The Board of Nursing Edn.

THE BOARD OF NURSING EDUCATION, NL CMAI (SIB)
NAME OF THE SCHOOL / COLLEGE

ADDRESS
........................
I.
TEL NO.
..........................
E-MAIL
..........................
FAX NO
..........................
GENERAL INFORMATION
A.
Name of the Trust/Management/Society:.................................................................................................................................
Government /Self financing/Religious :.................................................................................................................................. .
Name of the Trustee/Chairman/Director.....................................................................................................................................
B.
Other courses conducted by the Management:..........................................................................................................................
C.
State, the year school was established and the sanctioned number of admissions annually per each academic programme *:
D.
INC Inspection report (Latest)*
E.
State Council Inspection report (Latest)*
copyright@BNESIB 2010
II. ADMINISTRATIVE AND ACADEMIC CONTROL
A. Administrative Control*
1. School Administrative Committee (include responsibilities,Membership .Frequency, Minutes -Activities planned and implemented)
a. List of members of School Administrative Committee
NAME
2.
Policy manual*:
3.
Job Description :
a. Administrative staff *
b. Teaching staff *
c. Non Teaching Staff *
4.
Finance:
a. Name and designation of the drawing and disbursing authority..................
b. Approved Budget of the school * (Previous and current financial year)
II. ADMISSION POLICIES AND PROCEDURES:

A.
DESIGNATION
Method of Selection of students: Central /Institutional
B. List
the Selection Committee Members (include responsibilities,Membership ,Minutes) Designation

Name
C. Number of students for the Academic

programme/s 1. GNM
Year of Study
Regular
Repeat
I year
II year
III year
Internship
Total
i. Is stipend paid to the students Yes/No If yes, the amount

paidRs
ii. Is there any written agreement or service contract, Yes/No If yes no. of years,
2. ANM
Year of Study
I year
II year
Regular
Repeat
Total
i. Is stipend paid to the students Yes/No If yes, the amount

paidRs ....................
ii. Is there any written agreement or service contract, Yes/No If yes no. of years .........................
3.
Admission Protocol:
a. GNM*
b. ANM*
4.
COMMITTEES: (include responsibilities,Membership
committee)
a. General committee
b. Standing Committees
i. Curriculum Committee *
ii. Evaluation Committee *
frequency, Minutes -Activities planned and implemented, in the remarks column for each
iii.
iv.
v.
vi.
c. Adhoc
Committees
Discipline Committee *
Library committee
*
Staff selection Committee
Research committee *
i. Committee for co curricular activities

ii. Welfare committee
III STAFF POSITION OF THE SCHOOL

Staff recruitment * (selection Procedure adopted - Advertisement, committee, Type of appointment, Salary scale,
induction programme policy manual / Rules and regulation )
B.
C.
Non- Nursing Faculty *

Name
Qualification
Subject Taught
Non -Teaching Staff*

Name
Designation
Qualification
Registration No.
responsibiliti
Additional
es
Additional qualification
Midwife
State
Nurse
supervision/day
Clinical
Experience*
No of hours spent on
Formal Teaching/day
Subject taught
Years of Teaching
Administration/ day
Qualification*
Total
Designation*
After post - graduation
Age*
After DNEA
Name
After graduation
A. Nursing Faculty*:
D.
Involvement
faculty for any
of
other
Nursing Type of involvement

training
Hours Spend weekly
E. Involvement of Non - Nursing faculty for any other training programme

Name
Type of involvement
Hours Spend weekly
F. Involvement of Non teaching staff for any other training programme

Name
Type of involvement
Hours Spend weekly
G. Involvement of Nursing facultyin student activities( include in frequency matters discussed, scheduled meeting, informing the
progress) Parent teacher meeting Counseling sessions for students Counseling sessions for faculty
IV. PHYSICAL FACILITIEES :

Total area of the school:..............Sq. ft; Total area of the Land .................. Sq ft. ; Total Built In Area:.................... Sq ft.
Land/ Building : Own/Lease/Rent; Locality of the institution : Rural / Urban
Type of Roofing : Concrete/ Tiles /Asbestoses sheets /; Temporary constructions : Yes / No
Water Sourses: Own / Pachayat / Municipality/ Corporation; Drainage system : Open / Closed
A. School building:
Building Stability certificate*:
B.
Office rooms (include facilities available, furniture, equipments)

Principal
Area.............sq ft
Vice - Principal Area.........................sq ft

Tutors office:
Area................sq ft.
Other staff
C.
Class rooms - Numbers............(include facilities available, furniture, equipment, ventilation, adequacy)

Class rooms 1 *
Area.............sq ft
Seating capacity.......................
Class rooms 2 *
Area.............sq ft
Seating capacity.
Class rooms 3 *
Area.............sq ft
Seating capacity.
Class rooms 4
Area.............sq ft
Seating capacity.
D. Laboratory {include facilities available, furniture, equipment adequacy in remarks )

1. Nursing practice laboratory
Area.............sq ft
No. of beds............
Manikin : No. and Types :........................................
Articles for demonstration*
Hand washing facilities Running Water Facility
2. Nutrition laboratory
Area.............sq ft
Cooking facilities Work benches Cooking stove Gas connection Dietic

scales Utensils*
Set of cutlery Set of crockery Storing place Refrigerator Washing
facilities
Fire extinguisher
Type:
3. Community practice laboratory :
Area.............sq ft
No. of bags............
AV aids *:...............
Hand washing facilities:
4. Computer laboratory:
No. of computers..............; No. of printers.................; UPS
Fire extinguisher; Type: ......................................................
E.
Internet facility:
Library Area................................sq ft
Seating capacity................................................................................
Librarian Full time/ Part time; if part time hours of dut..................
Budget............. ........Yes/ No; If Yes, amount Budgeted Rs............
No.and list of
i. Professional books *
ii. Current journals *
iii. Current of magazines*
iv. News papers *
No. and of books purchased during the previous financial year * Separate space for reference books Library hours
Period of retention of booksProcedure for discarding outdated/ mutilated books
No. of computers..............Internet facility:
Photocopy machine: Available/ Not Available Fire extinguisher
Type:
Room for A.V. Aids Area :.............................sq ft.
Audiovisual aids*
TV, VCR OHP

LCD Projector Computer
Toilets Total nos......................................
No. of toilets for male students: . ................... No. of toilets for female students:
No. of toilets for male staff:........................... No. of toilets for female staff: ....
Garage
H.
Running
water
facilities
I.
Other facilities
Safe drinking water (Type of water purifier)*
ii. Fire extinguisher
Type:.............................
Is the staff trained to use it Play groun
dJ. Common rooms K. Record room
L. Store room
M. Examination hall / Multipurpose Hall: Capacity for seating......................
N. Auditorium: ; seating capacity .....................................
V. ACADEMIC/CURRICULAR PROGRAMME ' ^
A. Teaching system adopted by the school GNM I Year*
copvriahtBNESIB 201
Yes/No
No..............; Seating capacity
0,
II Year*
III Year *
Internship *
Teaching system adopted by the school
ANM I Year*
II Year*
B. Organization of the GNM curriculum
I Year
Master plan*:
Clinical rotation*:
Time Table*:
II Year
Master plan*:
Clinical rotation*:
Time Table*:
III Year
Internship
Master plan*:
Clinical rotation*:
Time Table*:
Master plan*:
Clinical rotation*:
Time Table*:
Organization of the ANM curriculum

I Year
Master plan*:
Clinical rotation*:
Time Table*:
YearMaster plan*:
Clinical rotation*:
Time Table*:
j
C. Evaluation of the Curriculum 1. Clinical Evaluation
Proforma for Clinical Evaluation with checklist and marking guide for different departments /postings *
a.
Clinical work record (procedure followed for signing the clinical record personnel permited to supervise
the procedure, ,Data entry & Date of signing, repeating procedures, action taken if not done correctly, entry in the procedure chart,
disciplinary action if there is any malpractice)
b.
c.
I
YEAR 1.
Evaluation
Log book (regulations for selection ofpatient for study, supervision, Correction, rewriting action taken if not done correctly,
evaluation criteria)
Diary (Evidence of care given to patients with different disease conditions, No. of hours spend by students in clinical area, clinical
posting evaluation criteria)
Clinical
(i)
(ii)
Clinical Evaluation frequency: fortnight /monthly/Annual

Evaulated by:..............................................................
(iii)
Internal assessment marks :

Mark entry by:...............................Verified by:...................................
Criteria for mark calculation *
a. Clinical work record

b. Log book
c. Diary
d. Clinical teaching(/c/w<5fe frequency, supervision, plans-incidental/scheduled)
(i)
Case presentation
(ii)
Nursing rounds
(iii)II YEAR
1. Clinical Evaluation
(i)
Clinical Evaluation frequency: fortnight /monthly/Annual
(ii)
Evaulated by:..............................................................
(iii)
Internal assessment marks :

Mark entry by:...............................Verified by:.........................

b. Logbook
c. Diary
e.
Clinical
teaching(/c/Je
frequency,
supervision,
incidental/scheduled)
(i)
Case presentation
(ii)
Nursing rounds
(iii)
(iv)
III Year
1. Clinical Evaluation
i. Clinical Evaluation frequency: fortnight /monthly/Annual
Evaulated by:..............................................................
iii. Internal assessment marks :
plans-
Mark entry by :..............................Verified by:...........................

b. Log book
Diaryf. Clinical teaching(ic/Je frequency, supervision, plans-incidental/scheduled)
(i) Case presentation
(ii)
Nursing rounds
(iii)
Internship
A.
B.
(iv)
Clinical Evaluation
(i)
Clinical Evaluation
(ii)
Clinical Evaluation Marks Monthly& Annual
(iii) Evaulated by( Involvement by ward sisters)
(iv)
Mark entry by whom(Verified by, Frequency of entry)
(v)
Criteria followed for internal mark calculation
Clinical teaching (Specify frequency, supervision, plans made)

(i)
(ii)
(iii)
C.
Case presentation
Nursing rounds
Clinical work record
D.
Evidence of clinical postings *
Written examination(blue print, frequency. guidelines followed,

covered,separate question paper for repeate test and repeaters) GNM
I Year
Unit test Question papers*
Term Test Question papers*
Model examination Question papers*
II Year
III Year
topics

Internship
ANM
I Year
II year
D. Students Welfare and Activities
Meetings & Special programmes*:
Opportunities to attend meetings conferences and workshops*:
Value based educational programme*
Achievement awards *
Parent teacher meetings*
Counselling
RECORD'S MAINTAINED IN THE SCHOOL
(The table of content, rectification of errors, personnel assigned for maintanance
and verification, filing of records) 1. Student's file
A
d
m
i
s
s
i
o
n
a
p
p
l
i
c
a
t
i
o
n
H
e
a
l
t
h
C
e
r
t
i
f
i
c
a
t
e
School Principal's recommendation:
High School certificate - original Higher Secondary Mark sheet - original Higher Secondary Certificate - original Clinical experience
Record School of Nursing records2. Records: (The table of content, rectification of errors, personnel assignedfor maintanance and
verification, filing of records) Daily attendance register(students & staff)
Class room registers Ward class register
Copies of transcripts given to graduates
School inventory register
Students practical work record(cumulative)
Rotation plan
Master Plan
Student's health Record
Sick leave and vacation record
Pre-test & interview grades:
School Admission register
Course outline
Time table
Marks registesr
F. INSERVICE EDUCATION FOR FACULTY MEMBERS
(Include frequency, amount budgeted, plans,)
Number and the list of education programme planned *
Number and the list of education programme conducted during the previous academic year*G. FACULTY DEVELOPMENT
VROGRAMM(Include amount budgeted, No. attended with designation, follow up) Number of faculty meetings planned *:
Number of faculty meetings conducted during the previous academic year*:
Workshops, seminars, conferences conducted *............
Workshops, seminars, conferences attended *.............................................................
........................
Provision for higher studies
VI. ACCOMMODATIONAL FACILITIES
Pfl 15 f fi, 17 iop
Own building/rental. Total built-in-area : ....................sq.ft

Total No. of students in the hostel:
...........................................
Staff of the Hostel
a. Separate hostel for male and female students:

b. Communication facilities *...............
c. Any other students/staff residing ...........................................
d. No. of students in one room : ........................
e . Floor space available/student.............................................Sq.ft. carpet area
f. Room cooler / Room warmer/ Fans:
g. Furniture *provided for each student:
h. Provision for washing and ironing clothes:
i. No .of Toilet: ................... No of bath rooms....................................
j. Provision for hot water*:
k. Sick room No. of cots---------------Toilet attached: Yes / No
1. Visitors room:
m. Seating capacity : ...............................: Toilet attached : Yes / No
n. Recreational facilities Indoor facilities*:
Outdoor facilities*:
q. Room for night duty students ; No. of Cots--------------r. Kitchen:
Area:.................Sq.ft
Cooking facilities electric/gas/firewood...................... Utensils and kitchen appliances*:
Washing yard:..............;
Drainage: Open/ Closed
Fire extinguisher
Type:............................................................................................
s. Provision for waste collection, segregation and proper disposal*: t. Store room
Area:.................Sq.ft
Ventilation:
Rat proof :
Cold storage facility:
Fire extinguisher; Type:...............................................
u. Dining Hall
Area:.................Sq.ft
Seating capacity-------Insect screening:
Hand washing facilities:
Running water facility :
Hostel Mess managed by..................................................

Mess fees......Rs..........(monthly)
Safe drinking water *:
Menu : (include Calories and protein provided)
Veg/Non-veg
Fire extinguisher Type:......................................................
Training given for Inmates
v. Pantry:
w. Warden's room: x. Security arrangement y. Students' involvement in hostel
management
VII. CLINICAL FACILITIES: % 11ti? |<?

Clinical nursing practice area - Hospital
1. Parent Hospital
A. Bed Distribution:
Distribution of beds
Medicine
Surgery
Obstetrics
Gynecology
Pediatrics
Orthopaedics
Psychiatry
Cardiology + ICU
Nursery
Ophthalmology
ENT
CommunicableDiseases
Male
Female Total
Average I.P/Day
Average
O.P./Day
Neurology
Statistics :(specify period from January 2009to December2009)
No.
No.
Additional
Qualification
Qualification Years
of State registration
Dates
experience
Midwife
Designation
Nurse
Qualification Years
of
State registration
experience
No of hours spent on Dates
respo
Addit
ional
ii. Non Administrative

Name
nursing staff*
Designation
Teaching
Name
Administration
Categorization of major and

minor surgeries* C. Staffing
pattern of the Nursing service
department
i. Administrative staff*
nsibil
respo
Addit
ities ional
Parent Hospital
Clinical supervision
Statistics
Number of average outpatients per day
Number of average inpatients per day
Total number of deliveries
Total number of normal deliveries
Total Number of abnormal deliveries
Total Number of operations
Number of major operations
Number of minor operations
Each shift
nsibiliti
Addition
Qualificati
Midwif
Nurse
Nurse patient ratio in each department*
Department
Ratio
Nurse : patient
Staff nurse : nurse supervisor
D. Records at the office of Nursing Superintendent * (table of content of the record, rectification of errors, personnel assigned for
maintanance and
verification, filing of records)
E. Reports/records* - maintained in the wards
F. New recruits (selection Procedure adopted - Advertisement, committee, Type of appointment,

Salary scale, induction programme policy manual / Rules and regulationG. Orientation
H. Continuing Nursing Education
I. Inservice education
Affiliated Institution I PQ J?
Name of the Institution and Address
Govt /Private affiliation order * :
fees for practice :
Affiliation sought for (year of study, Speciality, duration)............................
Distance from the parent hospital....................Km.
Transportation
arrangement
Accommodation facility:
Supervision (by whom, hours of supervision, articles available, recording,)
Intuitional policy on providing care by students from affiliated institution
Clinical affiliation permitted for other schools of nursing
Medicine
Surgery
Obstetrics
Gynecology
Pediatrics
Orthopaedics
Psychiatry
Male
Female
TotalI.P/Day
Average
Average
O.P./Day
Cardiology + ICU
Nursery______________
Ophthalmology________
ENT ________________
Communicable Diseases
Neurology
____________________
B. Statistics :(specify period from January 2009to December2009)
Statistics
__________________________________________________
Number
of
average
outpatients
per
day
__________________________________________________
Number
of
average
inpatients
per
day
__________________________________________________
Total
number
of
deliveries
__________________________________________________
Total
number
of
normal
deliveries
__________________________________________________
Total Number of abnormal deliveries_____________.
__________________________________________
Total
Number
of
operations
__________________________________________________
Number
of
major
operations
__________________________________________________
Number
of
minor
operations
__________________________________________________
C.
Name
Staf
Designation
Qualification Years
of No of hours spent on State registration
experience
Dates
No.
nsibil
respo
Addit
ities ional
Categorization of major and minor surgeries*
2
3
4
5
6
SI. Name
No.
Designation
Qualification Years
experience
Dates
No.
nsibil
respo
Addit
ities ional
iii. Non Administrative nursing staff*
Additional
Qualification
Midwife
Nurse
Clinical supervisi
Teaching
Administration
fing
patt
ern
of
the
Nur
sing
serv
ice
depa
1
Each shift
J. Records at the office of Nursing Superintendent * (table of content
Additional
Qualification
Midwife
Nurse
1
2
3
4
Department
Ratio
Nurse : patient
Staff nurse : nurse supervisor
of the record, rectification of errors, personnel assigned for

maintanance and
K. Reports/records* - maintained in the wards
L. New recruits (selection Procedure adopted Advertisement,
committee,
Type
of
appointment, Salary scale, induction
programme policy manual / Rules and
regulation
M. Orientation
N. Continuing Nursing Education O. Inservice
education
Affiliated Institution II
Name of the Institution and Address.........................................................................................................................................
G
o
v
t
/
P
r
i
v
a
t
e
a
f
f
i
l
i
a
t
i
o
n
o
r
d
e
r
*
:
f
e
e
s
f
o
r
p
r
a
c
t
i
c
e
:
Affiliation sought for (year of study, Speciality, duration)............................
Distance from the parent hospital.....................Km.
T
r
a
n
s
p
o
r
t
a
t
i
o
n
a
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r
a
n
g
e
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A
c
c
o
m
m
o
d
a
t
i
o
n
f
a
c
i
l
i
t
y
:
Supervision (by whom, hours of supervision, articles available, recording,)Intuitional policy

on providing care by students from affiliated institution
Clinical affiliation permitted for other schools of nursing
Medicine
Surgery
Obstetrics
Gynecology
Pediatrics
Orthopaedics
Psychiatry
Cardiology + ICU
Nursery
Ophthalmology
ENT
Communicable Diseases
Neurology
Male
Female
TotalI.P/Day
Average
B. Statistics :( specify period from January 2009to December2009)

Statistics
Number of average outpatients per day
Number of average inpatients per day
Total number of deliveries
Total number of normal deliveries
Total Number of abnormal deliveries
Total Number of operations
Number of major operations
Number of minor operations
Average
O.P./Day
nsibil
respo
Addit
ities ional
No.
Additional
Qualification
Midwife
Qualification Years
of
State registration
experience
No of hours spent on Dates
Nurse
Designation
Teaching
Name
Administration
C. Staffing pattern of the Nursing service department i.

Administrative staff"
Clinical supervision
Categorization of major and minor surgeries*

Department
Each shift
No.
Additional
Qualification
Qualification Years
experience
Dates
Midwife
Designation
Nurse
Name
Additional responsibilit
iv. Non Administrative nursing staff*
Ratio
Nurse: patient
Staff nurse: nurse supervisor
P. Records at the office of Nursing Superintendent * (table of content of the record, rectification of errors, personnel assigned for maintanance and
Q. Reports/records* - maintained in the wards
R. New recruits (selection Procedure adopted - Advertisement, committee, Type of appointment, Salary scale, induction programme policy manual
/Rules and regulation
S. Orientation
T. Continuing Nursing Education
U. Inservice education
VII. FIELD PRACTICE AREA

Facilities for Community Health Nursing Experience*
Specify the Community Health centres/programmes *
Distance in kms. from School of Nursing to urban area
Distance in kms. from School of Nursing to rural area
Transport facilities
Type
Vehicle no:
Capacity
Details
Date of Purchase:
Rural
Urban
1 .Population covered
2.No. of villages/wards
3.No. of families registered
4.Home deliveries conducted during the previous year
Trained Dais Hospital personnel
5. Clinics conducted
6. Cold chain facility
7. Residential facility
8. services rendered
1. Nursing staff*
SI.
No.
1
2
3
Name
Designation
Qualification
Years of experience
Registration
Nurse
Midwife
4
2. Job description of staff *
Field staff Teaching staff
3.
Specific Objectives for clinical posting - GNM

I*
II*
III*
Internship*
Specific Objectives for clinical posting - ANM I*
II*
4. Experiances provided for - GNM

I*
II*
III*
Internship*
5. Experiances provided for - ANM
I*
II*
6. Community Health Records

copyright@BNESIB
Register/Records
2010Names
of Rural
Urban
7. Teaching Aids Available at the centre*

Assessment tools *
Home visiting bag Number.........................................
List of Articles*
8. Suprvision of students GNM (by whom, no of students, objectives of the posting, signing procedures,correcting assignments
I
II
III
Internship
9. Supervision of students ANM (by whom, no of students, objectives of the posting, signing procedures,correcting assignments
I
II
Date:
Name and Signature of the inspector
Date:
Name and Signature of the Inspector
be sent as Enclosures

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The Board of Nursing Edn.

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THE BOARD OF NURSING EDUCATION, NL CMAI (SIB)

NAME OF THE SCHOOL / COLLEGE

INC Inspection report (Latest)*

State Council Inspection report (Latest)*

II. ADMINISTRATIVE AND ACADEMIC CONTROL

II. ADMISSION POLICIES AND PROCEDURES:

Method of Selection of students: Central /Institutional

the Selection Committee Members (include responsibilities,Membership ,Minutes) Designation

C. Number of students for the Academic

i. Is stipend paid to the students Yes/No If yes, the amount

i. Is stipend paid to the students Yes/No If yes, the amount

COMMITTEES: (include responsibilities,Membership

i. Committee for co curricular activities

III STAFF POSITION OF THE SCHOOL

Non- Nursing Faculty *

Non -Teaching Staff*

After post - graduation

Nursing Type of involvement

Hours Spend weekly

E. Involvement of Non - Nursing faculty for any other training programme

Hours Spend weekly

F. Involvement of Non teaching staff for any other training programme

Hours Spend weekly

IV. PHYSICAL FACILITIEES :

Office rooms (include facilities available, furniture, equipments)

Vice - Principal Area.........................sq ft

Class rooms - Numbers............(include facilities available, furniture, equipment, ventilation, adequacy)

D. Laboratory {include facilities available, furniture, equipment adequacy in remarks )

Cooking facilities Work benches Cooking stove Gas connection Dietic

TV, VCR OHP

No..............; Seating capacity

Organization of the ANM curriculum

Clinical Evaluation frequency: fortnight /monthly/Annual

Internal assessment marks :

a. Clinical work record

Internal assessment marks :

a. Clinical work record

Mark entry by :..............................Verified by:...........................

Mark entry by whom(Verified by, Frequency of entry)

Criteria followed for internal mark calculation

Clinical teaching (Specify frequency, supervision, plans made)

Clinical work record

Evidence of clinical postings *

Written examination(blue print, frequency. guidelines followed,

Term Test Question papers*

VI. ACCOMMODATIONAL FACILITIES

Pfl 15 f fi, 17 iop

Own building/rental. Total built-in-area : ....................sq.ft

a. Separate hostel for male and female students:

Hostel Mess managed by..................................................

VII. CLINICAL FACILITIES: % 11ti? |<?

ii. Non Administrative

Categorization of major and

F. New recruits (selection Procedure adopted - Advertisement, committee, Type of appointment,

B. Statistics :(specify period from January 2009to December2009)

Categorization of major and minor surgeries*

iii. Non Administrative nursing staff*

J. Records at the office of Nursing Superintendent * (table of content

of the record, rectification of errors, personnel assigned for

Supervision (by whom, hours of supervision, articles available, recording,)Intuitional policy

B. Statistics :( specify period from January 2009to December2009)

C. Staffing pattern of the Nursing service department i.

Categorization of major and minor surgeries*

Nurse patient ratio in each department*