Checklist for Gap Analysis of Training Site

Name of the State :- _____________________________________________________

Name of the District
Name of the Training Institute
Address
Name & Designation of
the Head of the institute
Contact Details
Name & Signature of the
person collecting information
Date:- ________________
:- _____________________________________________________
:- _____________________________________________________
:- _____________________________________________________
:- _____________________________________________________
:- Office :- __________________ Mobile :- _______________
Fax :- _________________ Email :- ________________
:- _____________________________________________________

I Infrastructure
1 Facilities
Government Building -1
1.1 Rented Building -2
Any Other -3
Functional =1 If Non-functional, Give
Yes = 1
Non-Functional = 2 reason /
No = 2
NA =3 Remarks, If any
1.2 Lecture Hall
If Yes, Seating Capacity in
numbers
A/C (Give Number )
Non A/C (Give Number)
1.3 Class rooms
If Yes, Seating Capacity in
numbers
A/C (Give Number)
Non A/C (Give Number in
Remarks)
1.4 Seminar/Conference Hall
If Yes, Seating Capacity in
numbers
A/C (Give Number)
Non A/C (Give Number)
1.5 Auditorium
If Yes, Seating Capacity in
numbers
A/C (Give Number)
Non A/C (Give Number)
1.6 Faculty rooms

1
 A/C (Give Number)
Functional =1 If Non-functional, Give
Yes = 1
S.No. Non-Functional = 2 reason /
No = 2
NA =3 Remarks, If any
Non A/C (Give Number)
Lighting arrangement adequate in
1.7
lecture halls and class rooms
Sound arrangement adequate in
1.8
lecture halls and class rooms
1.9 Toilet Facility
1.10 Water Supply
1.11 Electricity (sockets with extension
cord)
1.12 Power Back up (Inverter or
Generator)
1.13 Photocopy machine
1.14 Internet facilities
1.15 Phone
1.16 Fax Facility
1.17 In house mess facility
1.18 Transport facilities / Vehicle
Attached Facility for hands on
1.19
training (Clinical attachment)
1.20 Arrangement for tea/snack/lunch
1.21 Hostel facility available
No. of rooms(Give no.)
A/C
Non A/C
Single rooms(Give no.)
A/C
Non A/C
Double Occupancy(Give
no.)
A/C
Non A/C
Dormitory(Give no.)
A/C
Non A/C
Boundary wall around the hostel
1.22
present
1.23 Security arrangements available
Hostel within the campus
1.24
If no, mention the distance from the
institute(In actual)
Transport facility available for
1.25
mobility of the trainees

2
 2 Training aids
2.1 Audio Visual Aid with Accessories
Functional =1
Yes=1 If Non-functional, Give reason /
Indicators Non-Functional =2
No=2 Remarks, If any
NA =3
2.1.1 OHP
2.1.2 Projector
2.1.3 LCD TV
2.1.4 DVD
2.1.5 Demonstration Models
2.1.6 Cordless Mike
2.1.7 Tape Recorder
2.1.8 PA System
2.1.9 Mannequins
2.1.10 Camera
2.1.11 Conference System
2.2 Modules
2.3 IEC material
Blackboard with Chalk &
2.4
Duster
White board with Marker Pen &
2.5
Duster
2.6 Flip charts

3 Library Facility
Yes=1 Functional =1 If Non-functional, Give reason /
No=2 Non-Functional =2 Remarks, If any
NA =3
Literature available in form of
3.1
Books, Journals, Magazines
3.2 Training Guidelines/Modules
3.3 Borrowing Facilities
3.4 Internet Facilities
Photocopying Facilities

4 Computer Facility
Yes=1 Functional =1 If Non-functional, Give reason /
No=2 Non-Functional =2 Remarks, If any
NA =3
Computers accessible to
4.1
trainees
4.2 Scanner
4.3 Internet accessible to trainees
4.4 Software facility available
Statistical Package for Social
4.5
Sciences (SPSS)
4.6 EPI Info
5 Other Facilities for Trainees
5.1 STD call facilities

3
 5.2 Recreation facilities
Yes=1 Functional =1 If Non-functional, Give reason /
No=2 Non-Functional =2 Remarks, If any
NA =3
5.2.1 Television
5.2.2 Games(Carom, TT, Chess etc.)
5.2.3 Magazines
6 Residential facility for staff

II Status of Human Resource*

In
Name of the Post Sanctioned Positio Vacant Vacant Since Reasons for vacancy
n

* Give information on faculty, supporting staff &contractual staff (Consultants, computer assistants etc)

4
 III Profile of the Teaching/Training Staff
whether
In position Remarks,
Name Designation Qualification received TOT
since (Year) If any
or not
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

IV Details of Trainings conducted at the training institute

Mechanism for Facility Name of
Evaluation for the
Number
Training Field / Facility
Name of Category of Follow
Duration Methodology Clinical for
Training Trained persons Ongoing up of
used training field /
Trained Training Trained
available clinical
Personnel
(Yes/No) training

Note:-Append the copy of Annual training Calendar

5
V Details of Facility/Institute attached for field / clinical training
Whether located
Name of Health Name of within the Who are the
Facilities available
Care Facility the hands premises of the Trainers
for transporting the Remarks,
/Institute used on Training providing
trainees to the If any
for hands on training institute skilled
facility
training provided (If not mention Training
the distance)

VI Finance
Mention the
1 Source of Finance corresponding Remarks, If any
number
• Central -1
• State -2
• Development partners -3
• Both Central & State -4
• Both Central & development Partners -5
• Both State & development Partners -6
2 Procedure for getting finance
• Treasury -1
• ECS transfer -2
• Both Treasury & ECS transfer -3
Yes=1 / No=2 If No, Give Remarks

3 Do the institute receive the entire proposed budget

4 Do the institute receive its budget on time
5 Approximate Annual Budget proposed for last 2 years *
6 Emoluments received in last 2 years *
* Append a copy