Establishment of New Unani College-2014-15 (LOI)
Page 1 of 34
PART –I
CENTRAL COUNCIL OF INDIAN MEDICINE
NEW DELHI
VISITATION PROFORMA FOR ASSESSMENT OF AVAILABLE FACILITIES OF
TEACHING AND PRACTICAL TRAINING FOR ESTABLISHMENT OF NEW UNANI
COLLEGES & ATTACHED HOSPITAL
(For the Session 2014-15 Under Section 13 (A) of IMCC Act 1970)
(To be filled up by the Principal and countersigned by Secretary or President of the Society)
Section ‘A’
I.
GENERAL INFORMATION:-
1.
Date of visitation
2.
Name of the College with Complete Address with Email
ID & Website of College
(Mentioning taluka, dist., Pin code and other details)
3.
Purpose of Visitation
4.
5.
6.
Year of Establishment of Society / Trust
Year of Establishment of College
Name & Address of Managing Society / Trust
7.
Information of President / Secretary
of Society/Trust of College (For
Private / Private Aided college)
8.
9.
10.
Name & Address
Office Tel. No.
Residence Tel.
No.
Mobile No.
Email ID
Contact details of the Society/Trust
Contact No. of
of College
College
Contact No. of
Hospital
Fax
Email
Website
Information of Principal
Name
Office Tel. No.
Residence Tel.
No.
Mobile No.
Email
Home Address
Permanent
Address
Office Address
Whether Government / Grant-in-aid / Private /
Constituent College of University
Signature of Visitors with date
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Information of State Govt. Health
Secretary / AYUSH Secretary
dealing with the education of
Ayurved, Unani and Siddha
Information of State Govt. Director
of Unani / AYUSH
Page 2 of 34
Name & Address
Office Tel. No.
Residence Tel.
No.
Mobile No.
Email ID
Name & Address
Office Tel. No.
Residence Tel.
No.
Mobile No.
Email ID
NOC of State Govt.
Date/Period
Last visitation of State Govt.
Date
Information of University
Name
1. Chancellor (deemed university) /
Office Tel. No.
Vice chancellor
Mobile No.
2. Registrar
Name
Office Tel. No.
Mobile No.
Email ID
Details of consent of affiliation of
Name of
University.
University
Date & period of
affiliation
Last visitation of University
Date
Academic Year
Important
information
of Name of Nearest
connectivity
Airport &
Distance (km)
Name of Nearest
Railway station
& Distance (km)
Fee Structure
Management
seats
Government
seats
Name of the fee
fixation authority
Name of nearest Police Station
Name & Address
1.
2.
3.
1.
2.
3.
Telephone
Number
21.
Existing Intake Capacity
Signature of Visitors with date
Course
UG
PG (If existing)
Intake
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
II.
Page 3 of 34
DETAILS OF LAND
Presently the College, Hospital and Hostels are on its own land or lease, details be furnished as
mentioned below.
Details of Land
Total Area of Land (in acres)
Total constructed area required for college
building for 1st year as per MSR
Total constructed area of hospital building
(As per CCIM Norms in sq.mt.)
(up to 60)
(61 to 100)
3 Acres
5 Acres
660 sq.mt.
1320 sq.mt.
2,000 sq.mt.
Available
3,500 sq.mt.
*Area certificate of layout plan in blue print with details of Departments has been submitted or
not …………
Ownership of land if it is in the regional language,
then Certified English/Hindi translation duly
attested by Gazetted Officer has been submitted or
not
In the name of the Society/Trust
In the name of President/Secretary
Whether land is on ownership by registry or lease
basis. If on lease basis, then period of lease
Whether entire land is in one plot or more than
one. If more than one, then size and distance
between these plots*
(Government Authorized Engineer’s certificate to
be attached)
Whether the land available with the Society/Trust
is
entirely for Unani College and attached
Hospital or for any other Institute also, if so,
details thereof.
III.
Year
FINANCIAL INFORMATION (Attested audited Report to be enclosed)
Total income receipt during last
three years
Total expenditure receipt of last three
years
2011-2012
2012-2013
2013-2014
Details of the following to be provided: (from 1st Jan. 2013 to 31st Dec. 2013 and from 1st Jan.
2014 to 31st Aug. 2014)
1.
2.
3.
4.
Salaries of teaching and non teaching Staff
Salaries of the Hospital Staff
Non salary expenditure of the college
Non salary expenditure of the Hospital.
Signature of Visitors with date
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
Page 4 of 34
Section ‘B’
INFORMATION OF THE COLLEGE
Phase wise specific requirement (as per MSR)
1. ADMINISTRATIVE BLOCK
S.No.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Details
Availability in sq.mt.
Total Area in sq.mt. (up to 60 seats - 150 sq. mt. & 61 to 100
seats - 300 sq. mt.)
Office of the Principal
Personal Assistant Room
Reception
Visitors Lounge
Staff Committee Room
Clerk Room
Accounts’ Section
Record Room
Central Store
Separate Toilets for gents and ladies
Total Area
Whether space is available for establishment of
2nd year departments ?
Yes or No
2. KULLIYAT DEPARTMENT
S.
No.
1.
Requirement
Availability in sq.mt.
Total Required Area of deptt.
50 sq.mt. (up to 60) / 100 sq.mt.
(61 to 100)
2.
Departmental Space
Professor
3.
Reader
4.
Lecturer
5.
6.
Departmental Library cum Tutorial
Room
Departmental office
7.
Space for Non Teaching staff
Existing Sitting space in sq.mt.
Total Area
Signature of Visitors with date
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
Page 5 of 34
3. TASHREEHUL BADAN DEPARTMENT
S. No.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Requirement
Total Required Area of deptt.
125 sq.mt. (up to 60) / 250 sq.mt. (61 to
100)
Departmental Space
Professor
Reader
Lecturer
Well ventilated Dissection Hall with
exhaust fans and preferably air conditioned
A room for students with adequate lockers
and washbasins
Embalming Room with Storage Tank or
freezer for four dead bodies
Departmental office
Space for Non Teaching staff
Tashreeh ul Badan Museum with optional
micro-anatomy laboratory
Total Area
Availability
Existing Sitting space in sq.mt.
4. MUNAFEUL AZA DEPARTMENT
S. No.
1.
2.
3.
4.
5.
6.
7.
8.
Requirement
Total Required Area of deptt.
75 sq.mt. (up to 60) / 150 sq.mt.
(61 to 100)
Departmental Space
Professor
Reader
Lecturer
Departmental Library cum
Tutorial Room
Departmental office
Space for Non Teaching staff
Munafuel Aza (Physiology)
laboratory with optional facility
for biochemistry testing
Total Area
Signature of Visitors with date
Availability
Existing Sitting space in sq.mt.
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
Page 6 of 34
DETAILS OF REQUIREMENTS OF VARIOUS SECTIONS OF COLLEGE
1. LIBRARY
S. No.
a)
REQUIREMENT
Total Required Area of Library
(100 sq. mt.) for up to 60 intake & (200
sq. mt.) for 61 to 100 intake
Number of Rooms/Halls
Number of books required
(to start new college) :2000
(List of books be enclosed)
Ayurveda
b)
Unani
c)
Siddha
d)
e)
Modern
Others
Total
Journals/Magazines being subscribed Total
Medical
Other
Seating Capacity in reading room
 50 seats (up to 60 intake)
 80 seats (up to 61-100 intake )
1.
2.
3.
4.
5.
a.
b.
c.
6.
a.
b.
c.
AVAILABILITY
Working hours
Staff Adequate Staff
Librarian
Asst. Librarian
Library Attendant/Peon
Facilities available in the library
E-library – number of computers with printer
and internet facility
Photocopying machine and printer
Separate reading room for Faculty members
2. CLASS ROOMS
Requirement
Lecture Halls : 02
Available
Area :
80 X 2 = 160 sq. mt. (for up to 60 intake)
160 X 2= 320 sq. mt. ( for 61 to 100 intake)
Signature of Visitors with date
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
Page 7 of 34
3. HERBAL GARDEN
REQUIREMENT
1.
2.
3.
AVAILABILITY
Total Required Area of Herbal
Garden
(2500 sq. mt.) for up to 60 intake
& (4000 sq. mt.) for 61 to 100
intake
Required number of species of
medicinal plants with names : 50
(list to be enclosed)
Staff (List to be enclosed)
(a) Gardener – 1
(b) Multi purpose workers - 2
(i)
(ii)
(iii)
(iv)
_________________________
_________________________
_________________________
4. OTHER ALLIED INFRASTRUCTURE REQUIREMENTS OF COLLEGE
S.No.
1.
2.
3.
ALLIED INFRASTRUCTURE REQUIREMENTS
Hostel Facility
Sports and Games Facility – Available / Not Available
Transport facility – Available / Not Available
AVAILABILITY
IV. STATUS OF TEACHING STAFF REQUIRED FOR 1st YEAR
S.No.
Department
(1)
Kulliyat*
(2)
Tashreehul badan
(3)
Munafeul Aza
Total
Pay Scale of teachers
Intake
Capacity for
UG
Number of Teachers required
as per regulation
P
R
L
Up to 60
1 or 1
1
61 to 100
1
1
1
Up to 60
1 or 1
1
61 to 100
1
1
1
Up to 60
1 or 1
1
61 to 100
1
1
1
Up to 60
3
3
61 to 100
3
3
3
Required * one language teacher on contract basis
As per State govt. (Yes/No)
No. of Existing Teachers
P
R
UGC (Yes/No)
1. Professor
2. Reader
3. Lecturer
Mode of Payment and Allowances: through Bank / Cash (Enclose Proof)
Whether PF/GPF scheme is existing or not
Number of teachers possessing UG Qualification.
Number of teachers possessing PG Qualification.
Signature of Visitors with date
Principal’s Signature with date
L
Establishment of New Unani College-2014-15 (LOI)
Page 8 of 34
V. DETAILS OF TECHNICAL AND OTHER STAFF OF UNANI COLLEGE
S. No.
Department
1.
Library
2.
College office
3.
Kulliyat
4.
Tashreehul Badan
5.
Munafeul Aza
Post
Requirement
Librarian
Assistant Librarian
Library Attendant or Peon
Clerical Staff for
Administrative & Account
services
Attendant
1
1
1
4
Laboratory Technician
Museum Keeper
Lifter
Laboratory Technician
Museum Keeper
1
1
1
-
Existing
1
Note: - (The sweeper, Attendant, Lifter, Laboratory assistant, Data Entry Operator (DEO),
Multipurpose worker could be on contractual basis)
LIST OF ANNEXURES TO BE SUBMITTED BY COLLEGE
S.No.
1.
Annexure Number
Annexure-I
Name of the Annexure
Proforma to furnish the details of teaching staff appointed/Consent given
2.
Annexure-II
Proforma to furnish the salary details of teaching staff
3.
Annexure-III
Proforma to furnish the details of non- teaching staff
4.
Annexure-IV
Proforma to furnish the salary details of non- teaching staff
5.
Annexure-V
Proforma to furnish the details of hospital staff
6.
Annexure-VI
Proforma to furnish the salary details of hospital staff
7.
Annexure VII
Notarised affidavit to be filled up by the newly appointed teacher in the given
format
Signature of Visitors with date
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
Page 9 of 34
Annexure – I
Note: Please attach the following certified copies of the teachers:
a)
Consent letter
b)
Original Affidavit
c)
Under-graduate and Post-graduate degree certificates
d)
Registration certificate
e)
Proof of date of birth
f)
Appointment & Joining letter
g)
Experience & relieving certificates
h)
Certificate/ Proof of Change of Name ( In case of Change in Name)
Signature of Visitors with date
Principal’s Signature with date
Telephone Number & Mobile
Number of Teacher
Whether the
appointment/Consent is in
subject concerned or in
Allied subject as per CCIM
norms
Name of State Board &
Registration Number
Department in which teacher
has been appointed/Consent
Date of
appointment/Consent
Address
Depar
tment
(Subj
ect)
Nature of present
appointment (regular/
contractual/ deputation/ part
time/ adhoc)
Name of the
college
Designation
Date wise details of
Experience in
chronological order (1st
appointment to till date)
Duration
From - To
PG Qualification
with subject (University
& year)
Date of Birth
Father's Name
Middle
name
First Name
Name of the
Teacher
Sur Name
S.
N
o.
UG Qualification
(University & year)
PROFORMA TO FURNISH THE DETAILS OF TEACHING STAFF APPOINTED/CONSENT
Photograp
h of
Teacher
(Attested
by the
Principal)
Signature
of
Teacher
(At the
time of
visitation)
Establishment of New Unani College-2014-15 (LOI)
Page 10 of 34
Annexure – II
PROFORMA TO FURNISH THE SALARY DETAILS OF TEACHING STAFF
(1)
(2)
S.No.
(3)
Name of teacher
(4)
Designation
Pay Scale
(5)
Basic Pay
(6)
(7)
DA & Other
allowances
Deduction
GPF /CPF / IT
(8)
(9)
Gross Pay
Net pay
(10)
Contact No.
Annexure – III
PROFORMA TO FURNISH THE DETAILS OF NON- TEACHING STAFF
(1)
S. No.
(2)
Name of Employee
(3)
Father’s Name
(4)
Qualification
(5)
Date of appointment
(6)
Designation
(7)
Name of
Department
Annexure – IV
PROFORMA TO FURNISH THE SALARY DETAILS OF NON- TEACHING STAFF
S.No.
Name of the
employee
Designation
Scale of pay
Signature of Visitors with date
Basic Pay
DA & Other
allowances
Deduction
Gross Pay
Principal’s Signature with date
Net pay
Establishment of New Unani College-2014-15 (LOI)
Page 11 of 34
Annexure – V
PROFORMA TO FURNISH THE DETAILS OF HOSPITAL STAFF
S. No.
Name of Employee
Father’s Name
Date of Birth
Qualification
Date of appointment
Designation
Annexure – VI
PROFORMA TO FURNISH THE SALARY DETAILS OF HOSPITAL STAFF
S.No.
Name of the
employee
Designation
Scale of
pay
Signature of Visitors with date
Basic Pay
DA & Other
allowances
Deduction
Gross Pay
Principal’s Signature with date
Net pay
Establishment of New Unani College-2014-15 (LOI)
Page 12 of 34
Annexure-VII
NOTARISED AFFIDAVIT TO BE FILLED UP BY THE NEWLY APPOINTED/CONSENT
GIVEN BY TEACHER IN THE GIVEN FORMAT
S.
No.
1.
2.
3.
4.
Information of Teacher
Name of the Teacher (Sur Name- First NameMiddle Name)
Change of Name (if Applicable after marriage)
Date of Birth ( dd / mm / yyyy )
( xx/xx/xxxx)
UG Qualification (University & year)
5.
PG Qualification with subject (University &
year) of completion
6.
Ph.D (if applicable)
7.
Post wise details of Experience in chronological
order (* Date, Month and Year wise experience
should be mentioned)
8.
9.
10.
11.
12.
13.
14.
Present working Department (Subject)
Present Designation
Nature of present appointment
(regular/contractual/deputation/part time/ adhoc)
Name of present working college
Permanent Residential Address
Local Residential Address
State Board/ Council Registration detail
15.
Bank detail
16.
Contact Number
Pass Port Size
Photograph (To
be attested by
Principal)
To be filled up by Teacher
Year
Name of the
University
Subject
Year
Name of the
University
Subject
Year
Name of the
University
Duration
(dd/mm/yyy
y)
to
(dd/mm/yyy
y)
Department
(Subject)
Designation
Registration Number
Name of State Board
Salary Account Number
Name and Branch of Bank
Mobile Number
Residence Number
Permanent Residence Number
Email ID
Signature of Visitors with date
Principal’s Signature with date
Name of
the college
Establishment of New Unani College-2014-15 (LOI)
Page 13 of 34
I hereby solemnly affirm that the above information is correct as per my record and knowledge. I further affirm that if
any information given in this affidavit is found to be incorrect/ false, I shall be liable to be blacklisted or debarred from
service and to face any disciplinary action.
Date:
Signature of Deponent/ Teacher
I hereby solemnly affirm that the above information is correct as per my record and knowledge. I further affirm that if
any information given in this affidavit is found to be incorrect/ false, I have no objection for any disciplinary action
against the concerned teacher and myself.
Date:
Signature of Principal with Stamp
Signature of Visitors with date
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
Page 14 of 34
Section ‘C’
HOSPITAL
I.
REQUIREMENTS OF ATTACHED HOSPITAL OF UNANI COLLEGE
S.No
Particulars
1
2
Total constructed area of hospital building
Hospital Administration Block:
Superintendent room
Deputy Superintendent room
Medical officer’s (for 2 Resident Medical
Officer/Resident Surgical Officer)
Matron room
Assistant Matron room (for 2)
Reception and Registration
Out-Patient Departments (OPD)
Moalajat OPD with wash basin
Jarahat including Ain, Uzn, Anaf, Halaq wa Asnan
OPD with wash basin and Examination Room
Qabalat wa Amraze Niswan OPD with toilet and
Examination Room
Amraze Atfal OPD with wash room
Amraze Jild wa Tazeeniyat OPD with wash basin
Tahaffuzi wa Samaji Tib OPD with wash basin
Dressing and First Aid Room
Dispensary
Waiting Space for patients
Store
Male and Female Toilet for patients
In-Patient Department(IPD)
I.
II.
1.
2.
3.
4.
5.
6.
III.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
IV.
1.
Moalajat including Ilaj bit Tadbeer Male Ward with
attached toilet and bath room
2.
Moalajat including Ilaj bit Tadbeer Female Ward
with attached toilet and bath room
Jarahat including Ain, Uzn, Anaf, Halaq wa Asnan
Male Ward with attached toilet and bath room
Jarahat including Ain, Uzn, Anaf, Halaq wa Asnan
Female Ward with attached toilet and bath room
Niswan wa Qabalat Ward with attached toilet and
bath room
Amraze Atfal Ward with attached toilet and bath
room
Doctors’ duty room one for each department with
attached toilet- bath
Nursing staff duty rooms, one in each ward with
attached toilet-bath
3.
4.
5.
6.
7.
8.
Signature of Visitors with date
Required Built up area (in
sq.mt.)
Up to 60
61 to 100
seats
seats
3
4
2,000
3500
100
150
300
500
900
1650
Available
5
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
9.
V.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
VI.
1.
2.
3.
4.
5.
6.
7.
8.
9.
VII.
VIII.
IX.
X.
Store room for linen, etc.
Operation Theatres Block
Major Operation Theatre
Minor Operation Theatre
Labour Room with attached toilet and bath room
Neonatal care room
Central Sterilization or autoclave unit
Scrub room
Two Recovery room
Doctors’ duty room with attached toilet and bath
room
Interns or house officer or resident doctors room
with attached toilet and bath room.
Nursing staff room with attached toilet and bath
room
Ilaj bit Tadbeer Block:
Hammam
Dalak
Riyazat
Fasad
Kai,
Alq, Hajamat etc
Ilaj bil Tadbeer therapist Physicians Room
Ilaj bil Tadbeer Store room
Physiotherapy room
Central Laboratory:
Well equipped and spacious area with separate
sections for Pathology, Biochemistry and
Microbiology. Attached toilet shall be there for
collection of urine samples. Other latest diagnostic
facilities such as ECG also shall be provided.
Radiology or Sonography section
Radiology chamber with X-ray room, Dark room,
film drying room, store room, USG room, patients
waiting and dressing room, reception or registration
or report room
Hospital Kitchen and Canteen:
Store room
TOTAL
Signature of Visitors with date
Page 15 of 34
150
250
275
500
100
150
50
100
100
25
2,000
150
50
3,500
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
II.
Page 16 of 34
DETAILS OF OPD
NUMBER OF PATIENTS ATTENDED OPD
(Note:- Patients of Medical Camp should not be included)
(From 1st Jan. 2013 to 31st Dec. 2013)
S.
Month
No.
Moalaj
at
Information as provided by college
Amraze Jarahat & Qabalat
Amraze
Jild wa
Ain-Uznwa
Atfal
Tazeeniy
AnfAmraze
at
Halaq wa
Niswan
Asnan
Tahaffuzi
wa
Samaji
Tibb
Verification of
information by
Visitors as
correct / Not
1.
Jan. 2013
2.
Feb. 2013
3.
Mar. 2013
4.
April 2013
5.
May 2013
6.
June 2013
7.
July 2013
8.
Aug. 2013
9.
Sep. 2013
10. Oct. 2013
11. Nov. 2013
12. Dec. 2013
Total
Grand total
(From 1st Jan. 2014 to 31st Aug. 2014)
S.
Month
No.
Moalaj
at
Information as provided by college
Amraze Jarahat & Qabalat
Amraze
Jild wa
Ain-Uznwa
Atfal
Tazeeniy
AnfAmraze
at
Halaq wa
Niswan
Asnan
Tahaffuzi
wa
Samaji
Tibb
Verification of
information by
Visitors as
correct / Not
1.
Jan. 2014
2.
Feb. 2014
3.
Mar. 2014
4.
April 2014
5.
May 2014
6.
June 2014
7.
July 2014
8.
Aug. 2014
Total
Grand total
III.
DETAILS OF IPD
IPD SECTIONS WITH BED STRENGTH
Name of the Department
% of Bed
Distribution
(i) Moalajat including Ilaj Bit Tadbeer & Amraze jild
50%
Signature of Visitors with date
Number of Existing
Beds
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
wa Tazeeniyat
(ii) Jarahat including Ain, Uzn , Anaf wa Halaq
Page 17 of 34
25%
(iii) Qabalat wa Amraze Niswan wa Atfal
25%
Total Number of Beds (Minimum of 60 beds for upto 60 seats and 100 beds for
61 to 100 seats are required )
S. No.
1.
Bed distribution in various Departments of IPD
Moalajat Male Ward
Available beds
2.
Moalajat Female Ward
3.
Ilaj bit Tadbeer Male Ward
4.
Ilaj bit Tadbeer Female Ward
5.
Jarahat Male Ward
6.
Jarahat Female Ward
7.
Ain, Uzn, Anaf wa Halaq Ward
8.
Qabalat wa Amraze Niswan Ward
9.
Amraze Atfal Ward
Total
No. of wards/ Hall/ rooms in IPD
DETAILS OF IPD PATIENTS
(From 1st Jan. 2013 to 31st Dec. 2013)
S.
No.
Month
1. Total Number of Patients Admitted
Information as provided by college
Moalajat
Jarahat & Ain- Qabalat wa
Amraze Atfal
including Ilaj
Uzn-AnfAmraze
bit Tadbeer
Halaq wa
Niswan
Asnan
Verification of
information by
Visitors as correct /
Not
1.
Jan. 2013
2.
Feb. 2013
3.
Mar. 2013
4.
April 2013
5.
May 2013
6.
June 2013
7.
July 2013
8.
Aug. 2013
9.
Sep. 2013
10.
Oct. 2013
11.
Nov. 2013
12.
Dec. 2013
Total
Grand total
Signature of Visitors with date
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
Page 18 of 34
(From 1st Jan. 2014 to 31st Aug. 2014)
1. Total Number of Patients Admitted
S.
Month
Information as provided by college
No.
Moalajat
Jarahat & Ain- Qabalat wa
Amraze Atfal
including Ilaj
Uzn-AnfAmraze
bit Tadbeer
Halaq wa
Niswan
Asnan
1.
Jan. 2014
2.
Feb. 2014
3.
Mar. 2014
4.
April 2014
5.
May 2014
6.
June 2014
7.
July 2014
8.
Aug. 2014
Total
Grand total
2. Total Number of Bed Days Occupied (From 1st Jan. 2013 to 31st Dec. 2013)
S.
Month
Information as provided by college
No.
Moalajat
Jarahat & AinQabalat wa
Amraze
including Ilaj
Uzn-Anf-Halaq
Amraze
Atfal
bit Tadbeer
wa Asnan
Niswan
Verification of
information by
Visitors as correct /
Not
Verification of
information by
Visitors as correct /
Not
1.
Jan. 2013
2.
Feb. 2013
3.
Mar. 2013
4.
April 2013
5.
May 2013
6.
June 2013
7.
July 2013
8.
Aug. 2013
9.
Sep. 2013
10.
Oct. 2013
11.
Nov. 2013
12.
Dec. 2013
Total
Grand total
Total Number of Bed Days Occupied (From 1st Jan. 2014 to 31st Aug. 2014)
S.
Month
Information as provided by college
No.
Moalajat
Jarahat & AinQabalat wa
Amraze
including Ilaj
Uzn-Anf-Halaq
Amraze
Atfal
bit Tadbeer
wa Asnan
Niswan
1.
2.
3.
4.
5.
6.
7.
Verification of
information by
Visitors as correct /
Not
Jan. 2014
Feb. 2014
Mar. 2014
April 2014
May 2014
June 2014
July 2014
Signature of Visitors with date
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
Page 19 of 34
8.
Aug. 2014
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.
IV. DISPENSARY
Area of Store room of Drugs in sq.mt.
Area of dispensary
Details of quantity with name of drugs dispensed From (From 1st Jan. 2013 to 31st Dec. 2013 and
From 1st Jan. 2014 to 31st Aug. 2014) (List to be enclosed)
1.
2.
3.
4.
Medical Record Room (Area in sq.mt.)
Signature of Visitors with date
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
V.
Page 20 of 34
Declaration by the Principal of the Govt. / Private College
I _____________ s/o Shri
________________ Principal, ____________
_ (name of the College) solemnly writing that if any information provided by me in proforma and Annexure
found false. I shall be held responsible in the matter. I shall have no objection if any legal action is taken by the
CCIM against me.
Signature of Principal
Dated_______
Place:_______
VI.
Name with Stamp
Declaration by the Secretary/President of the Trust/Society of the Private College
I am, ____________________ s/o Shri ________________ Secretary/President ___________
__ (name of the Society) solemnly state that, looking after the management of the college & hospital. The
information provided by the Principal in the proforma and Annexures are true. If any information provided by
the Principal found false the undersigned has no objection for any legal action initiated by the CCIM against the
Principal and me.
Signature of Secretary/President
Dated: _______
Place: ____________
Signature of Visitors with date
Name with Stamp
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
VII.
S. No.
(1)
1.
2.
3.
4..
(a)
(b)
(c)
(d)
5.
6.
7.
8.
9
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
Page 21 of 34
REQUIREMENT OF STAFF IN UNANI HOSPITAL
Post
(2)
Hospital Superintendent (Principal or
dean of the college may also be exofficio)
Deputy Medical Superintendent
Consultants*
As per MSR
(3)
1
Existing Hospital Staff
(4)
1
Teachers of clinical
departments
05
Resident Medical Officers or Surgical
or Medical Officers (RMO or RSO or
MO)
Moalajat
01
Niswan wa Qabalat
02
Jarahat
01
Amraze Atfal
01
Matron or Nursing Superintendent
1
Staff Nurses for in Patient Department
1 for every 20 beds.
Ward Boy or Ayah
1 for every 10 beds.
Pharmacists
2
Dresser
2
Store Keeper
1
Office Staff (for registration, record
2
maintenance, data entry etc.)
Dark-Room Attendant
1
Operation Theatre Attendant
1
Modern medical Staff
Medical Specialist
1 part time/on contract
Surgical Specialist
1 part time/on contract
Obstetrician and Gynecologist
1 part time/on contract
Pathologist
1 part time/on contract
Anaesthesiologist
1 part time/on contract
Opthalmologist
1 part time/on contract
Paediatrician
1 part time/on contract
Radiologist
1 part time/on contract
Dentist
1 part time/on contract
Physiotherapist
1 part time/on contract
X-Ray Technician or Radiographer
1
Staff for Ilaj bit Tadbeer Section for Out-Patient Department (Out Patient Department) and InPatient Department (In Patient Department)
Ilaj bit Tadbeer Specialists
Teachers of Ilaj bit Tadbeer
teaching department.
House officer or Clinical Registrar or
1
Section Resident (Unani)
Ilaj bit Tadbeer Nurse
1 (in addition to the nurses
indicated at Sl. No. 6)
Ilaj bit Tadbeer Assistant
1 male and 1 female
Messieurs
1 Male 1 Female
Staff of Operation Theatre
Jarahat Specialist
Teachers of Ilmul Jarahat
department
Operation theatre Attendant
1
Signature of Visitors with date
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
32.
33.
Dresser
Nurses
34.
Labour Room
Qabalat wa Amraze Niswan Specialists
35.
Page 22 of 34
1
1; these will be in addition to
the nurses indicated at S. No.
6
Teachers of Qabalat wa
Amraze Niswan Department
1
Midwife
Clinical Laboratory
36.
Laboratory Technicians
37.
Peon or Attendant
Teaching Pharmacy and Quality Testing Laboratory
38.
Pharmacy Incharge (Teachers of Ilmul
Advia /Saidla Deptt.)
39.
Peon or Attendant
40.
Workers
41.
Analytical Chemist (Part time)/(Lab
Technician)
42.
Pharmacognosist (Part time)/ (Lab
Technician)
Total no. of Hospital Staff
Note:- Detailed information of hospital staff to be furnished.
2
2
1
1
2
1
1
* Consultants - at least one specialist doctor or clinical teacher, each of Moalajat, Ilaj Bid Tadbeer,
Jarahat, Ain, Uzn, Anaf wa Halaq, Amraze Niswan wo Ilmul Qabalat and Amraze Atfal required for
operating the hospital.
VIII. OTHER INFORMATION OF HOSPITAL
S.NO.
FACILITIES REQUIRED
1.
Labour Room with Facilities For Neonatal Care
2.
AVAILABILITY
Number of Deliveries performed
From 1st Jan. 2013 to 31st Dec. 2013
and From 1st Jan. 2014 to 31st Aug. 2014
Central Laboratory:
Well equipped and spacious area with separate sections for Pathology,
Biochemistry and Microbiology. Attached toilet shall be there for
collection of urine samples. Other latest diagnostic facilities such as
ECG also shall be provided.
Total number of investigation done
From 1st Jan. 2013 to 31st Dec. 2013
Total Number of Haematological Tests.
Total Number of Bio-Chemistry Tests.
Total Number of Serology Test.
Total Number of Microbiology Tests.
and From 1st Jan. 2014 to 31st Aug. 2014
Total Number of Haematological Tests.
Total Number of Bio-Chemistry Tests.
Total Number of Serology Test.
Total Number of Microbiology Tests.
Signature of Visitors with date
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
Page 23 of 34
No. of Investigations carried out (Enclose the supporting Document)
From 1st Jan. 2013 to 31st Dec. 2013
From 1st Jan. 2014 to 31st Aug. 2014
3.
Radiology or Sonography section
Radiology chamber with X-ray room, Dark room, film drying room,
store room, USG room, patients waiting and dressing room, reception or
registration or report room
Number of X-Rays, ECG and USG (Enclose the supporting Document)
From 1st Jan. 2013 to 31st Dec. 2013
a) X-Rays b) ECG c) USG -
4.
From 1st Jan. 2014 to 31st Aug. 2014
a) X-Rays b) ECG c) USG -
IX.
OPERATION THEATRE
Operation Theatre Details
Area (in Sq. mt.)
Block: For 60 intake - 150 sq.mt.
For 61 to 100 intake - 250 sq.mt.
Major OT (Facilities available)
Minor OT (Facilities available)
Air conditioning
Pre operative Room with attached toilet
Sterilization room – ASV
Fumigation Details
Changing and wash room with attached toilet
Operation theater (Area in sq. mt.)
Recovery Room (Area in sq. mt.)
Number of operations done (Enclose list)
From 1st Jan. 2013 to 31st Dec. 2013
From 1st Jan. 2014 to 31st Aug. 2014
X.
Existing in sq. mtr.
Exist/Not
ILAJ BIT TADBEER DEPARTMENT
AREA :
Area Required
Existing
Remarks
Up to 60 intake - 275 sq. mt.
For 61-100
- 500 sq. mt.
PROCEDURES CARRIED OUT :
Total no. carried Total no. carried out Verification by Visitors
Name of Procedures
out From 1st Jan. From 1st Jan. 2014 to
2013 to 31st Dec. 31st Aug. 2014
2013
Hammam
Dalak
Signature of Visitors with date
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
Riyazat
Fasad
Kai
Alq, Hajamat etc.
Others
INSTRUMENTS :
Name of the Instrument
Page 24 of 34
Number of Instruments Available (as Verification by Visitors as
provided by college)
correct / Not correct
Apparatus needed for Hajamat (Cupping Set)
Dalak Table
Riyazat
Taleeq (Aquarium for leeches)
Fasad (Venesection Set)
Hamam
Others
XI.
DETAILS OF EQUIPMENT AND INSTRUMENTS FOR VARIOUS SECTIONS OF COLLEGE
& HOSPITAL
A) DISSECTION HALL
S.No.
Name of Equipment and Instruments
1.
Bone Cutters of various types and sizes
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
Forceps of various types
Chisels
dissecting scissors of various types and sizes
Tagging
Knifes of various types
Needles of various types
Dissection tables (full size)
Dissection table ( half size)
Laboratory trays
Glass jars with cover for specimen
Embalming machine
Rocking pump/foot sprayer
Disinfecting machine
Buckets
Formaldehyde solution
Carbolic acid
Sodium acetate
Potassium acetate
Disinfecting solution
Glycerin
Dummy cadaver and models of body parts
Whole body skeleton, bones, dissected/preserved
body organs etc
Number of Equipment and Instruments
available
B) PHYSIOLOGY (MUNAFEUL AZA) LABORATORY
S.No
Name of Equipment and Instruments
Signature of Visitors with date
Number of Equipment and Instruments
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
Page 25 of 34
available
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
Microscopes with oil immersion
Westergren’s pipette for ESR
Haematocrit Tube
Sahli’s Haemoglobinometer
Haemocytometer
Sphygmomanometer
Stethoscopes
Clinical Thermometer
Knee Hammer
Tuning forks
Electrocardiograph
Stop watches
Water Distillation still
Thermometers, balances, Microslides,
Cover slips, glassware
Centrifuge with speed control
Colorimeter (photoelectric)
pH meter Electric
pH comparator with disc
Refrigerator
Newton’s colour wheel In a batch
Spirometer
Tonometer
Hydrometer
Viscometer
Osmometer
Stalagmometer
Sterilizer
C) LABOUR ROOM
S.No.
Name of Equipment and Instruments
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
Shadowless Lamp
Suction Machine (Neonatal)
Oxygen Cylinder and Mask
Foetal Toco Cardiograph
Radiant Warner
Phototherapy Unit
Weighing Machine (Paediatric)
Patient trolley
Anaesthesia trolley
Infantometer
Vacuum extractor
Foetal Doppler
Low cavity forceps
Steriliser
Machintosh rubber sheet
Catguts and Thread
Speculum – Sim’s
-Cuscos
Signature of Visitors with date
Number of Equipment and Instruments
available
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
S.No.
Name of Equipment and Instruments
18.
Instruments for labour and Episiotomy (Scissors,
forceps, needle holders etc.)
Baby tray
Draw Sheets
Plastic Aprons
HIV kit for emergency patients
Plain and Hole towels
Gloves
Nebuliser
Foetoscope
Auto Clave
Drums
Instrumental Trolley
OT tables with head Up and head low facility
Double dome Shadowless lamp
Pulse Oxymeter
Oxygen Cylinder
Resuscitation kit
Boyle’s apparatus
Electro Cautery
MTP Suction Machine
Anaesthesia Kit
Blunt and Sharp Curettes
Dilators set (Hegar’s, Hawkins)
Anterior Vaginal Wall retractor
Uterine sound
Volsellum
MTP Suction Curette
Needles
Needle holders
Sponge holding forceps
Towel Clips
Retractors abdominal (Doyne’s etc.)
Green armytage forceps
Uterus holding forceps
Kocher’s forceps
Artery forceps (Long, short, Mosquito)
Scissors- different sizes
Forceps obstetrics
Tongue depressor
Endotracheal tubes
B.P. apparatus
HSG Cannula
Cord Cutting appliances
I.U.C.D. removing hook
Bladder Sound
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
Page 26 of 34
Number of Equipment and Instruments
available
D) OPERATION THEATRE
S. No.
Name of Equipment and Instruments
Signature of Visitors with date
Number of Equipment and Instruments
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
Page 27 of 34
available
I
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
JARAHAT
Spot light (Shadowless ceiling fitted)
Needle holding Forceps (big-medium-small)
Aprons
Specimens Jar
Dressing drums of Assorted size
Drum stand
IV Stand
X-ray View Box (double)
Surgeon’s gown
Mask and caps
Gauze, cotton and Bandage
Gloves of different size
Cheetles Forceps
Towel Clips
Mosquito forceps
Scissors straight (Tailor)
Scissors curved of different sizes
Stitch removal Scissors
Dissection forceps
Sinus forceps
Probes – Assorted size
Pointed scissors
Gastric and Intestinal clamps (occlusive and
crushing)
Abdominal Retractors
Tissue Forceps
Bob Kock’s Forceps
Kocher’s forceps
Urethral Dilators
Rubber catheters of Assorted size
Metal Catheters
Corrugated Rubber drain
Suturing Needle (straight/curved) of Assorted size
Surgical Thread
Sponge holding forceps
Right Angle cholecystectomy Forceps
Stone holding forceps
Proctoscope with or without illuminator
Bougies (Megars)
Allies Forceps small
Allies Forceps Big
Pile holding forceps
Artery Forceps small
Artery Forceps big
Artery Forceps Medium
Sigmoidoscope Rigid/flexible
Barron Pile’s Gun
Laryngoscope Pediatric/Adult
Boyles Apparatus
Multiparameter Monitor
Signature of Visitors with date
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
II
89.
90.
91.
92.
93.
94.
95.
96.
97.
98.
Page 28 of 34
Ambu Bag
Suction machine Electrical/Manual
Generator (Minimum 30 KV)
Emergency light
Fire Extinguisher
Skin grafting knife with handle
Surgical blades of different size
BP Handle of different size
Vertical BP Instrument
Self Retaining Retractor
Bone Drill Machine
Bone cutter
Giggly Saw
Scoop
Periosteum elevator
Maggler Forceps
E.T. Tubes of different sizes
High Pressure Autoclave
Fumigator
Refrigerator
Nitrous Oxide Cylinder
Exhaust Fan
X.ray view box
Auto linen Washing Machine
Hydrolic Operation Table
Shadow less lamp ceiling
Anaesthesia Trolley/Boyle’s Apparatus
Instrument Trolley
Endotracheal Tube
Ambu Bag
Proctoscope with or without illumination
Revolving Stool
Gabriel Syringe
Stretcher with trolley
Mosquito forceps
Piles holding forceps
Needle holder
BP Apparatus
Suction Machine
AIN (EYE):
Ophthalmic Equipments/Instruments for
Operative Surgery
Operating Microscope with Coaxial Illumination
and foot control
Bipolar Wet field cautery
Mini Halogen Light (table mouning)
Ophthalmic operation table with head rest
Sterilizing box /case with mats
Lens insertion forceps
Keratome
Barraquer wire speculum (adult/child/infant)
Desmarres lid retractors
Cat-paw lacrimal retractor
Signature of Visitors with date
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
99.
100.
101.
102.
103.
104.
105.
106.
107.
108.
109.
110.
111.
112.
113.
114.
115.
116.
117.
118.
119.
120.
121.
122.
123.
124.
125.
126.
127.
128.
129.
130.
131.
132.
133.
134.
135.
136.
137.
138.
139.
140.
141.
142.
143.
144.
145.
146.
147.
148.
149.
150.
151.
Page 29 of 34
Mueller lacrimal sac retractor
Dastoor iris retractor
Castro Viejo caliper
MeyrhoeferChalazion curette
Sinsky lens manipulating hook
IOL Manipulator
Foreign body spud
Lewis lens loop (vectis)
Cystotome and spoon
Mule Evisceration spoon
Wells Enucleation spoon
Iris repository (double-ended)
Tooks Corneal knife
Graefe Strabismus hook
Jameson muscle hook
Smith lens expressor
Wills cautery with copper ball-point
Barraquer blade braker and holder
LangsIacrimal sac dissector
Kelly Glaucoma punch
West Lacrimal Chiesel
Elevator (double ended)
Mallet
Nasal speculum adult/child
Pigtail Probe with Suture holes
Wilder punctum Dilator
Bowman lacrimal probes
Towel clamp
Hartman mosquito forceps
Colibri forceps 1*2 teech
Mc. Person corneal forceps with tying platform
Kelman Mc. Pherson angled forceps
Mc. Phersons tying forceps
Dressing forceps, serrated
Moorfieldconjuctival forceps
Fixation forceps
Beer cilea (epilation) forceps
Arruga capsular forceps
SnellenEntropion clamp
Chalazion clamps
Chalazion clamps
Iris scissors
Westcott tenotomy scissors
Vannas straight scissors
De-Weckers iris scissors
Strabismus scissors
Enucleation scissors
Barraquer needle holder
Castroviejo micro needle holder
Silcok needle holder with sid lock
Air injection cannula
Healon aspirating cannula
AC was cannula
Signature of Visitors with date
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
152.
153.
154.
155.
156.
157.
158.
159.
160.
III
161.
162.
163.
164.
165.
166.
167.
168.
169.
170.
171.
172.
173.
174.
175.
176.
177.
178.
179.
180.
181.
182.
183.
184.
185.
186.
187.
188.
189.
190.
191.
Page 30 of 34
Lacrimal cannula
Hydrodialysis cannula
J-loop cannula (rt./It. With silicon tubing)
Simcoe direct I/A cannula with silicon tubing
Irrigating aspirating handle
Lens dialer
Superior Rectus forceps
Eye wash glasses
Swimming Goggles
ENT-Surgical/Operative procedural
Instruments
Aural Syringe
Jobson’s Aural Probe
Eustachian Catheter
Mastoid Retractor
Mastoid Gouge
Mallet
Mastoid Cell seeker with scoop
Nasal Foreign Body hook
Nasal packing forceps
Antral Trocar cannula
Antral Burr
Nasal Snare
Freer’sseptal knife
Ballinger’s swivel knife
Bayonet Shaped gouge
Walshman’s forceps
Laryngeal forceps
Boyle-Davis mouth gag
Tongue plate with throat suction
Tonsil holding forceps
Tonsillar suction
Tonsillar Dissector
TonsillarSuare
Guillotine
Adenoid curette with cage
Peritonsillar abscess draining forceps
Fuller’s Tracheostomy Tube
Steriliser box
Cheatel’s Forceps
Other consumable articles like gloves, syringes,
bandages etc.
ENT operating microscope and lens
E) OUT PATIENT DEPARTMENT
S. No.
Name of OPD
1.
Moalajat
Signature of Visitors with date
Equipment, Instrument, Furniture
etc required as per norms of CCIM
X-Ray View Box
BP Apparatus
Stethoscope
Examination Table
Number of Equipment and
Instruments available
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
2.
Jarahat
3.
Ain-Uzn-Anf-Halaq wa
Asnan
4.
5.
Qabalatwa Amraze
Niswan
Amraze Atfal
Signature of Visitors with date
Page 31 of 34
Thermometer
Tongue depressor
Cotton balls
Torch
Measuring tape
Weight and height measuring stand
Knee Hammer
Washbasin
Hand washing facility
Drainage facility
Minor OT.
Instruments for anorectal examination
Examination Table
BP Apparatus
Thermometer
Surgical Blades
Cotton Balls
Gauze pieces
X-ray viewing Box
Stethoscope
Cheetle’s forceps
Torch
Tuning forks
Ophthalmoscope/fundoscope
Auroscope
Examination Table
X-Ray Viewing Box
BP Apparatus
Stethoscope
Thermometer
ENT kit
Torch
Bull’s lamp
Weighting machine
Sim’s speculum
Thermometer
Cusco’s speculum
Examination Table
Lamp stand
Torch
X-Ray Viewing Box
BP Apparatus
Stethoscope
Measuring tape
Washbasin
Scale
Weighing machine
Torch
View Box
Thermometer
BP Apparatus
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
6.
Ilaj bit Tadbeer
Page 32 of 34
Stethoscope
Examination Table
As per Moalajat
Massage table, Glass tank for
Leeches, Cupping sets, Venesection
set etc.
Note.- There should be proper seating arrangement for internees/students in the OPD.
Signature of Visitors with date
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
Page 33 of 34
CENTRAL COUNCIL OF INDIAN MEDICINE, NEW DELHI
Guidelines/Instructions for Colleges regarding Visitation
1. College may download the updated visitation proforma (Part I) from website of CCIM and may use it
to expand the tables wherever necessary. Annexure III (MS-excel format) should be separately
downloaded from CCIM website, duly filled & sent along with the visitation proforma. Hard copy of
visitation proforma (Part I) is enclosed for ready reference.
2. Any change in the prescribed format will not be accepted by CCIM.
3. Read the proforma carefully before filling up.
4. College should keep ready three sets of Visitation proforma duly signed on each page by the
Principal/ Dean/ Director along with all annexure for visitors.
5. New teacher appointed after visitation of the college will not be considered/counted in the faculty list
of the concerned college.
6. Any data / documents submitted by the college after visitation will not be accepted by the central
council.
7. College shall bear the whole responsibility of typographical errors in the OPD/IPD data and
experience of teachers. In previous years, due to incomplete information and typographical errors in
the visitation proforma, colleges have to face the Hearing. Therefore, college is advised to submit all
the relevant information and fill the proforma in proper manner as per the given guidelines. (Note:While furnishing details of various section please crosscheck various requirement from notified
Indian Medicine Central Council (Minimum Standard Requirements of Unani Colleges and attached
Hospitals) Regulations, 2013)
8. Page-wise Index of all annexure should be provided.
9. Attested copy of UG, PG & Registration Certificates, Experience Certificates, Joining report,
Relieving letter and all other relevant documents and original notarized affidavit (as per annexureVII) of newly appointed teachers after the last visitation should be attached.
10. Teachers of Govt. colleges/ constituent colleges of University should also submit the affidavit of
newly appointed teachers after the last visitation.
11. If false affidavit/ false experience is submitted by any teacher or if teacher is found in duplicity, then
legal action will be initiated by the central council against the concerned teacher and Principal of the
college.
12. Copy of Form No. 16 issued for purpose of income tax should be submitted in respect of all the
teaching staff. (Not admissible for Govt./ constituent colleges of University).
13. Financial information should be filled as per enclosed proforma.
14. College should make arrangement of videographer and photographer during visitation of CCIM team
for preparing CD and group photographs with Teaching staff and non-teaching staff of College and
Medical and Paramedical staff of Hospital with the visitors separately. The name of each staff
member should be mentioned on the bottom of the photograph. It is to be noted that without CD &
Photograph, the visitation report will not be accepted by CCIM.
15. If college has any queries/ doubt/ other information required regarding the visitation proforma, you
are requested to contact telephonically or send an email to the central council on the given mail-ID,
indiaccim@gmail.com.
16. The filled up visitation proforma shall be typed and submitted in a separate CD to the visitors.
*************
Signature of Visitors with date
Principal’s Signature with date
Establishment of New Unani College-2014-15 (LOI)
Page 34 of 34
CHECK LIST
Following documents should be enclosed with Part-I :1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
12)
13)
14)
15)
16)
Registration certificate of Institute or Society or Trust.
Memorandum and managing body of Institute.
No Objection certificate by state Government.
Consent of Affiliation by University (Form No. 5)
Area Certificate of layout plan in blue print with details of Dept. of College & Hospital (For
Establishment of New College).
Proof showing the land available with the society / trust is entirely for Unani college and attached
hospital.
Audited statement of last 3 years.
Copy of Constitution of Governing body.
Infrastructure of Departments (List of Charts, Models, Equipments etc.)
Information of Teaching Staff (UG & PG Degree Certificates, Affidavits, Appointments, Consent
letters, Registration Certificate etc.)
List of prepared medicines with quantity during last year.
List of Medicinal Plant’s Species in Herbal Garden.
List of Hospital Staff as per given format.
List of Instruments, Equipments in Pathology Lab, Labour Room, Ilaj Bit Tadbeer Department,
Operation Theatre.
R.C.T.C. Book of Ambulance.
Any other relevant information details.
Signature of Visitors with date
Principal’s Signature with date