of Owner Remarks

Own

Attach verified Documents of ownership

Lease agreement for minimum 05 years on judicial stamp paper is required.

Lease

None

2. FINANCIAL STATUS

2.a. Working Capital- At least 0.5 million rupees as working capital present in Bank (Yes/No) Attach Attested Bank guarantee/Statement

2.b. Copy of last Audit Report: (Yes/No) (Attach evidence).

3. HOSPITAL

i) Name: __________________

ii) HCC Registration/License No. _________________________________

iii) No of Beds______________

iv) Facility Details ______________________

v) Ownership

How many other Paramedical/other Institutes have MoU with the hospital

Own Hospital with all required disciplines available (attach evidence).

Memorandum of Understanding ( MoU) /Lease/ Contract on requisite judicial Stamp Paper (Valid till passing out of the last admitted student) with Govt: / Autonomous or Private Hospital with all required disciplines available (attach evidence).

4. TEACHING STAFF / FACULTY 4 (a) . Lecturers (Basic Subjects):----

S.No. Subject Required Qualification

Up to50 students

Remarks

1. Anatomy MBBS 1 MBBS - PMDC registered Minimum 3 full time teachers for basic subjects . In case of Government servants, NOC from the relevant officer . Non-Medical faculty e.g. Pharm. D, M.Sc.( Biochem), BSc. Tech. with 05 yrs experience

to be given 2/3rd as that of Medical qualifications. For Pharmacology Pharm D also acceptable

2. Biochemistry MBBS 1

3. Pathology MBBS 1

4. Physiology MBBS 1

5. Pharmacology MBBS 1

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4 .b General Subjects

S.No. Subject Required Qualification

Number Available (Yes / No)

Remarks

1. English M.A 1

2. Pak-Study M.A 1

3. Islamyat M.A 1

4. Computer Science

BS / Diploma in Comp Science

1

4.c. Specialty Specific

S.No. Subject Required

Qualification Up to 50 students Available

(Yes / No) Remarks

MBBS 1 Registered with PM&DC

MBBS 1

MBBS 1

At least one MBBS Lecturer per two specialties is required.

One Assistant Professor and above / Distt. Specialists in the relevant clinical subjects must be given a supervisory role but they will not be counted as replacement of lecturers.

All staff members shall be employed on a written agreement between the employee & the employer stating clearly the terms & conditions of service.

The minimum salary for permanent staff shall not be less than the government

scales. Contract with the clinical supervisor is mandatory.

4.d. . Non Teaching / Administrative Staff

S.No. Name of Post Qualification Available

(Yes / No)

1. Managing Director MBBS /BDS /MBA with experience

2. Principal MBBS/BDS with Health related 05 years experience

3. Superintendent / Accountant MBA/BBA/B.COM

4. Receptionist FA /F.SC with DIT

5. Student Affairs Clerk FA /F.SC

6. Class-IV / Chowkidar Matric

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5. INFRASTRUCTURE

5.a. . General

Structure Capacity Size Available (Yes / No)

Remarks

One Lecture Hall

Seating for all Students of Ist. semester

As per No of Students allowed

The Hall should be properly ventilated and equipped with proper chairs (chairs with side pan for writing) and teaching facilities including rostrum, big white board fixed on the wall, wall clock, fans and Multimedia.

Lecturers’ Office

Common Room (female) 500-700 sqft (Min require)

Cafeteria

Administration office

Hostel

5b. Examination Hall/ Auditorium

15 sq.ft /student For 100-150

5c. CLASS ROOMS

At Least one class room/Technology.Min 05 class rooms each with a minimum capacity of 15-20 students

5d - MUSEUM:

20 students capacity The models to be present in Anatomy museum. (ANNEX I)

5.e . LABORATORY-----

Each Institute must have its own one basic science & one clinical laboratory The equipment to be present in the Laboratory (ANNEX I Minimum Required Size Capacity of Students Available (Yes/No)

15 sq.ft /student 15x50= 450 sqft approximately

25-50 students

5.f. PHARMACY / PHARMACOLOGY (Optional)

Name of equipment /reagents Quantity Available

(Yes/No) Remarks

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6. LIBRARY: 6 (a) General

Internet connection ---- (Compulsory)

Photostat, Fax, Printer

Books - Annex III ((All books must be stamped with Institutes name and Library Number allotted))

Seating arrangement Note:

Reference Books (recent edition), preferably comprehensive books of local Authors

Seating arrangement should be present for 20-25 students with central table 6.b. . Magazines/Newspaper:

S.No. Name of magazines Required Available

(Yes/No) Remarks

1. Health related Magazine 10 2. Urdu Adab 05 3. News paper One Urdu and One English

7. COMPUTER LABORATORY

Minimum Required Capacity of Students Available (Yes/No) 15 sq ft /student 15x50= 450 sq ft approximately

25

should be set up in a separate room with proper seating arrangement.

computers 05

Internet Facilities

Scanning / Printing / FAX Facility

8. Teaching Aids

N ame of Equipment Minimum Required

Available (Yes/No)

Remarks

Multimedia 1

Projectors 1

Teaching Charts Large size on panaafalx

All systems

9.

Miscellaneous 1. Biometric Attendance System - (Yes/No) 2. Water Supply (Bore well / Hand Pump / Public Health water Supply) (Yes/No) 3. Backup light source Generator /UPS (must) ---

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10. SCORE CHART

Spot Max credit

points

Minimum required (70%) Obtained

Essential/Prerequisit

e

Any No will result in No further action

Building/Premises

Financial

Infrastructure

Hospital

Faculty

Max

Note: Excepot in essentials in all others 80% in

individual Parameters is must for qualifying.

CONSENSUS REPORT

Recommended Not Recommended

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Permanent / Regular Members

S.No. Name Designation & Department/Institution Signature

1.

2.

3.

Convener Inspection Committee: Date:

Recommended by the Inspection Team:

Not Recommended for Recognition/ Affiliation:

Recommended for Provisional Recognition/ Affiliation for _Years

The Institute has the facilities for imparting theoretical training / teaching to

students The Number of Students for Each Specialty / Technology / Discipline Shall be fixed /

determined as per availability of clinical facilities in the Associated Hospitals /

Affiliated Hospitals.

CHAIRMAN (Sig)

NAME

DESIGNATION

MEMBER (1) (Sig)

NAME

DESIGNATION

MEMBER (2) (Sig)

NAME

DESIGNATION

MEMBER (3) (Sig)

NAME

DESIGNATION

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Undertaking by

Director/Head of Paramedics Institution*

I, Mr. _____________s/o __________________solemnly affirm that the information provided and facilities noted in Pre-Inspection Proforma are available in this institute and will show continuous maintenance, improvement and strengthening failing which the affiliation granted will be deemed to have been cancelled forthwith.

Name of Director / Principal Signature: CNIC No.

Address:

Witness No.1 Witness No.2

Signature Signature Name: Name: Father Name: Father Name: CNIC No. CNIC No.

*On judicial Stamp Paper

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ANNEX I

Name of Models Minimum required quantity

Available (Yes/No)

Remarks

Upper & lower limb 1

Different loose bones. (Long bones, short bones & falt bones)

1 set

Skeleton (Human)-Large size 1

Liver model (Human) 1 set

Kidneys model(Human) 1

Heart models(Human) 1

Lungs model(Human) 1

Brain model (Human) Separable.

1

Plastic body (Torso) - Large size 01

Eye model 01

Ear model 01

Female pelvis 01

Male pelvis 01

Knee joint 01

Ankle joint 01

Elbow joint 1

Wrist joint 01

Shoulder joint 01

Larynx model 01

Different anatomical charts (large size)----on Panaflax

One each

X-Ray viewer 01

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ANNEX II

Regents / Equipment Minimum required quantity

Availa ble (Yes/ No)

Remarks

Spectrophotometer / ERMA Colorimeter

1

Binocular microscopes 05

Water bath with 1

Centrifuge 1

Autoclave 01

Hot air oven 01

Analytical balance 01

ESR stands with tubes (Wintergreen)

02

Sahli’s Hemoglobinometer 05

Neubar’s chambers 03

RBC, WBC pipits 02 each

Jester ( Automatic pipettes) 01

Pipettes ( 01 ml, 02ml, 05ml & 10 ml)

04 each

Stop watch 02

Slides 06 packets

Different stains (Gram stain, ZN stain, Leishman stain & Gimsa’s stain

One set each

Benedict’s solution 02 bottle

Different chemical reagents for clinical tests

Blood Grouping Anti sera 01 set

Pregnancy kit 01 set

Rheumatoid Arthritis factor Kit 01 set

Syringes 100

Distillation plant 01

Refrigerator 01

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ANNEX III

Subject Books required

Available (Yes/No)

Deficiency Remarks

Anatomy 40-50

Pathology 40-50

Pharmacology 30-40

Bio Chemistry 30-40

Physiology 30-40

English 20-30

Islamiat 20-30

Pak-Study 20-30

Anesthesia 05

Cardiac 05

Dental 10

Dialysis 05

Gastroenterology 10

Health 50

M.C.H 05

Ophthalmology 05

Orthopedic 05

Pathology 30

Pharmacy 10

Physiotherapy 05

Public Health 10

Psychiatry 05

Radiotherapy 05

Surgical 05

Pulmonology 05

Radiology 05

Neurophysiology 05

General Subjects 20

Dictionary 05

Inspection Proforma for Paramedical Institution (9-16)

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Computers/scanners 01

Thermometers 10

Weight machines 1

Malaria charts 1

Kidney trays 02

Tongue depressor 10

Racks for small twelve test tubes & holders

04

Racks for large test tubes & holders 04

Glassware. Beakers, cylinders, flasks & Petri dish

Sufficient number