INSPECTION PROFORMA - 2018

BDS RECOGNITION

AS PER DCI REGULATIONS 2006 & REVISED BDS COURSE REGULATIONS 2007

(All Points and parameters are to be verified and established in person by the designated Inspectors. All necessary documents to be verified by the Principal/Dean for submission along with the report)

No. of Seats applied for: 50

DCI Ref/ Letter No: DE-______Dated: ______

Date of Inspection : ______

Name and Address of Inspectors

1.  ______

______

______

2.  ______

______

______

Note:-

I: This Proforma to be duly typed, filled, printed and NOT hand written.

o  Each page should be duly signed by the Principal/Dean.

o  Proforma should be submitted to the Inspectors on their arrival.

o  Inspector should verify all the contents of the proforma and submit the same alongwith their observation in PEN to the council within 48 hours of Inspection.

o  All documents should be submitted to the DCI in English or translated in English and certified by the competent authority.

II: No annexure, except consolidated list of teaching staff in the Dental Council of India prescribed format, will be attached alongwith the Inspection Proforma.

Signature of Principal/Dean with seal

I. SCRUTINY OF REQUISITE PERMISSIONS

Name & Postal Address of the Proposed Dental College / :
Email Address for Correspondence / :
Telephone & Fax No. / :
Status (mark tick appropriate columns) / : / Government Private
Registration details of the
Society/Trust: / : / ______
State Government Essentiality/ Permission Certificate / : / Issued By:
No. & Date:
Valid Upto:
University Affiliation (Deemed/Govt./Private)
Status of University Affiliation (mark tick appropriate columns) / : / Issued By:______
Name of University:
______
Consent Provisional
No. & Date:
Valid Upto:

II. Date and number of last annual admission with details*

Category / No. Admitted / Dates of Admission
Commence / End / Remarks of Inspector
S.C.
S.T.
Backward
General
Others
Total

*Note: Where admission(s) has/have been done without the permission of the competent authority the reason thereof be given in each and every case separately duly certified by the Principal of the Institution.

Signature of Principal/Dean with seal

III. MEDICAL COLLEGE ATTACHMENT:

Own Medical College / Private Medical College / Govt. Medical College

Name & Address of the Medical College______

______

______

Name of the Principal/Dean: ______

Email address and contact number:______

a.  Medical College duly recognized by Medical Council of India.

/ : / Yes / No
b.  Distance from Dental college to Medical college by road (please clarify as to whether you have physically verified /taking the reading of Taxi/Car Meter) by ticking yes or no / :
: / ____km
Yes / No
c.  Whether MOU is signed by competent Authorities between Medical and Dental College for teaching purpose. / : / Yes / No
d.  Validity Period of MOU / : / ____yrs
e.  Whether the above mentioned Medical College is attached to any other Dental College other than the proposed dental college. / : / Yes / No
f.  GOI Notification No. & Dated / : / ______

IV. Hospital*: Requirement of the 100 bedded General Hospital for clinical teaching of BDS students drawn up in accordance with the parameters prescribed by BIS/NABH (applicable if Medical College is more then 10 kms away).

Own Hospital / Medical College Hospital / Private Hospital / Govt. General Hospital
Whether the permission of the attached 100 bedded hospital is issued by the competent authority? / : / Yes / No
Name and Full Address of Hospital:
Name of the CMO with Tel No. & Mobile No.:
Name of the Issuing Competent Authority:
Distance of the hospital from the Dental College / :
By Road (please clarify as to whether you have physically verified/taking the reading of Taxi/Car Meter)
Number of Beds in Hospital / : / Total: ______

Signature of Principal/Dean with seal

Department / Required / Allotted / Occupancy / Remarks of Inspector
During last 6 months / On the day of inspection
General Ward – Medical including allied specialities / 30
General Ward –Surgical including allied specialities / 30
Private Ward (A/C & Non A/c) / 9
Maternity Ward / 15
Paediatric Ward / 6
Intensive Care Services (4% of bed strength) / 4
Critical Care Services (6% of bed strength) / 6

Area Requirements (As per BIS/NABH)

Required / Available / Remarks of Inspector
Covered Area / 20 sq.m./bed
Inpatient Services / 40%
Outpatient Services / 35%
Department and supportive services / 25%

Man Power Requirement

(The consultants in the various departments should have atleast 8 years teaching experience after post graduation)

.Medical Staff

Department / Required / Available / Remarks of Inspector
General Surgery / 2
General Medicine / 2
Obstetrics & Gynaecology / 2
ENT / 2
Paediatrics / 2
Anaesthesia / 2
Orthopaedics / 2
Pharmacologist / 1
Radiologist / 1
GDMO / 1
Community Medicine / 1
Hospital Administration / 1

Signature of Principal/Dean with seal


Nursing Staff

Designation / Required / Available / Remarks of Inspector
Matron / 1
Sister Incharge / 6
O.T. Nurses / 6
General Nurses / 20
Labour Room Nurses / 4

Health Staff

Designation / Required / Available / Remarks of Inspector
Female Health Assistant / 1
Extension Educator Paramedical Staff / 1
Lab Technician/Blood Bank Tech / 4
ECG Technician / 1
Pharmacist / 4
Sr. Radiographer / 1
CSSD / 2
Medical Records / 1

Engineering Staff

Designation / Required / Available / Remarks of Inspector
Civil / 2
Mechanical / 2
Electrical / 2
Engineering Aid / 4

Other Staff

Designation / Required / Available / Remarks of Inspector
Drivers / 2
Carpenter / 1
Cooks / 2
Barber / 1
Class IV including chowkiders / 55

Administrative Staff

Designation / Required / Available / Remarks of Inspector
Office Superintendent / 1
Head Clerk / 1
Cashier / 1
Stenographer / 1
UDC / 2
LDC / 4

Signature of Principal/Dean with seal


V. CLINICAL MATERIAL (No. of patients) to be checked at the end of the OPD and filled by the Inspectors:

a.  ATTACHED HOSPITAL
Attendances / : / During Inspection: ______
Average (Last 6 months): ______
b. DENTAL COLLEGE HOSPITAL Attendances / : / During Inspection: ______
Average (Last 6 months): ______

(Attendance Register to be checked & signed at the beginning and end of OPD).

*Minimum requirement of new patient’s is 50 patients per day for the 1st year in the Dental OPD

*Minimum requirement of new patient’s for attach hospital is as per MCI Regulations.

Signature of Principal/Dean with seal

Signature of Inspector-1 Page 39 of 53 Signature of Inspector-2

VI. DENTAL TEACHING STAFF

S.
No. / Designation / Faculty Name / DOB / Original Affidavit with date / DCI UID (if available) & Adhaar No. / Form 16 / Total Service college wise in all the previous Institutes (attach appendix) / DOJ & Experience in present institute / Total Experience as on 15th June of current year / *Present during Inspection with signature or absent
1. / PRINCIPAL/ Dean
from any
specialty

PROSTHODONTICS & CROWN BRIDGE

1. / PROFESSOR
1. / READER
2 / READER

ORAL PATHOLOGY AND ORAL HISTOLOGY

1 / PROFESSOR
2. / READER

Signature of Principal/Dean with seal

CONSERVATIVE DENTISTRY & ENDODONTICS

1 / PROFESSOR
2. / READER
3 / READER

ORAL & MAXILOFACIAL SURGERY

1 / PROFESSOR
2. / READER

PERIODONTICS

1 / PROFESSOR
2. / READER

Signature of Principal/Dean with seal


ORTHODONTICS

1 / PROFESSOR
2. / READER

PEDODONTICS

1. / READER

ORAL MEDICINE

1. / READER

PUBLIC HEALTH DENTISTRY

1. / READER

Signature of Principal/Dean with seal

LECTURERS MDS (25%) : ______

S.
No. / MDS with specialty / Faculty Name / DOB / Original Affidavit with date / DCI UID (if available) & Adhaar No. / Form 16 / Total Service college wise in all the previous Institutes (attach appendix) / DOJ & Experience in present institute / Total Experience as on 15th June of current year / *Present during Inspection with signature or absent /
1.  / Prosthodontics
2.  / Prosthodontics
3.  / Conservative Dentistry
4.  / Conservative Dentistry
5.  / Oral Pathology & Microbiology
6.  / Oral & Maxillofacial Surgery

Signature of Principal/Dean with seal

7.  / Periodontics
8.  / Oral Medicine

TUTORS BDS (75%): ______

S.
No. / Tutors with BDS Qualifications / Faculty Name / DOB / Original Affidavit with date / DCI UID (if available) & Adhaar No. / Form 16 / Total Service college wise in all the previous Institutes (attach appendix) / DOJ & Experience in present institute / Total Experience as on 15th June of current year / *Present during Inspection with signature or absent /
1. 
2. 
3. 
4. 

Signature of Principal/Dean with seal

5. 
6. 
7. 
8. 
9. 
10. 
11. 
12. 
13. 
14. 

Signature of Principal/Dean with seal

15. 
16. 
17. 
18. 
19. 
20. 
21. 
22. 

Note:- All affidavits of the teaching staff and their requisite documents should be in the same order as mentioned above

*If the teaching staff is on leave, than attach the sanctioned leave by the college authority.

* Less than one year teaching experience will not be considered.

1. Faculty UID No. issued by the Dental Council of India available in www.dciindia.org.in

2. The appointment of faculty in private dental colleges should be made through proper selection committee (as per University Act of the concerned State).

Signature of Principal/Dean with seal

Signature of Inspector-1 Page 39 of 53 Signature of Inspector-2

SUMMARY - DENTAL TEACHING & CLINICAL STAFF

Department / Professor-6* / Reader-11 / Lecturer-8 / Tutor-22
Required / Available / Remarks of Inspector / Required / Available / Remarks of Inspector / Required / Available / Remarks of Inspector / Required / Available / Remarks of Inspector
Prosthodontics / 1 / 2 / 2 / 4
Conservative Dentistry / 1 / 2 / 2 / 4
Oral Pathology & Microbiology / 1 / 1 / 1 / 2
Oral & Maxillofacial Surgery / 1 / 1 / 2 / 4
Periodontics / 1 / 1 / 0 / 2
Pedodontics / 1 / 0 / 1
Public Health Dentistry / 1 / 0 / 3
Oral Medicine & Radiology and diagnosis / 1 / 1 / 1
Orthodontics / 1 / 1 / 0 / 1
Total / 6* / 11 / 8 / 22

* Includes the Principal/Dean who can head any one of the six specialties.

Note: There should NOT be more than ONE Professor in each specialty.

Attach list of entire faculty department-wise in attached DCI prescribed Performa as Annexure-I. Signature of Principal/Dean with seal

VII. MEDICAL TEACHING STAFF (Eligibility will be as per MCI Regulations – Latest)

ANATOMY

S.
No. / Designation / Faculty Name / DOB / Original Affidavit with date / DCI UID (if available) & Adhaar No. / Form 16 / Total Service college wise in all the previous Institutes (attach appendix) / DOJ & Experience in present institute / Total Experience as on 15th June of current year / *Present during Inspection with signature or absent
1. / Reader
1. / Lecturer
2. / Lecturer

PHYSIOLOGY

1. / Reader
1. / Lecturer
2. / Lecturer

Signature of Principal/Dean with seal

BIOCHEMISTRY

S.
No. / Designation / Faculty Name / DOB / Original Affidavit with date / DCI UID (if available) & Adhaar No. / Form 16 / Total Service college wise in all the previous Institutes (attach appendix) / DOJ & Experience in present institute / Total Experience as on 15th June of current year / *Present during Inspection with signature or absent
1. / Reader
1. / Lecturer
2. / Lecturer

PHARMACOLOGY

1. / Reader
1. / Lecturer
2. / Lecturer

Signature of Principal/Dean with seal

GENERAL PATHOLOGY

S.
No. / Designation / Faculty Name / DOB / Original Affidavit with date / DCI UID (if available) & Adhaar No. / Form 16 / Total Service college wise in all the previous Institutes (attach appendix) / DOJ & Experience in present institute / Total Experience as on 15th June of current year / *Present during Inspection with signature or absent
1. / Reader
1. / Lecturer
2. / Lecturer

MICROBIOLOGY

1. / Reader
1. / Lecturer
2. / Lecturer

Signature of Principal/Dean with seal


GENERAL MEDICINE

S.
No. / Designation / Faculty Name / DOB / Original Affidavit with date / DCI UID (if available) & Adhaar No. / Form 16 / Total Service college wise in all the previous Institutes (attach appendix) / DOJ & Experience in present institute / Total Experience as on 15th June of current year / *Present during Inspection with signature or absent
1. / Reader
1. / Lecturer
2. / Lecturer

GENERAL SURGERY

S.
No. / Designation / Faculty Name / DOB / Original Affidavit with date / DCI UID (if available) & Adhaar No. / Form 16 / Total Service college wise in all the previous Institutes (attach appendix) / DOJ & Experience in present institute / Total Experience as on 15th June of current year / *Present during Inspection with signature or absent
1. / Reader
1. / Lecturer
2. / Lecturer

Signature of Principal/Dean with seal

ANESTHESIA

S.
No. / Designation / Faculty Name / DOB / Original Affidavit with date / DCI UID (if available) & Adhaar No. / Form 16 / Total Service college wise in all the previous Institutes (attach appendix) / DOJ & Experience in present institute / Total Experience as on 15th June of current year / *Present during Inspection with signature or absent
1. / Reader
1. / Lecturer

Note:- All affidavits of the teaching staff and their requisite documents should be in the same order as mentioned above

* If the teaching staff is not present, whether the sanctioned leave certificate is attached?

Signature of Principal/Dean with seal

Signature of Inspector-1 Page 39 of 53 Signature of Inspector-2