SCHEME FOR OBTAINING PERMISSION OF PHARMACY COUNCIL OF INDIA TO START PHARM.D. OR PHARM.D. AND PHARM.D.

(POST BACCALUERATE) PROGRAMME
All applications under this scheme be submitted to the Secretary, Pharmacy Council of India, before the prescribed date mentioned in the schedule

1. Eligibility Criteria: The following organizations shall be eligible to apply in the SIF for permission to start the Pharm.D., programme/s namely: a. A State Government / Union Territory b. A University c. A Registered Society under the Societies Registration Act

2. Qualifying Criteria: Conditions to be fullfilled by person, institution, society or University to qualify to apply to PCI for permission to start Pharm.D. programme/s: a. The consent of Affiliation for the proposed Pharm.D./ Pharm D (PB) programmes by the applicant from a University (as given in the prescribed format of PCI). b. No admission shall be made by the applicant to the proposed Pharm.D. programme/s without prior permission of the PCI. c. The applicant shall provide necessary additional infrastructural facilities as prescribed by the PCI under “Appendix – B” of Pharm.D. regulations for the starting of Pharm.D. programme/s. Opening of the Pharm.D. programme/s in a hired or rented building shall not be permitted. d. The applicant should have been approved under section 12 of the Pharmacy Act 1948 for the conduct of B.Pharm course. e. The applicant shall provide 300 bed hospital facility as prescribed under regulation 2) of “Appendix – B” of Pharm.D. regulations. ( Memorandum of Understanding as given in the prescribed format of PCI shall be furnished).

Signature of the Head of the Institution 1

Signature of the Inspectors

3. Form and Procedure: a. The applicant, subject to the fulfillment of above eligibility and qualifying criteria and also the requirements specified under the Pharm.D. regulations shall submit application in prescribed Standard Inspection Format (SIF) only, in triplicate to start the Pharm.D. programme/s to the Pharmacy Council of India. b. The SIF shall be submitted by the applicant either by Courier, Registered Post or in person to the Secretary, Pharmacy Council of India, New Delhi, along with a nonrefundable application fee of Rs.2.00 lakhs in the form of Demand Draft in favour of „Pharmacy Council of India‟ payable at New Delhi. The said fee covers registration of application, technical scrutiny, contingent expenditure and two inspections. Beyond two inspections, the normal inspection fee prescribed by council will apply as prescribed under para 4 of this scheme. c. The schedule for receipt of applications for the starting of Pharm.D programme and processing of applications by the Pharmacy Council of India is given in the para 6 of this scheme. d. The applications received by the Pharmacy Council of India will be registered in the council office for scrutiny. Registration of application will only signify the acceptance of the application for scrutiny. Incomplete applications will be rejected summarily without refund of application fee. The applicant may apply a fresh within the stipulated time alongwith the non-refundable application fee. e. The Council will scrutinize the application in the first instance in terms of the feasibility of starting the proposed programme/s at the said institution. W hile evaluating the application, the council may seek clarification or additional information from the applicant as deemed necessary and carry out physical inspection to verify the information supplied by the applicant. f. After examining the application and after conducting necessary physical inspections, the Council office shall submit to the Central Council factual report stating that: i. The applicant fulfils the eligibility and qualifying criteria. ii. The applicant has the necessary managerial and financial capabilities to establish the Pharm.D. programme. iii. The applicant has a feasible and time bound programme for recruitment of faculty and staff as prescribed in the Pharm.D. regulations and that the necessary posts stand created.

Signature of the Head of the Institution 2

Signature of the Inspectors

iv . The applicant has appointed staff for 1st year of Pharm.D., & 4th year of Pharm.D. (Post bacculearte) programme. v. The applicant has not admitted students without prior permission of PCI. vi. Deficiencies of any kind shall be pointed out indicating whether these are remediable or not. g. The Central Council may then permit/approve/reject the application for conduct of Pharm.D., Programme/s and accordingly issue letter in a time bound manner specifying annual targets to be achieved by the applicant during the following years, if permission/approval is granted. h. The recommendation of the Central Council shall be final. i. The permission to establish the Pharm.D., Programme will be given initially for a period of one year and will be renewed on yearly basis subject to verification of the achievements of annual targets. It is the responsibility of the institution to apply to the Pharmacy Council of India for purpose of renewal six month prior to the expiry of the initial permission. This process of renewal of permission will continue till such time the establishment of all infrastructural facilities and staff requirements prescribed in the Pharm.D. regulation are completed and approval under section 12 of the Pharmacy Act 1948 for the conduct of Pharm.D programme is granted to the institution. j. The Council may then extend the approval of Pharm.D., Programme under section 12 of Pharmacy Act 1948 conducted by the institution for a period 1/3/5 years as the case may be for which the institution shall apply to the Pharmacy Council of India six months prior to the expiry of approval held. k. The Council may obtain any other information from the institution as it deems necessary. 4. Fee Struc ture: The fee structure prescribed for Pharm.D programme is as under Detail 1. Starting of Pharm.D programme (including inspections) to be submitted with the application 2. Yearwise approval and inspection fee 3. Approval under section 12 ( including fees for two inspections) 4. Verification of compliance if any 5. Annual affiliation fee after approval under section 12 fees for Amount 2 Rs.2,00,000 Rs.1,00,000 Rs.2.00,000 Rs.1,00,000 Rs. 50,000

Signature of the Head of the Institution 3

Signature of the Inspectors

5. Reapplication : W herever the Central Council has rejected the application of the applicant for the conduct of Pharm.D. programme/s the applicant may apply afresh for the conduct of Pharm.D. programme/s in the ensuing year following the dates of submission etc., mentioned in the schedule under para 6 of this scheme. 6. Schedule for submission of application and processing: Sl. No. a. b. c. d. Stage of processing Receipt of application Completion of inspection Approval of central council Issue of letter of approval by PCI last date 30t h September 31st December 31st March 30t h April for 2008-09 only 31st July 14t h August 30t h august 10t h September

Signature of the Head of the Institution 4

Signature of the Inspectors

PHARMACY COUNCIL OF INDIA STANDARD INSPECTION FORM -

Appendix-26 I.No.3658 of 85 /CC (8 t h & 9th April, 2010)
th

Formatted: Font: 13 pt Formatted: Font: 4 pt Formatted: Font: 13 pt

PHARM.D PHARM.D. and PHARM.D (POST BACCALAUREATE)

General Information pertaining to :1. 2. College and hospital (Pharmacy Practice site) Courses of Study leading to:Pharm D. course Name of Institution: ………………………………………………………………………. Place and Address: ………………………………………………………………………….. Principal/Dean Tel. No. Off. ……………………………Res.………………………Fax .…………………. Mobile No. : ………..……….…………………………………………………………….…… email : ………..……….…………………………………………………………….…………… Name and address of Affiliating University: ………………………………………… Name and address of the attached hospital:

Date :

Signature of Dean/Principal

------------------------------------------------------------------------------------------------------------This form shall be precisely filled in, verified and signed by the Head/Principal, of the institution and forwarded in triplicate to the Secretary, Pharmacy Council of India. The entries should be as required under the PCI (Pharm.D.) regulations and norms.

Signature of the Head of the Institution 5

Signature of the Inspectors

I. Programme or . Inspection No. _____________________ (BLOCK LETTERS ) 2.D. D.D. 1 Applicant is for Pharm.2 a) Year of Establishment of the Institution b)Year of starting Pharm D programme A – I . Pharm.Pharm.4 Status of the course conducting body: Government / University / Autonomous / Aided / Private (Enclose copy of Registration documents of Society/Trust) Signature of the Head of the Institution 6 Signature of the Inspectors .I. and Pharm.Pharm. : To be filled up by inspectors Date of Inspection: NAME OF THE INS PECTORS : 1. _____________________ PART – I A .C. and Pharm. (Post Baccalaureate) Programmes (To be filled and submitted to PCI by an organization seeking approval of the course /continuation of the approval) (S IF-D) To be filled up by P.PHARMACY COUNCIL OF INDIA S tandard Inspection Format (S .GENERAL INFORMATION A – I. Fax No.D.F) for . E-mail A – I . D. : FILE No. (Post Baccalaureate) (Tick the relevant Box) A – I .D.3 Name of the Institution: Complete Postal address: STD code Telephone No.

E-M ail A – I . Fax No. Office Residence Mobile No.6 Name. Designation and Address of person to be contacted Name Designation Address STD Code Telephone No. Fax No.8 Name of the Examining Authority Complete Postal address: STD code Telephone No.5 Name.7 Name and Address of the Head of the Institution A – I . address of the Society/Trust/ M anagement (attach documentary evidence) STD Code: Telephone No: Fax No: E-mail Web Site: A – I . E-mail Website Signature of the Head of the Institution 7 Signature of the Inspectors .A – I .

A – I .D. and Date Approved Intake Actually Admitted M.D.9 APPLICATION FOR INS TITUTION S EEKING APPROVAL FOR PHARM. give status Yes No A – I.Pharm Approval Letter No. No Dated b. Pharm. DETAILS OF INS PECTION/AFFILIATION FEE PAID Name of the Course (a) Pharm. D. 10 b STATUS OF APPLICATION / APPROVAL* Course Pharm. 10 STATE GOVT UNIVERS ITY Remarks of the Inspectors ----------------------- Whether other Educational Institutions/Courses are also being run by the Trust / Institution in the same Building / campus? If yes. Approval Letter No. 10 a Status of the Pharmacy Institution : Independent Building Wing of another college Separate Campus Multi Institutional Campus Any Other. D. APPROVAL STATUS OF THE INSTITUTION Name of Approved Intake Approved and the up to Admitted Course D. D.Pharm.Pharm. (P. D. OR PHARM. Post Baccalaureate Affiliation Fee/Inspection fee for/up to the year 200 – 200 200 – 200 PCI D.B) Permissible 30 10 Intake Proposed / Approved Intake Remarks * Enclose relevant PCI / Affiliating University approval documents Signature of the Head of the Institution 8 Signature of the Inspectors . Approval Letter No. (b) Pharm. (POS T BACCALAUREATE) PROGRAMME (Tick appropriate box) a. D. AND PHARM. please specify A – I. and Date Approved Intake Actually Admitted B. D. and Date Approved Intake(department wise)_ Actually Admitted Note: Enclose relevant documents A –I.

1 Name of the Principal/Head Teaching Experience Required Qualification/ M.4 Pay S cales: Staff Actual experience Remarks of the Inspectors Deficiencies rectified / Not rectified Intake reduced/S topped in the last 03 years* Government/Trust/S ociety/Individual/University Enclosed / Not Enclosed Enclosed / Not Enclosed Scale of pay PF Gratuity Pension benefit Yes / No Remarks of the Inspectors Teaching Staff AICTE /UGC/S tate Govt. (b) Pharm. Pharm 15 years in teaching or Experience Research out of which 5 years should be as PhD Professor.2 For institution seeking extension of approval Course Date of last Remarks of the Inspection last Inspection Report (a) Pharm. Post Baccalaureate * Enclose Documents (write NA if not applicable) B –I . * Documentary evidence should be provided Qualification* B –I . D.B .Details of the Institution B –I .3 Type of Institution Details of the Governing Body Minutes of the last Governing council Meeting B –I . Yes / No NonTeaching AICTE /UGC/S tate Government Staff Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No B –I .5 Co – Curricular Activities / S ports Activities Whether college has NSS Unit? NSS Programme Officer’s Name Whether students participating in University level cultural activities / Co.curricular/sports activities Physical Instructor Sports Ground Yes/No Yes/No Available / Not available Individual / Shared Signature of the Head of the Institution 9 Signature of the Inspectors .D.

Particulars Amount No.Expenditure Total 3. Expenditure Particulars Amount Remarks of the Inspectors CAPITAL EXPENDITURE 1. Note: Enclose relevant documents Signature of the Head of the Institution 10 Signature of the Inspectors . Others 2. Government b. 1.2 Please provide following Information Receipts Sl. 6. Grants a. Others 5. Library Fee 2. 6. Tuition Fee Sl. Salary MAINTENANCE EXPENDITURE i College ii Others University Fee (If any) Apex Bodies Fee Government Fee Misc. No. 4. Building 3.C .1 Resources and funding agencies (give complete list) C –1. Equipment 4. Union Fee Others REVENUE EXPENDIUTRE 1 2. S ports Fee 3.FINANCIAL S TATUS OF THE INSTITUTION Audited financial S tatement of Institute should be furnished C –1. 5.

Pharm. each 1 Laboratory Area (8 Labs) 2 Subject . Norms No.mts. D. Class rooms: Total Number of Class rooms available and number provided for Pharm. Programs: 2.D (Post Baccalaureate) Programme * Sl.Pharmacy Practice . D.mts. Signature of the Head of the Institution 11 Signature of the Inspectors . & of the Area in Inspectors S q.Phytochemistry or Pharmaceutical Chemistry . Building c. each (Desirable) 75 Sq.Total Preparation Room for each lab (One room can be shared by two labs. if it is in between two labs) I yr 1 1 1 3 II yr 1 1 2 III yr 1 1 IV yr V Total yr 2 2 2 2 8 3 1 2 1 10 Sq.mts.D. g./B. D. D. Infrastructure for Minimum requirement as per Available Remarks No.mts. D. * Required 2 Pharm. Remarks of the Inspectors : ____________ acres : Own/Rented/Leased : Enclosed/Not available : Enclosed/Not available : Built up Area Class D. Land Details to be in the name of Trust and Society i) Own – Records to be enclosed Sale deed/relevant document d. 75 Sq.mts. Total Built up Area of the college building in Sq. Post Baccalaureate (* To accommodate 30 students for Pharm D and 10 for Pharm.mts f. a. Building: i) Approved Building plan. Pharm. Amenities and Circulation Area in Sq. Post Baccalaureate ) 3. each (Essential) Available area in S q.Pharm.PART. Additional Area provided for Pharm. (Post Baccalaureate) Programme Available Numbers Required Area for each Class Room 90 Sq. D and Pharm.mts.D. (M inimum) * Year wise requirement will be considered. or Pharm. Availability of Land for the Pharmacy College b. e.Life Science (Pharmacology. Physiology. Laboratory requirement for both Pharm.Pharmaceutics and Pharmacokinetics Lab .mts. and Pharm. Pathophysiology) .II PHYS ICAL INFRASTRUCTURE 1.

All the Laboratories should be well lit & ventilated 2. (Tertiary Care Own Hospital desirable) Medicine Teaching Hospital approved by (Compulsory) MCI* or University * (Any three of the below) Govt. in area 30 Sq . Area in S q . Administration Area: Sl. 4. 4. The workbenches should be smooth and easily cleanable preferably made of non-absorbent material. Balance room should be attached to the concerned laboratories. Orthopedics Dept.mts 80 Sq. The water taps should be non-leaking and directly installed on sinks Drainage should be efficient. 1. Hospital * Surgery Pediatrics Corporate type * Gynecology and Obstetrics Psychiatry * Attach a copy of MOU between institution Skin and VD & Hospital. 5. † 80-100 Sq. mts Available No. of Pharmacy Practice/Clinical 3 Sq.No. 3. All Laboratories should be provided with basic amenities and services like exhaust fans and fuming chamber to reduce the pollution wherever necessary.mts Remarks of the Inspectors 1 2 3 4 Principal’s Chamber Office – I – Establishment Office – II – Academics Confidential Room Signature of the Head of the Institution 12 Signature of the Inspectors . per Pharmacy in Hospital student The Institutions will not be permitted to run the above course in rented/leased building.mts 60 Sq.4 5 6 7 8 a) b) Area of the M achine Room Central Instrument Room Store Room – I Store Room – II (For Inflammable chemicals ) Hospital with teaching facility – (Please tick) c) d) 9. Name of infrastructure Requirement as per Norms in number 01 01 Requirement as per Norms. All the laboratories should be provided with safety measures like fire safety.mts. chemical exposure safety and bio safety.mts with AC 1 (Area 100 Sq mts) 1 (Area 20 Sq mts) 300 bedded hospital. 6.

Area in S q. Requireme nt as per Norms in number 01 01 01 01 01 01 01 1 2 3 4 5 6 7 Girl’s Common Room (Essential) Boy’s Common Room (Essential) Toilet Blocks for Boys Toilet Blocks for Girls Drinking Water facility – Water cooler (Essential). mts Remarks of the Inspectors 1 2 3 4 Animal House Library Museum Auditorium / M ulti Purpose Hall (Desirable) Herbal Garden (Desirable) Name of infrastructure 250 – 300 seating capacity Adequate Number of M edicinal Plants Requirement as per Norms in area 60 Sq. Library. Student Facilities: Sl. S taff Facilities: Sl Name of No.5. and (n=No of Pharm. infrastructure 1 Requirement Requirement as per Norms as per Norms in number in area Available No. mts 24 Sq. mts 9 Sq. mts 24 Sq. mts 150 Sq. Area in S q. Animal House [should have approval of the Committee for the Purpose of Control and S upervision of Experiments on Animals (CPCS EA)] and other Facilities: [ Sl No. Boy’s Hostel (Desirable) Girl’s Hostel (Desirable) 8 Power Backup Provision (Essential) 01 Signature of the Head of the Institution 13 Signature of the Inspectors . D. mts Remarks of the Inspectors HODs for Pharm. Museum. mts / Room ( single occupancy ) 20 Sq mts / Room (triple occupancy) Available No. mts/ Room Single occupancy 9 Sq. No. mts (May be attached to the Pharmacognosy lab) Available No. mts Remarks of the Inspectors 5 01 7. mts 60 Sq. Area in S q. mts 50 Sq. Post teachers) Baccalaureate Programme 6. D.D. M inimum 4 20 Sq mts x 4 and Post Baccalaureate Programme 2 Faculty Rooms for 10 Sq mts x n Pharm. Name of infrastructure Requirement Requirement as as per Norms per Norms in area in number 01 01 01 01 80 Sq.

A. mts Remarks of the Inspectors Computer Room Computer (Latest configuration) Printers Multi M edia Projector Generator (5KVA) 9.mts. Library books and periodicals The minimum norms for the initial stock of books yearly addition of the books and the number of journals to be subscribed are as given below: Sl. Amenities (Desirable) Name Principal’s quarter Staff quarters Canteen Parking Area for staff and students Bank Extension Counter Co operative Stores Guest House Auditorium Seminar Hall Transport Facilities for students Medical Facility (First Aid) 100 Sq. Computer and other Facilities: Name Required Available No. mts 16 x 80 Sq mts 100 Sq. (No) the Inspectors Title No.8. 1 Number of books 150 1500 adequate coverage of a large number of standard text books and titles in all disciplines of pharmacy 2 Annual addition of 150 books per year books 3 Periodicals 20 National Hard copies / online 10 International periodicals Signature of the Head of the Institution 14 Signature of the Inspectors . Area in S q. Item Titles Minimum Volumes (No) Available Remarks of No. mts Available No. mts 10. Area in S q. 1 system for every 10 students 1 printer for every 10 computers 01 01 Requirement as per Norms in area 120 Sq. mts Not Available Remarks of the Inspectors 80 Sq.

B. 18. 14. Subject wise Classification of books available: Sl. No 1 2 3 4 5 6 7 8 9 10 11 12 13. Lib 10 +2 / PUC 1 1 2 Required Available Remarks of the Inspectors Signature of the Head of the Institution 15 Signature of the Inspectors . Lib B. 15. 17. Library S taff: Staff 1 2 3 Librarian Assistant Librarian Library Attenders Qualification M.4 5 6 7 8 CDs Adequate Nos Internet Browsing Yes/No Facility (M inimum ten Computers) Reprographic Facilities: Photo Copier 01 Fax 01 Scanner 01 Library Automation and Computerized System (desirable) Library Timings 10. 19.C. 21 Subject Titles Pharmacy Practice Human Anatomy & Physiology Pharmaceutics (Dispensing & General Pharmacy) Pharmacognosy Pharmaceutical Organic Chemistry Pharmaceutical Inorganic Chemistry Pharmaceutical microbiology Pathophysiology Applied Biochemistry & Clinical Chemistry Pharmacology Pharmaceutical Jurisprudence Pharmaceutical Dosage Forms Community Pharmacy Clinical Pharmacy Hospital Pharmacy Pharmacotherapeutics Pharmaceutical analysis Medicinal Chemistry Biology Computer Science or Computer Application in pharmacy Mathematics/Statistics Available Numbers Remarks of the Inspectors 10. 16. 20.

D. D.PART III ACADEMIC REQUIREMENTS Course Curriculum: 1. of working days for PHARM. D. Post Baccalaureate: Commencement DD/MM/YY No of Days 6. D. : Summer: No of Days Winter: 4. Post Baccalaureate: Summer: Completion DD/MM/YY No of Days Winter: 7. D. Total Number of working days for Pharm.: Commencement DD/MM/YY Completion DD/MM/YY Theory Practicals Remarks of the Inspectors No of Days 3. Vacation for Pharm. Time Table copy Enclosed: a.D.D. D. course b. D. Date of Commencement of session for Pharm. Post Baccalaureate Programme 2. Pharm. Total No. Post Baccalaureate (Requirement not less than 200 working days/year) 8. Pharm. Post Baccalaureate Course (Tick √) Yes Yes No No Signature of the Head of the Institution 16 Signature of the Inspectors . Class Pharm. Vacation for PHARM.D. S tudent S taff Ratio: (Required ratio --.Theory → 30/40:1 and Practicals → 20:1) If more than 20 students in a batch 2 staff member to be present provided the lab is spacious. Academic Calendar Proposed date of Commencement of session / sessions for PHARM.: (Requirement not less than 200 working days/year) 5. Pharm.

of classes x 3 4 5 6 7 hours per class 3 3 3 3 1 1 1 1 Practicals Tutorials 1 Human Anatomy and Physiology Pharmaceutics Medicinal Biochemistry Pharmaceutical Organic Chemistry Pharmaceutical Inorganic Chemistry Remedial Mathematics/ Biology Total hours * Write NA if not Applicable ** for Biology Remarks of the Ins pectors 2 3 1 3 16 3** 18 1 6 = (40) Signature of the Head of the Institution 17 Signature of the Inspectors .10. of classes No of Hours Prescribed No of Hours Prescribed No of Hours conducted Conducted No of Hrs Conducted No of Hrs Conducted No.* First year Pharm D: Subject No of Theory Classes Prescribed No of Hrs 2 3 2 3 3 Total No. Whether the prescribed numbers of classes per week are being conducted as per PCI norms.

of classes Prescribed No of Hours Prescribed No of Hours Prescribed No of Hours conducted No of Hrs Conducted No of Hrs Conducted No of Hrs Conducted 2 3 4 5 6 7 No.Second Year Pharm D: Subject No of Theory Classes Practicals Tutorials Total No. of classes x hours per class 3 1 3 3 3 2 3 17 3 3 3 9 1 1 1 1 1 6 = 32 Remarks of the Ins pectors 1 Pathophysiology Pharmaceutical Microbiology Pharmacognosy & Phytopharmaceuticals Pharmacology-I Community Pharmacy Pharmacotherapeutics-I Total Hours Signature of the Head of the Institution 18 Signature of the Inspectors .

Third year Pharm D: Subject No of Theory Classes Practicals Tutorials Total No. of Prescribed No of Hours Prescribed No of Hours Prescribed No of Hours classes conducted No of Hrs Conducted No of Hrs Conducted No of Hrs Conducted 2 3 4 5 6 7 No. of classes x hours per class 3 3 1 3 3 2 3 2 16 3 3 3 3 15 1 1 1 1 5 = 36 Remarks of the Ins pectors 1 Pharmacology-II Pharmaceutical Analysis Pharmacotherapeutics-II Pharmaceutical Jurisprudence Medicinal Chemistry Pharmaceutical Formulations Total hours Signature of the Head of the Institution 19 Signature of the Inspectors .

Signature of the Head of the Institution 20 Signature of the Inspectors . of Hours of Tutorials Total No.Fourth year Pharm D: Subject No of Theory Classes No.5" *Pharm D (PB) students shall undergo Pharmacotherapeutics I and II subject as an additional subject in the FOURTH year of Pharm D programme as per the prescribed syllabus and scheme of examination. of Practical/Hos pital classes Posting conducted No of Hours Prescribed No of Hours Prescribed No of Hours No. of classes x Conducted No of Hrs Conducted No of Hrs Conducted hours per class 3 4 5 6 7 3 1 3 3 1 1 1 Remarks of the Ins pectors 1 *Pharmacotherapeutics-III Hospital Pharmacy Clinical Pharmacy Biostatistics Methodology Biopharmaceutics Pharmacokinetics Clinical Toxicology Total hours & Prescribed No of Hrs 2 3 2 3 Research 2 & 3 3 1 2 15 12 1 6 = 33 F or matted: Indent: Left: 0.

D. and Pharm. 11. of Hours of Seminars Total No. Post Baccalaureate Sl. Post Baccalaureate Total work load Remarks of the Ins pector Th Pr Th Pr Signature of the Head of the Institution 21 Signature of the Inspectors .Fifth year Pharm D: Subject No of Theory Classes Prescribed No of Hrs 2 3 3 2 No. D. No Name of the Faculty Subjects taught Pharm. Work load of Faculty members for Pharm. D. of Hos pital Posting * classes conducted No of Hours Prescribed No of Hours Prescribed No of Hours Conducted No of Hrs Conducted No of Hrs Conducted No. Pharm.D. of classes x hours per class 3 4 5 6 7 1 1 1 Remarks of the Ins pectors 1 Clinical Research Pharmacoepidemiology and Pharmacoeconomics Clinical Pharmacokinetics & Pharmacotherapeutic Drug Monitoring Clerkship * Project work (Six Months) Total hours 8 20 20 1 4 = 32 * Attending ward rounds on daily basis.

Percentage of students qualified in GATE in the last Three Years Details No.D. Pharm.Workload of Faculty members per week for Pharm. of Students Qualified Percentage Year 200Year 200Year 200- 15. No Name of Subjects the taught Faculty I Th Pr II Th Pr Pharm.D. Sl. Work load of Faculty members per week for Pharm. No Name of the Faculty Subjects taught Pharm. and Pharm. (Post Baccalaureate) Sl. of Students Appeared No.12. (Post Baccalaureate) I II III Th Pr Th Pr Th Pr Total work load Remarks of the Inspector 14. Whether Professional Society Activities are Conducted (Enclose details) Yes No Signature of the Head of the Institution 22 Signature of the Inspectors . D.D. and Pharm.D. Total work load Remark s of the Inspect or III IV Th Pr Th Pr V Th Pr 13.D.D.

Signature of the faculty Remarks of the Inspectors 2. Details of Teaching Faculty available for teaching for Pharm.D. 1. Details of Teaching Faculty exclusively available teaching for Pharm.Pharm.Pharm. Pharm PhD Others Part Time Signature of the Head of the Institution 23 Signature of the Inspectors . and Pharm. D. Course to be enclosed in the format mentioned below: Sl Name Designation No Qualification Date of Joining Teaching Experience State Pharmacy Council Reg No.. and M. Qualification and number of S taff Members Qualification B. (Post Baccalaureate) Course to be enclosed in the format mentioned below: Sl No Name Designation Qualification Date of Joining Teaching Experience After After UG PG State Pharmacy Council Reg No. Courses to be enclosed in the format mentioned below: Sl Name Designation No Qualification Date of Joining Teaching Experience State Pharmacy Council Reg No.PERS ONNEL TEACHING STAFF. Pharm M. Details of Teaching Faculty available with the institution for teaching for D. B. Signature of the faculty Remarks of the Inspectors 4.Pharm.PART IV . D. Signature of the faculty Remarks of the Inspectors 3.

D. (Post Baccalaureate) courses department wise for full duration of course/courses*: Professor: Asst. or Pharm. Professor Lecturer No. Professor Lecturer Professor Asst. Professor Lecturer Professor Asst.5.D and Pharm. Professor Lecturer Professor Asst. Professor: Lecturer Department/Division Department of Pharmaceutics Name of the post Professor Asst. Signature of the Head of the Institution 24 Signature of the Inspectors . S taff Pattern for Pharm. D. Required 1 1 2 1 1 3 1 1 2 1 1 1 1 2 3 Provided by the institution Remarks of the Inspectors Department of Pharmaceutical Chemistry (Including Pharmaceutical Analysis) Department of Pharmacology Department of Pharmacognosy Department of Pharmacy Practice * Year wise availability will be assessed. Professor Lecturer Professor Asst.

Department / Division Department of Pharmaceutics Name of the post Numbers Required Total 1 1 2 1 1 3 Provided by the institution I yr II yr III yr IV yr V yr Tota l Department of Pharmaceutical Chemistry (Including Pharmaceutical Analysis) Department of Pharmacology I II III IV V yr yr yr yr yr Professor 1 Asst. Practice Professor Lecturer Total 1 1 1 1 1 1 1 1 1 6 1 6 1 6 1 3 1 1 1 1 2 1 1 1 1 2 3 22 * For teaching Mathematics Part Time lecturer may be employed. Signature of the Head of the Institution 25 Signature of the Inspectors . Professor Lecturer Department of Professor Pharmacognosy Asst. 1 Professor Lecturer 1 2 Remarks of the Inspectors Professor Asst. 1 Professor Lecturer 1 1 Professor 1 Asst. Professor Lecturer Department of Professor Pharmacy Asst.

And above Duration of 5 yrs. Details of Faculty Retention for: Name of Faculty Member Period Duration of 15 yrs. or Pharm.D. Selection criteria and Recruitment Procedure for Faculty: a. Pharm SSLC 3 4 5 Degree Degree D. No. More than 50% 50% Percentage 8. b. and Pharm. And above Less than 5 yrs. Details of Faculty Turnover Name of Faculty Period Member % of faculty retained in last 3 yrs 25% Less than 25% 9.D (Post Baccalaureate course) for full duration of course/courses*. d. 1 2 Designation Laboratory Technician Laboratory Assistants or Laboratory Attenders Office Superintendent Accountant Store keeper Required Number 1 for each Dept 1 for each Lab (minimum) 1 1 1 Required Available Remarks of the Qualification Number Qualification Inspectors D. Sl. Number of Non-teaching staff available for Pharm. And above Duration of 10 yrs. Whether Recruitment Committee has been formed Whether Advertisement for vacancy is notified in the Newspapers Whether Demonstration Lecture has been conducted Whether opinion of Recruitment Committee Recorded Yes / No Yes / No Yes / No Yes / No 7. BCA or Graduate with Computer Course 6 Computer Data Operator 1 Signature of the Head of the Institution 26 Signature of the Inspectors . D.Pharm or a Bachelor degree recognized by a University or institution. c.6.

and M . * Year wise availability will be assessed.Pharm.Pharm. courses conducted by the institution are complied with or not. Signature of the Head of the Institution 27 Signature of the Inspectors . 10 11 Office Staff I Office Staff II Peon Cleaning personnel Gardener 1 2 2 Adequate Adequate Degree Degree SSLC ----- .. B.Inspectors to verify whether the Non teaching staff requirements for D.Pharm.7 8 9.

No Name Qualification Designation B asic pay Rs. DA Rs. Whether facilities for Research / Higher studies are provided to the faculty? (Inspectors to verify documents pertaining to the above) 12. Scope for the promotion for faculty: Promotions Yes 14. Signature of the Head of the Institution 28 Signature of the Inspectors . Details of Non-teaching staff members (list to be enclosed) : Sl No Name Designation Qualifi cation Date of Joining Experience No No Signature Remarks of the Ins pectors Yes/ No 18. Whether Supporting Staff (Technical and Administrative) are encouraged for skill up gradation programs. Whether faculty members are allowed to attend workshops and seminars? (Inspectors to verify documents pertaining to the above) 13.10. Gratuity Provided Yes 15. Total Signatu re 11. PT Deductions TDS EP F B ank A/C No PAN No EP F A/c no.Scale of pay for Teaching faculty (to be enclosed): Sl. CCA Rs. Other all owance Rs. HRA Rs.

7. 3.DOCUMENTATION Records Maintained: Essential Sl. 13. 9. 4. 14.Teaching Staff Fee paid Registers Acquittance Registers Accession Register for books and Journals in Library Log book for chemicals and Equipment costing more than Rupees one lakh Job Cards for laboratories Standard Operating Procedures (SOP’s) for Equipment Laboratory M anuals Stock Register for Equipment Animal House Records as per CPCSEA Institutional ethical Committee Internship log book & rotation certificates issued by Preceptors Signature of the Head of the Institution 29 Signature of the Inspectors . 15. 10. 8. 5. 17 18 Admissions Registers Individual Service Register Staff Attendance Registers Sessional M arks Register Final M arks Register Student Attendance Registers M inutes of meetings. No Records Yes No Remarks of the Inspectors 1 2. 6. 11. 12. 16.PART V .

Expenditure in Rs Remarks of the Ins pectors* Incurred No.Financial Resource allocation and utilization for the past three years: (Audited Accounts for previous year to be enclosed) Sl Expenditure in Rs.PART – VI 1. Expenditure in Rs Remarks of the Ins pectors * No. Total amount s pent on chemicals and glassware for the pas t three years: Sl Expenditure in Rs. Expenditure in Rs. Expenditure in Rs Remarks of the Ins pectors * Incurred No. Total amount s pent on equipments for the pas t three years: (Enclose purchase invoice) Sl Expenditure in Rs. Total Sanctioned budget allocated Equipment Incurred Total budget allocated Equipment Sanctioned Incurred Total budget allocated Equipment Sanctioned Signature of the Head of the Institution 30 Signature of the Inspectors . Expenditure in Rs. Expenditure in Rs. Total Sanctioned budget allocated Chemicals Glassware Incurred Total budget allocated Chemicals Glassware Sanctioned Incurred Total budget allocated Chemicals Glassware Sanctioned 3. Total Recurring budget sanctioned Non Recurring Total budget sanctioned Recurring Non Returning Total budget sanctioned Recurring Non Returning 2.

Total amount s pent on Books and Journals for the pas t three years: Sl No. Expenditure in Rs.4. Expenditure in Rs. Expenditure in Rs Remarks of the Ins pectors* Incurred 1 2 Total Sanctioned budget allocated Books Journals Incurred Total budget allocated Books Journals Sanctioned Incurred Total budget allocated Books Journals Sanctioned *Last three years including this academic year till the date of ins pection Signature of the Head of the Institution 31 Signature of the Inspectors .

smooth muscle. Post Baccalaureate A. Connective. Working Yes / No Remarks of the Ins pectors 8 9 10 Signature of the Head of the Institution 32 Signature of the Inspectors .No. 1 2 3 4 5 6 7 Name Microscopes Haemocytometer with Micropipettes Sahli’s haemo meter Hutchinson’s spirometer Spygmomanometer Stethoscope Permanent slides for various tissues/organs -(Epithelial. DEPARTMENT OF PHARMACOLOGY: I. pancreas..PART VII – EQUIPMENT AND APPARATUS Department wise List of Minimum equipments required for Pharm.& Nervous tissues/ skin.D. kidney.D.) Models for various organs Specimen for various organs and systems Skeleton and bones Minimum required Nos. Muscular. 15 20 20 01 05 ( desirable 10) 05 ( desirable 10) One pair of each tissue Organs and endocrine glands One slide of each organ system One model of each organ system One model for each organ system One set of skeleton and one spare bone Available Nos. liver etc. Equipment: S. and Pharm.

11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Different Contraceptive Devices and Models Muscle electrodes Lucas moist chamber Myographic lever Stimulator Centrifuge Digital Balance Physical /Chemical Balance Sherrington’s Kymograph Machine or Polyrite Sherrington Drum Perspex bath assembly (single unit) Aerators Computer with LCD Software packages for experiment Standard graphs of various drugs Actophotometer Rotarod Pole climbing apparatus Analgesiometer (Eddy’s hot plate and radiant heat methods) Convulsiometer Plethysmograph Digital pH meter One set of each device 01 01 01 01 01 01 01 10 10 10 10 01 01 Adequate number 01 01 01 01 01 01 01 Signature of the Head of the Institution 33 Signature of the Inspectors .

O.No 1 2 3 4 5 Name Folin-Wu tubes Dissection Tray and Boards Haemostatic artery forceps Hypodermic syringes and needles of size 15. Working Yes / No Remarks of the Ins pectors NOTE: Adequate number of glassware commonly used in the laboratory should be provided in each laboratory and department. Apparatus: S. B.No.24. Equipment: S. DEPARTMENT OF PHARMACOGNOSY: I.26G Levers. 15 02 02 02 01 01 01 02 01 01 01 15 15 01 01 Available Nos.D. cannulae Minimum required Nos. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Name Microscope with micro meter Digital Balance Autoclave Hot air oven B. Working Yes / No Remarks of the Ins pectors Signature of the Head of the Institution 34 Signature of the Inspectors .incubator Refrigerator Laminar air flow Colony counter Zone reader Digital pH meter Sterility testing unit Camera Lucida Eye piece micrometer Incinerator Moisture balance stage Minimum required Nos. 60 10 10 10 20 Available Nos.II.

20 20 10 10 10 01 Available Nos. Working Yes / No Remarks of the Ins pectors Signature of the Head of the Institution 35 Signature of the Inspectors . Working Yes / No Remarks of the Ins pectors NOTE: Adequate number of glassware commonly used in the laboratory should be provided in each laboratory and department.No. DEPARTMENT OF PHARMACEUTICAL CHEMISTRY : I. 1 2 3 4 Name Hot plates Oven Refrigerator Analytical Balances for demonstration Minimum required Nos. Equipment: S. C. Apparatus: S. 1 2 3 4 6 7 Name Reflu x flas k with condenser Water bath Clavengers apparatus Soxhlet apparatus TLC chamber and sprayer Distillation unit Minimum required Nos. 05 03 01 05 Available Nos.16 17 18 19 20 21 Heating mantle Flourimeter Vacuum pump Micropipettes (Single and multi channeled) Micro Centrifuge Projection Microscope 15 01 02 02 01 01 II.No.

No.5 6 7 8 9 10 11 12 13 Digital balance sensitivity Digital Balance (1mg sensitivity) Suction pumps Muffle Furnace Mechanical Stirrers Magnetic Stirrers Thermostat Vacuum Pump Digital pH meter Microwave Oven 10mg 10 01 06 01 10 10 01 01 02 with II. Working Yes / No Remarks of the Ins pectors NOTE: Adequate number of glassware commonly used in the laboratory should be provided in each laboratory and department. 02 20 20 40 20 40 Available Nos. Signature of the Head of the Institution 36 Signature of the Inspectors . Apparatus: S. 1 2 3 4 5 6 Name Distillation Unit Reflu x flas k and condenser single necked Reflu x flas k and condenser double/ triple necked Burettes Arsenic Limit Test Apparatus Nesslers Cylinders Minimum required Nos.

No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Name Mechanical stirrers Homogenizer Digital balance Microscopes Stage and eye piece micro meters Brookfield’s viscometer Tray dryer Ball mill Sieve shaker with sieve set Double cone blender Propeller type mechanical agitator Autoclave Steam distillation still Vacuum Pump Standard sieves. 44. 12. 80 Tablet punching machine Capsule filling machine Ampoule washing machine Ampoule filling and sealing machine Tablet disintegration test apparatus IP Tablet dissolution test apparatus IP Monsanto’s hardness tester Pfizer type hardness tester Minimum required Nos. 8. 66.D. Working Yes / No Remarks of the Ins pectors Signature of the Head of the Institution 37 Signature of the Inspectors . 10 05 05 05 05 01 01 01 01 01 05 01 01 01 10 sets 01 01 01 01 01 01 01 01 Available Nos. 10.22. sieve no.24. Equipment: S. DEPARTMENT OF PHARMACEUTICS: I.

24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 Friability test apparatus Clarity test apparatus Ointment filling machine Collapsible tube crimping machine Tablet coating pan Magnetic stirrer. 500ml and 1 liter capacity with speed control Digital pH meter All purpose equipment with all accessories Aseptic Cabinet BOD Incubator Bottle washing Machine Bottle Sealing Machine Bulk Density Apparatus Conical Percolator (glass/copper/ stainless steel) Capsule Counter Energy meter Hot Plate Humidity Control Oven Liquid Filling Machine Mechanical stirrer with speed regulator Precision Melting point Apparatus Distillation Unit 01 01 01 01 01 05 EACH 10 01 01 01 02 01 01 02 10 02 02 02 01 01 02 01 01 Signature of the Head of the Institution 38 Signature of the Inspectors .

No. Working Yes / No Remarks of the Ins pectors NOTE: Adequate number of glassware commonly used in the laboratory should be provided in each laboratory and department.II. E. DEPARTMENT OF PHARMACEUTICAL BIOTECHNOLOGY: S. medium. Apparatus: S. 15 15 05 20 05 each 01 05 03 10 Available Nos.No 1 2 3 4 5 6 7 8 9 Name Ostwald’s viscometer Stalagmometer Desiccator* Suppository moulds Buchner Funnels (Small. 1 2 3 4 5 6 7 8 9 Name Orbital shaker incubator Lyophilizer (Desirable) Gel Electrophoresis (Vertical and Horizontal) Phase contrast/Trinocular Microscope Refrigerated Centrifuge Fermenters of different capacity (Desirable) Tissue culture station Laminar airflow unit Diagnostic kits to identify infectious agents Minimum required Nos. large) Filtration assembly Permeability Cups Andreason’s Pipette Lipstick moulds Minimum required Nos. 01 01 01 01 01 01 01 01 01 Available Nos. Working Yes / No Remarks of the Ins pectors Signature of the Head of the Institution 39 Signature of the Inspectors .

smooth muscle. Equipment: S. kidney. DEPARTMENT OF PHARMACY PRACTICE : a.. pancreas. 1 2 3 Name Colorimeter Microscope Permanent slides (skin. Working Yes / No Remarks of the Ins pectors 10 11 12 4 5 6 Adequate 1 Adequate 7 2 Signature of the Head of the Institution 40 Signature of the Inspectors .) Watch glass Centrifuge Biochemical reagents for analysis of normal and pathological constituents in urine and blood facilities Filtration equipment Minimum required Nos.No. 2 Adequate Adequate Available Nos. F. liver etc.Rheometer 01 Viscometer 01 Micropipettes (single and multi 01 each channeled) 13 Sonicator 01 14 Respinometer 01 15 BOD Incubator 01 16 Paper Electrophoresis Unit 01 17 Micro Centrifuge 01 18 Incubator water bath 01 19 Autoclave 01 20 Refrigerator 01 21 Filtration Assembly 01 22 Digital pH meter 01 NOTE: Adequate number of glassware commonly used in the laboratory should be provided in each laboratory and department.

8 9 10 11 12 13 14 1 15 1 16 1 17 Adequate 18 1 19 1 20 1 21 1 22 1 23 1 24 1 NOTE: 1. Computers and Internet connection (Broadband). six computers for students with internet and staff computers as required. Filling Machine Sealing Machine Autoclave sterilizer Membrane filter Sintered glass funnel with complete filtering assemble Small disposable membrane filter for IV admixture filtration Laminar air flow bench Vacuum pump Oven Surgical dressing Incubator PH meter Disintegration test apparatus Hardness tester Centrifuge Magnetic stirrer Thermostatic bath 1 1 1 1 Unit Adequate Adequate Signature of the Head of the Institution 41 Signature of the Inspectors .

Working Yes / No Remarks of the Ins pectors Available numbers Working Yes/No Remarks of the Ins pectors G. 6 7 8 9 10 11 12 13 14 15 16 17 S. 4. 2.Visible Spectrophotometer Minimum required numbers 05 05 05 10 10 05 01 Adequate Adequate Adequate Adequate Adequate Adequate 02 02 01 02 Minimum required Nos.No 1. 01 01 01 Available Nos.b. 1 2 3 Name Sphygmomanometer Glucometer Peak Flow Meter Different inhalers and nebulisers Insulin Pens Weighing Machine Spirometer Drug Information Softwares CDs on various diseases Charts on counseling aids Patient Information Leaflet Computers Internet Connection Printer Scanner Copier Machine LCD Projector Name Colorimeter Digital pH meter UV. 3. 5.No. Equipments/facilities required at the practice site in the hospital: S. CENTRAL INSTRUMENTATION ROOM: Signature of the Head of the Institution 42 Signature of the Inspectors .

Exchanger Lyophilizer (Desirable) 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 Signature of the Head of the Institution 43 Signature of the Inspectors . Hydrogen.4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Flourimeter Digital Balance (1mg sensitivity) Nephelo Turbidity meter Flame Photometer Potentiometer Conductivity meter Fourier Transform Infra Red Spectrometer (Desirable) HPLC HPTLC (Desirable) Atomic Absorption and Emission spectrophotometer (Desirable) Biochemistry Analyzer (Desirable) Carbon. Nitrogen Analyzer (Desirable) Deep Freezer (Desirable) Ion.

per student along with consent to provide the professional manpower to support the programme.No. Signature of the Head of the Institution 44 Signature of the Inspectors .Govt. (Post Baccalaureate) courses: Hospital Details S. Nature of Hospital . 1 Name/ Infrastructure Hospital* with teaching facility Minimum 300 bedded Hospital Minimum required Nos.D. Within the same limits of Corporation or Municipality or Campus with Medical Faculty involvement as adjunct faculty Provided Remarks of the Ins pectors 3 * Approval letter of the Hospital Authority to be annexed along with MOU.Own . ++ To be certified by the Dean/Director/Medical Supdt.Corporate Hospital 2 Place for Pharmacy Practice Department + Available specialties ++ Minimum carpet area of 3 sq. (Minimu m area requirement 120 sq. Hospital Requirements for running Pharm D or Pharm.Teaching hospital recognized by MCI or University .mts.mts ) Medicine (Compulsory-with minimum of 120 beds) (Any three of the following) Surgery Pediatrics Gynecology and Obstetrics Psychiatry Skin and VD Orthopedics 4 Location of the Hospital Give details. of the hospital.H. + Inspectors are required to personally verify the space provided at the hospital and meet the hospital administrators for interaction.D and Pharm. Hospital not below the level of district Hospital .

45 Unit wise Medical Staff: Unit _____ S. UG/P G QUALIFICATION Bed strength _________ Experience Dat e wise t eaching/Professional experience with designat ion & Instit ution Designat ion Inst it ut ion From To Period Subject wit h Year of passing Inst it ut ion University Signature of the Head of the Institution 45 Signature of the Inspectors . No. Designat ion Name wit h Dat e of Birth Nat ure of employment Full time/part time/Hon.

Average daily bed occupancy rate: Average daily operations: Major Minor Year-wis e available clinical materials (during previous three years ). Intensive Care facilities I. of beds Equipment Average bed occupancy III. of beds Equipment Average bed occupancy Signature of the Head of the Institution 46 Signature of the Inspectors . Average daily IPD. NICU No. of beds Equipment Average bed occupancy II. ICU No. PICU No. ICCU No. of Beds Equipment Average bed occupancy IV.46 Other Ancillary staff available: Epidemiologist Statistician Phys iotherapist Available Clinical Material: Average daily OPD.

Pharmacy Practice staff details at the hospital – Name Qualification Signature of Faculty Signature of the Head of the Institution 47 Signature of the Inspectors . provided B.mts .D.mts . of beds Equipment Average bed occupancy Specialty clinics and services being provided by the department: ………………………………………………………………………………………………… ………………………………………………………………………………………………… ………………………………………………………………………………………………… Details for Pharm. Library – Departmental Library standard text and references Indexing and Abstracting services for DI services should be included as separate annexure. Dialys is No. Minimum Requirement Pharmacy Practice Area 60 Faculty area 30 Drug Information Centre 30 Computer Student Computer/Internet facility* intake Ratio 1:4 * Internet Facility with a minimu m broad band connection Facility Area in Sq. A. C. Accommodation Area in Sq. student and faculty.47 V.

Journal Club.D. Case presentation.48 STANDARD INS PECTION FORM (Pharm. Date of inspection:Name of Inspector:1 Name of the institution Name and other particulars of Institution (Principal/Head) Qualification detail. please mention the frequency with which each activity is held. Course 2. Log book of Pharm. Seminar Subject Review ADR meeting Lectures (separately held for Pharm. Prescribed mode of admission to Scheduled Pharm.D. Whether Pharm.D. 3. 4.D. Experience: Adequate/Inadequate Age Signature of the Head of the Institution 48 Signature of the Inspectors .. Academic Activities. students: Maintained/ Not maintained.) TEACHING PROGRAMME/INTERNS HIP PROGRAMME 1.D s tudents ) Guest lectures Video film Others . s tudents participate in beds ide counselling or not ? ……………………. Summary of Inspection report – (check list) to be completed by the Inspector.

Full/Partial Total number of beds Dept.Pharm. Sufficient/Insufficient Other deficiency. paid and not working in any other institution s imultaneous ly. Staff position for B.Pharm.49 2 Name of the institution Name and other particulars of Institution (Principal/Head) Qualification detail. Library in the hospital supporting Drug Information Services Clinical Material Adequate/Inadequate No of publications from the department during 3 years Exa mination conduct As per norms of PCI/Not as per norms of PCI Standard of Exa mination Satis factory/Not satis factory 3 4 5 6 7 8 9 Signature of the Head of the Institution 49 Signature of the Inspectors . Experience:Adequate/Inadequate Age Date of last inspection of the institution : Number of admission at B.Detailed proforma (with photograph affixed) in respect of every teacher must be obtained s igned by the concerned teacher. Professors Lecturers . HOD and Head of institution . . wise Instruments and other expected facilities Adequate/Inadequate Bed side teaching Yes/No Laboratory Technician Number and Names Department Research Laboratory Yes/No Departmental Library – Book/Journals Adequate/Inadequate Central Library – Books/Journals pertaining to the department Space for Pharmacy Practice Department at the Hospital Adequate/Inadequate Indoor wards(Units/Department) & OPD space Adequate/Inadequate Offices for Faculty members Adequate/Inadequate Class Rooms and seminar rooms Adequate/Inadequate Dept.To ensure that staff is full time. Requisite important information of the Hospital Number of department in the Hospital Teaching complement in each Dept. if any Yes/No Total Teachers in the Pharmacy Practice Department (with requisite qualifications & Experience Des ignation Number Name Total Experience Professors Asst.All teachers should be physically identified.

D students admitted No.D Year students admitted and available staff during the last 5 years 2008 2009 2010 2011 2012 11 Other relevant facilities in the Institution 12. No. of staff available S pecific remarks if any by the Inspector: (No recommendations regarding permiss ion/recognition be made) Give factual position only). Signature of the Head of the Institution Signature of the Inspectors 50 .50 10 Year-wis e number of Pharm. of Pharm. Signature of the Inspector __________________________________________________________________________________ Note : S pecific mention of required facilities as per PCI norms and commensurate with the degree under consideration must be made specifying whether these are Available/Not available.

51 Compliance of deficiencies reflected in last Inspection Report S pecific observations if not rectified Observation of the Inspectors: 1. The team is requested to record their comments only after physical verification of records and details. 2. which is with you now and record the observations. The Inspection Team is instructed to physically verify the details and records filled up by the college in the application form submitted by the college. Signature of Inspectors: 2. opinions and recommendations in clear and explicit terms. Note: 1. Signature of the Head of the Institution 51 Signature of the Inspectors .

(e) v. Nature of appointment: Permanent / Temporary / Adhoc / Honorary / Part-time 1. 1.(b) Date of Birth & Age …………………………………………………… 1. 1. Authorities : P hotograph Photo ID submitted :Passport copy / Driving Licence / PAN Card / Voter ID/ MCI Smart ID Card/State Pharmacy Council ID.(e) iv. P hone & Fax Number With Code: Office: Residence: _________________________________ _________________________________ 1.(f ) Residential Address of empl oyee : ______________________________________________________________ ________________________________________________________________ _________________________________________________________________ 1. Number ……………………… Issued by …………………………… P hotograph Without Photo ID.(e) iii.(c) Recent P assport size photo of the Employee Signed by Dean / P rincipal of the college.(h ) E-mail address: _________________________________ Mobile Number : _________________________________ 1.(i ) Date of joining present institution : ________________________ as ______________________ Signature of the Head of the Institution 52 Signature of the Inspectors .(d) Submit P hoto ID proof issued by Govt.(e)(i)a Certi fied copies of present appoint ment order at present institut e attached. City: ______________________________________________________________________ 1.(e) i. 1. Whet her belongs to : SC / ST / OBC / Ex-service / Others. Declaration form will be rejecte d and will not be considere d as te aching faculty.(a) Name……………………………………………………………… 1. 1. College: ___________________________________________________________________ 1. Department ________________________________________________________________ 1.52 Name of the College : ______________ _________________________ Date of Ins pection : ________________________________________ STAFF DECLARATION FOR M – 2008 – 2009. Present Desi gnation:_________________________________________________________ 1. 1.(e) vi.(e)ii.(g ) Copy of Passport /Voter Card / Ration Card / Electricity Bill / Driving License Attached as a proof of residence.

D. 4 . Year Regist rati on No. 3.Pharm College & Univ. degree attach ed.53 1.(i)a Joining report at the present institut e attached. 2.Pharm Ph.(a ) Before joini ng present institution I was worki ng at __________________________________ as _____________________________________ and relieved on ______________________ aft er resigning / retiring (Relieving order is enclosed from the previous institution). Copies of valid State Pharmacy Council Registrati on Certificate to be attached. Qualifications : Quali fi cation B.(b ) I am not worki ng anywhere else in the State or outside the State in any capacity full-time / part -time.(a ) 2. with SPC Name of the Pharmacy Council State M. Signature of the Head of the Institution 53 Signature of the Inspectors . 2.(b ) Copies of Degree certificates of UG and PG/and Ph.D. Det ails of the previ ous appointments/teaching experience Designation Department Name of Institution From DD/MM/YY To DD/MM/YY Total Experience in years & months Lecturer Assist ant Professor Associat e Professor Professor 4 .

(b ) 5 .(a ) 7 . It is declared that each stat ement and/ or cont ents of t his declaration and /or documents. certi fi cates submitted alongwith the decl aration form. is ______________________/ I am not havi ng PAN C ard.(c ) (Copy of my PAN & Form 16 (TDS certi fi cate) for fi nanci al year __________are attached) Decl arati on 1. I have drawn total emoluments from this college as under:- Amount Received July. 2008 January.(c ) 6. 2009 May. Signature of the Empl oyee: Endorsement Date: Place: This endorsement is the certi fication that the undersi gned has satisfied himsel f /hersel f about the correct ness and veracity of each cont ent of t his declaration and endorses the abovementioned declaration as true and correct. 2009 TDS 7 . 2009 March. 2. 2008 Octob er. Number of Research publications in Journals duri ng the last 3 (Three) academi c years : 5 . I have not worked at any ot her P harmacy college/Industry or present ed mysel f at any i nspecti on from October 2007 onwards till dat e. 2008 August. by the undersigned are absolut ely true.54 5.(a ) 5 . 2009 April. 2008 November.(b ) Int ernational Journals:___________________________ National Journals:_______________________________ State/Other Journals:_____________________________ Number of Research Proj ects on hand:_______________________ I am having PAN Card and my PAN No. In the event of any st at ement made in this declaration subsequently turning out to be incorrect or false the undersigned has understood and accept ed that such misdeclaration in respect to any content of t his declaration shall also be treated as a gross misconduct thereby renderi ng the undersi gned liable for necessary disciplinary action (incl udi ng removal of his name from Pharmacy Register). 2009 June. Signature of the Head of the Institution 54 Signature of the Inspectors . 2008 Septemb er. 2009 February. correct and auth entic. 2008 Decemb er. 7 .

Relieving ord er from the previ ous institution.Pharm. Authoriti es : Passport / Driving Licence / PAN Card / Voter ID/PCI Smart ID Card/State Pharmacy Council ID Certi fi ed copi es of present appoi ntment order at present institute./Ph.(a) 7.(g) 1. The person will not be counted as a teachers if the original of Photo ID proof./M. Date: Place: Count ersi gned by the Director/ Dean/Princi pa l Remarks S.(d) Documents Recent Passport size photo of t he Employee. 4. Photo ID proof issued by Govt. Signature of the Head of the Institution 55 Signature of the Inspectors . Signed by Dean / Princi pal of the coll ege.D. Formatted: Right 2.(i)a 2. Registration Certificates / Degree certificates / PAN Card are not produced for verification at the time of inspection. PAN Card Form 16 (TDS certificate) for financial year 2006-2007 Submitted Yes / No Yes / No Yes/No Yes / No Yes/No Yes / No Yes / No Yes / No Yes / No Yes / No 1.Pharm.(c) Signed by the Teacher : Date : Signed by the Inspector : NOTE : 1.(c) 1.(e)(i)a 1. Joini ng report at the present institute.No 1. Countersigned by Dean / Principal. Copies of Degree certificates B. Copy of ex peri ence certificate for all teaching appointments held before joining present institute. Copy of Passport /Voter Card / Ration Card / Electricity Bill / Driving License Attached as a proof of residence. Date : Date : The Declaration Form will not be accepted and the person will not be counted as teacher if any of the above documents are not enclosed / attached with the Declaration Form.(a) 7.55 I have verified the certificates/ documents submitted by the candidate with the original certificates/ documents as submitted by the teach er to the institute and with the concerned institute and have found them to be correct and authentic. In the event of this declaration turning out to be either incorrect or any part of this declaration subsequently turning out to be incorrect or false it is understood and accepted that the undersigned shall also be equally responsible besides the declarant himself/herself for any such misdeclaration or misstatement. 3.

Pharm & Pharm. Details of Academic calendar. Latest audited financial statement of the institute. Budget allocation and utilization. Building area details of the Institution for conducting existing courses.B Checklist for PCI Inspectors S. Approval and NOC / Affiliation orders from PCI / University showing academic year with intake for B. Particulars Enclosed / Verified Remarks of the Ins pectors 3. 4. No 1. Document showing registration of the Society / Trust/ Management. 9.56 APPENDIX I . Additional area provided for Pharm.D programs. Signature of the Head of the Institution 56 Signature of the Inspectors . 5. 2. Signed copy of MOU with a 300 bedded (minimum) hospital and its details. 8. 7. Constitution of GC/GB of the institution and minutes of the meetings held in the past 3 years. 10. Details of the Inspection/ Affiliation fee paid to PCI. a.D programs.D & Pharm. b. Pharm. Pharmacy Practice department layout and location map in the hospital.D Post Baccalaureate staff list and declaration forms with required documents. 6.

13. 17. Statistics details showing hospital Bed occupancy rate. Verification of essential records (as per SIF Part V documentation) Examination results of the institution for the previous academic year. etc. List of books and journals specific for Pharm. 12. and case presentation records. Signature of the Inspectors Signature of the Head of the Institution 57 Signature of the Inspectors . Time table of theory /practical and hospital postings. Student hospital activity details like ward round participation. 15.57 11. 14.D course and the numbers added in last three academic years. Details of the CPE / Workshop / seminar programs conducted in the institution (For previous two years). patient counseling. drug information service. List of Preceptors at Hospital. 16.

58 Signature of the Head of the Institution 58 Signature of the Inspectors .

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