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 AdmissionCommence / 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 CollegeName & 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 / Nob. 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 HospitalWhether 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 InspectorDuring 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 InspectorCovered 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 InspectorGeneral 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
Matron / 1
Sister Incharge / 6
O.T. Nurses / 6
General Nurses / 20
Labour Room Nurses / 4
Health Staff
Designation / Required / Available / Remarks of InspectorFemale 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 InspectorCivil / 2
Mechanical / 2
Electrical / 2
Engineering Aid / 4
Other Staff
Designation / Required / Available / Remarks of InspectorDrivers / 2
Carpenter / 1
Cooks / 2
Barber / 1
Class IV including chowkiders / 55
Administrative Staff
Designation / Required / Available / Remarks of InspectorOffice 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:
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. / PROFESSOR1. / READER
2 / READER
ORAL PATHOLOGY AND ORAL HISTOLOGY
1 / PROFESSOR2. / READER
Signature of Principal/Dean with seal
CONSERVATIVE DENTISTRY & ENDODONTICS
1 / PROFESSOR2. / READER
3 / READER
ORAL & MAXILOFACIAL SURGERY
1 / PROFESSOR2. / READER
PERIODONTICS
1 / PROFESSOR2. / READER
Signature of Principal/Dean with seal
ORTHODONTICS
2. / READER
PEDODONTICS
1. / READERORAL MEDICINE
1. / READERPUBLIC HEALTH DENTISTRY
1. / READERSignature 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. / Periodontics8. / 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-22Required / 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. / Reader1. / 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. / Reader1. / 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. / Reader1. / Lecturer
2. / Lecturer
Signature of Principal/Dean with seal
GENERAL MEDICINE
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