1

GOVERNMENT OF KARNATAKA Form No:

Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

ANNEXURE-I
Documents to be maintained by Individual course coordinator/Lecturer
(To be submitted at the time of Inspection)

Sl. Ref No Particulars INS - FORMAT No

No
1 Vision and Mission of the institute 01

2 Vision, Mission, And Program Education Objectives of the 02

Program

3 Academic Calendar of The Institution 03

4 Academic Calendar of The Program 04

5 Class Time Table 05

6 Lab/workshop Time Table 06
7 Personnel Time Table 07

8 Approved Key List of The Students 9

9 Lesson Plan 10
10 Details of Seminars and workshops conducted to bridge the 11
curriculum gap
11 Details Of Concepts Covered by The Course 12
coordinator at the end every month
12 CIE (written Test) Format (1st & 2nd Year) 13
13 CIE (Skill Test) Format (1st & 2nd Year) 14

14 CIE (Pathway Courses) Format (5th semester) 15

15 Attainment of Course outcome 16

16 Attainment of Program outcome and Program Specific Outcome 17

17 Details of the remedial classes conducted for students with poor 18

academic performance
18 Class attendance Register with R.R.No

19 Proctor dairy

20 Course file:
 Profile of the Lecturer
 Syllabus copies of the course
 Work allotment letter
 Course material such as Notes/PPT/e-content, Any other
learning resource material
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

 SEE Question Paper and Model question papers related

to the course
 Scheme of valuation with Model Answers for CIE-Tests
 Laboratory manuals
 Sample of lab records, blue books, drawing sheets for
Verification
 List of projects guided, and Title of the Project presently
guiding.
21 Record Of additional Duties entrusted (NSS, NCC, CCTEK, etc.)

22 Details of short-term training program and workshops attended.

23 Stock Ledgers of Equipment’s, Consumables,

with individual R.R. Nos. and the updated Indent Book.
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-01

Institution Name: Institution code:

Vision and Mission of the institute

Vision of the Institute:

Mission of the Institute:

Signature of the Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-2

Institution Name: Institution code:

Program:

Vision, Mission, And Program Education Objectives of the Program

Vision of the Program:

Mission of the program:

Program Education Objectives (PEO):

PEO 1 -

PEO 2 -

PEO 3 -

PEO n -

Establish consistency of PEOs with Mission of the Program/Department

PEO M1 M2 Mn

PEO 1

PEO 2

PEO 3

PEO n

Signature of the Program coordinator Signature of the Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-3

Academic Calendar of the Institution

Institution Name: Institution code: Academic year:

Week Day Date Activities

Morning Session Afternoon Session

Monday
Tuesday
Wednesday
1
Thursday
Friday
Saturday
Sunday

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Note All the Co-Curricular (Including Curriculum gap), Extra Curricular activities for odd & even Semester are to be
planned at the commencement the academic year in line with the BTE academic calendar of events.

Signature of the Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-4
Academic Calendar of the Program
Institution Name: Institution code: Academic year:

Week Day Date Activities

Morning Session Afternoon Session

Monday
Tuesday
Wednesday
1
Thursday
Friday
Saturday
Sunday

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Note: 1. All the Co-Curricular (Including Curriculum gap), Extra Curricular activities for odd & even Semester
are to be planned at the commencement the academic year in line with Institution academic calendar of
events.

Signature of the HOD & Seal Signature of the Principal with Seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-5
Class Time Table for The Year: 202 _- 202 _
Institution Name: Institution code: Academic year: With effect from:

Name of the Program: Semester: L.H./DH No:

DAY PERIOD 1 2 3 4 5 6 7

TIME

MON

TUE

WED

THU

FRI

SAT

Note :1) Duration of each period is one hour.

2) Monday to Friday contact hours - 7 Hours
3) Saturday Contact Hours – 5 hours
4) Total Contact Hours / week – 40 Hours.

Signature of the Program coordinator with Seal Signature of Principal with Seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-6
Lab/workshop Time Table for The Year: 202 _ - 202 _
Institution Name: Institution code: Academic year: With effect from:

Name of the Program: Semester: Name of the Lab incharge:

DAY PERIOD 1 2 3 4 5 6 7

TIME

MON

TUE

WED

THU

FRI

SAT

Note :1) Display lab Time Table in all the LABORATORIES. indicating name of the lab conducted & Batches as per Scheme of Studies.
2) Monday to Friday contact hours - 7 Hours
3) Saturday Contact Hours – 5 hours
4) Total Contact Hours / week –40 hours

Signature of lab in charge/Foreman Signature of program coordinator with Seal Signature of Principal with Seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-7
Personnel Time Table for The Year: 202 _ - 202 _
Institution Name: Institution code: With effect from:
Name of the Program: Semester/s: Academic year:
Name of the Course Co-Ordinator: Designation: .

Time-
Sl. No. of Week Room >
Course/subject Class Time
No. Students Day No.
Day !

Mon

Tue

Wed

Thur

Fri

Sat

Note: 1) Shade the hours engaged with different pattern for different courses
2) Where a class is handled jointly with other staffs indicate the name of the joint staff in “Subject” column.

Theory(T) Lab/Practical (P) Drawing(D) Total:(T+P+D) contact hours

……… hrs. ……….. hrs. ……….. hrs. ……… hrs.
Signature of course coordinator Signature of program coordinator with Seal Signature of Principal with Seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-9
Approved Key List of the Students for the Academic Year: 202 - 202_

Institution Name: Institution code:

Name of the Program: Semester: Academic year:

Sl.No Register Number of the Student Name Of the Student Remarks

1

Signature of the Principal With seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-10
Lesson Plan: year 202 _ - 202 _
Institution Name: Institution code:
With Effect from: Name of the Program: Semester:
Academic year: Name of course coordinator: Course:

Session CO PO Concepts Planned Time Concept Teacher Student Pedagogy Teaching Learning Remarks by
No Planned date Allotted Covered Activity Activity Adopted aids used outcomes Program coordinator
Week achieved

1
1
2

13 n

Signature of course coordinator Signature of program coordinator with Seal

Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-11

Details of Seminars and workshops conducted to bridge the gap in curriculum(gap)

Institution Name: Institution code:

Academic year:

Name of the Program:

Semester:

Name of course coordinator:

Course:

Sl Gap Action Date Resource Mode No of Relevance

No Taken Person with (Online/Off Students to PO and
Designation line) Attended PSO

Signature of course coordinator Signature of program coordinator with Seal

Signature of Principal wit seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-12

Details of the Concepts Covered by the Course Coordinator at the end of

every month

Institution Name: Institution code:

Academic year:

Name of the Program:

Semester:

Sl. Name of the Course Semester No. of No. of No. of Percentage of Signature of the
No. Course Taken sessions as sessions sessions concepts Course coordinator
Coordinator per taken to be Covered
syllabus taken
1

Signature of course coordinator Signature of program coordinator with Seal

Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-13
CIE (written Test) Format (1st & 2nd Year)

Institution Name: Institution code:

Name of the Program: Academic year:

Course I/II/III/IV Date

CIE (written Test) I/II/III Sem
Name

Course 30
Duration 80 mins Marks
Code

Note: Answer one full question from each section. Each full question carries 10 marks.

Cognitive Course Program

Section Assessment Questions Marks
Levels Outcome Outcome

1
I
2

3
II
4

5
III
6

Note:

 Question should test the Knowledge attained during the course

 Each question may have one, two or three subdivisions.
 Choice questions in each section must carry the same weightage of marks, Cognitive level, and
course outcomes.
 Institutions can modify the above format as per requirement of the course/program curriculum
only after approval from IQAC

Signature of Paper Setter Scrutinised by Approved by IQAC Chairmen Signature of the Principal with seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-14
CIE (Skill Test) Format (1st & 2nd Year)

Institution Name: Institution code:

Name Of the Program: Academic year:

Course I/II/III/IV Date

CIE (Skill Test) I/II/III Sem
Name

Course Conduct for 100

Duration 180 mints Marks
Code marks

Cognitive Course Program

Assessment Questions Marks
Levels Outcome Outcome

Note:

 Question should test the skill attained during the course

 Skill test must be conducted for 100 marks
 Number of questions are as mentioned in the curriculum
 Questions should be at same cognitive level as that of SEE
 Use the same scheme of valuation as that of SEE
 Institutions can modify the above format as per requirement of the course/program curriculum
only after approval from IQAC

Signature of Paper Setter Scrutinised by Approved by IQAC Chairmen Signature of the Principal with seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-15
CIE for Pathway Courses (5th semester)

Institution Name: Institution code:

Name of the Program: Academic year:

Semester V
Partway Course Max Marks 30
Pathway Course Duration 4 hours
Code
Name of the course Date
coordinator
Note: Answer one full question from each section
Q. No. Question CL CO PO Marks
L3/L4
Section-1 (Theory) – 10 marks
1.a)
b)
2.a)
b)
Section-2 (Practical) - 20 marks
3)
4)

Note:

 Question should test the Knowledge and skill attained during the course
 Questions should be at same cognitive level as that of SEE
 Use the same scheme of valuation as that of SEE 2

Signature of Paper Setter Scrutinised by Approved by IQAC Chairmen Signature of the Principal with seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-16
Attainment of Course Outcome

Institution Name: Institution code:

Program:
Semester: Session: July-Nov 202-
Course: Course code:
Course coordinator: Academic year:
Note: IQAC of the Institution can set the Attainment level based on the past data of Student performance in the program/course
Attainment Description
Level 1 60% of the students reached the target
Level 2 70% of the students reached the target
Level 3 80% of the students reached the target
Course Outcome Target
Continuous Internal Evaluation 60% of the marks
Semester End Examination Class Average

Note: IQAC of the Institution can set the Course Outcome Target based on the past data of Student performance in the program/course

Mapping of Course Outcome with the Questions in the CIE Test/practicals/Activities/Assignment/Workshops/Seminars/Industry visits/etc

CO CIE 1 CIE 2 CIE 3 CIE 4 CIE 5 Practical’s Activities Assignments Workshops Seminars Industry visits Any other
CO1
CO2
CO3
CO4
Contd

INS - FORMAT-16
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

Attainment of Course Outcome

Continuous Internal Evaluation (CIE)

CO 1 – Write the Course Outcome Statement
CO 1 Linked with POs and PSOs- Map the CO1 linked with the Program Outcomes (POs) and Program Specific Outcomes Semester End Exams
(PSO)
Assessment Tools CIE1 CIE2 CIE3 CIE4 CIE5 CIE..n Activities, Total Total Target
etc.. Marks Marks marks
Map the allotted for scored by Achieved Marks Target
Question/responses CO 1 from the student (Y/N) Scored in marks
belongs to CO1 in CIE, All for CO 1 SEE Achieved
Activities, Assessments, Assessment from All (Y/N)
Workshops, seminars, Tools Assessment
industrial visits etc.. Tools
Allotted marks for
questions on CO1
Reg Name of the
No student
1

n
Number of Students Achieved the Target
Percentage of Students Achieved the Target
Attainment Level
Overall CO1 Attainment level considering 40% of CIE and 60% of SEE
Note:
 This format can be used for all COs of the Course
 This format can be modified depending upon Course/Program requirement after approval from IQAC as per the needs of the curriculum

Signature of course coordinator Signature of program coordinator Signature of IQAC Chairmen Signature of Principal wit seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS FORMAT-17
Attainment of Program Outcome (PO) and Program Specific Outcomes (PSO)
Institution Name: Institution code:
Program:
Semester: Session: July-Nov 202-
Course: Course code:
Course coordinator: Academic year:
Map Course Outcomes with PO and PSO using 1,2,3 Strengths (1-Low,2-Medium,3- High) in below Table

Course Outcomes Program Outcome Program Specific Outcomes

PO1 PO2 PO3 PO4 PO5 PO6 PO7 PSO1 PSO2

CO1
CO2
CO3
CO4
Calculate and Tabulate the PO and PSO Attainment using Strengths 1,2,3 (Direct Method) in below table

Course Outcomes CO Attainment Program Outcome Program Specific

Outcomes
PO1 PO2 PO3 PO4 PO5 PO6 PO7 PSO1 PSO2

CO1
CO2
CO3
CO4
Average

Note: Prepare similar PO –PSO Attainment (Direct method) calculation for all the courses of a program contd
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-17
Attainment of Program Outcome (PO) and Program Specific Outcomes (PSO)
Indirect attainment based on student exit survey, alumni survey, and employer survey

Type of Survey Indirect PO and PSO Attainment

Student exit survey
Alumni survey
Employer survey
Average
Note- Prepare similar PO –PSO Attainment (Indirect method) for all PO and PSO

Tabulate the PO –PSO Attainment for all the courses of a program

Course Course Code Program Outcome Program Specific Outcomes

PO1 PO2 PO3 PO4 PO5 PO6 PO7 PSO1 PSO2

n
Direct PO Attainment
(Avg of all courses)
Indirect PO Attainment
(Avg of 3 surveys)
Overall PO Attainment
(80% direct+ 20% indirect)

Signature of course coordinator Signature of program coordinator Signature of IQAC Chairmen Signature of Principal wit seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-18
Details of the Remedial classes conducted for students
Institution Name: Institution code:

Name of the Program: Academic year:

Semester Course Reg No Name of Concepts needs Date of Impact Signature of the
the Remedial class delivery Observed Course
Student Coordinator

Signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

ANNEXURE-2

Documents to Be maintained by HOD/Program Coordinator

(Documents to be submitted at the time of Inspection)

Sl. Ref No Particulars INS -FORMAT No

No

1 Vision and Mission of the institute H1

2 Vision, Mission, and Program Education Objectives of the H2
program

3 Academic Calendar of the Institution H3

4 Academic calendar of the Program H4

5 Class Time Table H5

6 Lab Time Table H6

7 Personnel Time Table H7

8 Master Section Time Table H8

9 Approved Key List of the Students H9

10 Lesson Plan H10

11 Details of Seminars and workshops conducted to bridge the H11

curriculum gap
12 Details of the Concepts Covered by The Course H12
coordinator at the end every month
13 CIE (written Test) Format (1st & 2nd Year) H13

14 CIE (Skill Test) Format (1st & 2nd Year) H14

15 CIE (Pathway Courses) Format (5th semester) H15

16 Attainment of Course Outcome H16

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

17 Attainment of Program Outcome (PO) and Program Specific H17

Outcomes (PSO)
18 Details of the remedial classes conducted for H18
students
19 Success index without backlog. H19

20 Success index with backlog. H20

21 Academic performance Index for year-1 H21

22 Academic performance Index for year-2 H22

23 Academic performance Index for year-3 H23
24 Placement Index for 3 years H24
25 Result analysis - Faculty wise H25
26 Result analysis – Program wise H26
27 Consolidated Attendance Register (with R.R.No.) H27
28 Shortage of attendance to be announced at the end of every H28
month.
29 Final attendance report to be sent to SBTE H29
30 Consolidated I.A. Marks Register (with R.R.No.) H30
31 Faculty information of all Teaching and non-Teaching staff H31
32 Facility and Technical support H32
33 Statement Showing List of Lab/ workshop Equipment H33

34 Department meeting minutes Register and proceedings

35 BTE Result Sheet

36 C09, C 15 and C20 Curriculum document.

37 Records of meeting & discussions held with all Stake
holders.
38 Record Of additional Duties entrusted to faculty (NSS, NCC,
CCTEK, etc.)
39 Details of Publication of technical magazines, newsletters,
etc.,
40 Participation in inter-institute / state/national events by
students of the program of study
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H1

Institution Name: Institution code:

Vision and Mission of the institute

Vision of the Institute:

Mission of the Institute:

Signature of the Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H2

Institution Name: Institution code:

Program:

Vision, Mission, And Program Education Objectives of the Program

Vision of the Program:

Mission of the program:

Program Education Objectives (PEO)

PEO 1 -

PEO 2 -

PEO 3 -

PEO n -

Establish consistency of PEOs with Mission of the Department

PEO M1 M2 Mn
PEO 1
PEO 2
PEO 3
PEO n

Signature of the Program coordinator Signature of the Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H3
Academic Calendar of the Institution
Institution Name: Institution code: Academic year:
Week Day Date Activities

Morning Session Afternoon Session

Monday
Tuesday
Wednesday
1
Thursday
Friday
Saturday
Sunday

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Note:All the Co-Curricular (Including Curriculum gap), Extra Curricular activities for odd & even Semester are to be
planned at the commencement the academic year in line with the BTE academic calendar of events.

Signature of the Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H4
Academic Calendar of the Program
Institution Name: Institution code: Academic year:

Week Day Date Activities

Morning Session Afternoon Session

Monday
Tuesday
1 Wednesday
Thursday
Friday
Saturday
Sunday

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Note: 1. All the Co-Curricular (Including Curriculum gap), Extra Curricular activities for odd & even Semester are
to be planned at the commencement the academic year in line with Institution academic calendar of events.

Signature of the HOD & Seal Signature of the Principal with Seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H5

Class Time Table for The Year: 202 _ - 202 _ _

Institution Name: Institution code: Academic year: With effect from:
Name of the Program: Semester: L.H./DH No:

DAY PERIOD 1 2 3 4 5 6 7

TIME

MON

TUE

WED

THU

FRI

SAT

Note :1) Duration of each period is one hour.

5) Monday to Friday contact hours - 7 Hours
6) Saturday Contact Hours – 5 hours
7) Total Contact Hours / week – 40 Hours.

Signature of program the Program coordinator with Seal Signature of Principal with Seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H6

Lab/workshop Time Table for The Year: 202 _ - 202 _

Institution Name: Institution code: Academic year: With effect from:

Name of the Program: Semester: Name of the Lab in charge:

DAY PERIOD 1 2 3 4 5 6 7

TIME

MON

TUE

WED

THU

FRI

SAT

Note :1) Display lab Time Table in all the LABORATORIES. indicating name of the lab conducted & Batches as per Scheme of Studies.
5) Monday to Friday contact hours - 7 Hours
6) Saturday Contact Hours – 5 hours
7) Total Cotact Hours / week –40 hours

Signature of lab in charge/Foreman Signature of program coordinator with Seal Signature of Principal with Seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H7
Personnel Time Table for The Year: 202 - 202 _
Name of Institution: Institution code: With effect from:

Name of the Program: Semester: Academic year:

Name of the Course Co-ordinator: Designation: .

Time-
Sl. No. of Week Room
Course Class Time
No. Students Day No.
Day
Mon
Tue
Wed
Thur
Fri

Sat
Note: 1) Shade the hours engaged with different pattern for different courses
3) Where a class is handled jointly with other staffs indicate the name of the joint staff in ‘Subject” column.

Theory Practical Drawing Total in contact hours

……… hrs. ……….. hrs. ……….. hrs. ……… hrs.

Signature of course coordinator Signature of program coordinator with Seal Signature of Principal with Seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H8
Master Section Time Table for the Year: 202 -202_
Name of Institution: Institution code: With effect from:

Name of the Program: Semester: Academic year:

PERIOD 1 2 3 4 5 6 7
DAY CLASS
TIME

I / II Sem

MON III/IVSem

V/VISem

I / II Sem

TUE III/IVSem

V/VISem

I / II Sem

WED III/IVSem

V/VISem

I / II Sem

THU III/IVSem

V/VISem

I / II Sem
FRI
III/IVSem
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

V/VISem

I / II Sem

SAT III/IVSem

V/VISem

Signature of program coordinator with Seal Signature of Principal with seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H9

Approved Key List of the Students for the Academic Year: 202_ -202_

Name of Institution: Institution code:

Name of the Program: Semester: Academic year:

Sl.No Register Number of the Student Name Of the Student Remarks

Signature of the Principal With seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H10
Lesson Plan the year: 202 - 202 _
Name of Institution: Institution code: With Effect from:

Name of the Program: Semester: Academic year:

Name of course coordinator: Course:

Week Session CO PO Concepts Planned Time Concept Covered Teacher Student Pedagogy Teaching Learning outcomes Remarks by
No Planned date Allotted Activity Activity Adopted aids used achieved Program
coordinator

1
1
2
3
4

13 n

Signature of course coordinator Signature of program coordinator with Seal Signature of Principal with Seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H11

Details of Seminars and workshops conducted to bridge the gap curriculum gap

Name of Institution: Institution code: Academic year:

Name of the Program: Semester:

Name of course coordinator: Course:

Sl Gap Action Taken Date Resource Person with Mode (Online/Off No of Students Relevance to
No Designation line) Attended PO and PSO

Signature of course coordinator Signature of program coordinator with Seal Signature of Principal wit seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H12

Details of the Concepts Covered by the Course Coordinator at the end every month

Name of Institution: Institution code: Academic year:

Name of the Program: Semester:

Sl. Name of the Course Semester No. of sessions No. of sessions No. of sessions Percentage of Signature of the
No. Course Coordinator Taken as per syllabus taken to be taken concepts Covered Course coordinator

Signature of course coordinator Signature of program coordinator with Seal Signature of Principal with Seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H13
CIE (written Test) Format (1st & 2nd Year)

Name of Institution: Institution code:

Name of the Program: Academic year:

Course I/II/III/IV Date

CIE (written Test) I/II/III Sem
Name

Course 30
Duration 80 Mints Marks
Code

Note: Answer one full question from each section. Each full question carries 10 marks.

Cognitive Course Program

Section Assessment Questions Marks
Levels Outcome Outcome

1
I
2

3
II
4

5
III
6

Note:

 Question should test the Knowledge attained during the course

 Each question may have one, two or three subdivisions.
 Choice questions in each section must carry the same weightage of marks, Cognitive level, and course outcomes.
 Institutions can modify the above format as per requirement of the course/program curriculum only after approval
from IQAC

Signature of Paper Setter Scrutinised by Approved by IQAC Chairmen Signature of the Principal with seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H14
CIE (Skill Test) Format (1st & 2nd Year)

Name of Institution: Institution code:

Name of the Program: Academic year:

Course I/II/III/IV Date

CIE (Skill Test) I/II/III Sem
Name

Course Conduct for 100

Duration 180 Mints Marks
Code marks

Cognitive Course Program

Assessment Questions Marks
Levels Outcome Outcome

Note:

 Question should test the skill attained during the course

 Skill test must be conducted for 100 marks
 Number of questions are as mentioned in the curriculum
 Questions should be at same cognitive level as that of SEE
 Use the same scheme of valuation as that of SEE
 Institutions can modify the above format as per requirement of the course/program curriculum only after approval
from IQAC

Signature of Paper Setter Scrutinised by Approved by IQAC Chairmen Signature of the Principal with seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H15
CIE for Pathway Courses (5th semester)

Name of Institution: Institution code:

Name of the Program: Academic year:

Semester V
Partway Course Max Marks 30
Pathway Course Code Duration 4 hours
Name of the course Date
coordinator
Note: Answer one full question from each section
Q. No. Question CL CO PO Marks
L3/L4
Section-1 (Theory) – 10 marks
1.a)
b)
2.a)
b)
Section-2 (Practical) - 20 marks
3)
4)

Note:

 Question should test the Knowledge and skill attained during the course
 Questions should be at same cognitive level as that of SEE
 Use the same scheme of valuation as that of SEE 2

Signature of Paper Setter Scrutinised by Approved by IQAC Chairmen Signature of the Principal with seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H16
Attainment of Course Outcome

Name of the Institution: Institution code:

Program:
Semester: Session: July-Nov 202-
Course: Course code:
Course coordinator: Academic year:

Attainment Description
Level 1 60% of the students reached the target
Level 2 70% of the students reached the target
Level 3 80% of the students reached the target
Note: IQAC of
the Institution can set the Attainment level based on the past data of Student performance in the program/course

Course Outcome Target

Continuous Internal Evaluation 60% of the marks
Semester End Examination Class Average
Note: IQAC of the Institution can set the Course Outcome Target based on the past data of Student performance in the program/course
Mapping of Course Outcome with the Questions in the CIE Test/practicals/Activities/Assignment/Workshops/Seminars/Industry visits/etc
CO CIE 1 CIE 2 CIE 3 CIE 4 CIE 5 Practical’s Activities Assignments Workshops Seminars Industry visits Any other
CO1
CO2
CO3
CO4
Contd
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H16
Attainment of Course Outcome
[

Continuous Internal Evaluation (CIE)

CO 1 – Write the Course Outcome Statement
CO 1 Linked with POs and PSOs- Map the CO1 linked with the Program Outcomes (POs) and Program Specific Outcomes (PSO) Semester End Exams
Assessment Tools CIE1 CIE2 CIE3 CIE4 CIE5 CIE..n Activities, Total Total Target
etc.. Marks Marks marks
Map the allotted for scored by Achieved Marks Target
Question/responses CO 1 from the student (Y/N) Scored in marks
belongs to CO1 in CIE, All for CO 1 SEE Achieved
Activities, Assessments, Assessment from All (Y/N)
Workshops, seminars, Tools Assessment
industrial visits etc.. Tools
Allotted marks for
questions on CO1
Reg Name of the
No student
1

n
Number of Students Achieved the Target
Percentage of Students Achieved the Target
Attainment Level
Overall CO1 Attainment level considering 40% of CIE and 60% of SEE
Note:
 This format can be used for all COs of the Course
 This format can be modified depending upon Course/Program requirement after approval from IQAC as per the needs of the curriculum

Signature of course coordinator Signature of program coordinator Signature of IQAC Chairmen Signature of Principal wit seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS FORMAT-H17
Attainment of Program Outcome (PO) and Program Specific Outcomes (PSO)
Name of the Institution: Institution code:
Program:
Semester: Session: July-Nov 202-
Course: Course code:
Course coordinator: Academic year:
Map Course Outcomes with PO and PSO using 1,2,3 Strengths (1-Low,2-Medium,3- High) in below Table

Course Outcomes Program Outcome Program Specific Outcomes

PO1 PO2 PO3 PO4 PO5 PO6 PO7 PSO1 PSO2

CO1
CO2
CO3
CO4
Calculate and Tabulate the PO and PSO Attainment using Strengths 1,2,3 (Direct Method) in below table

Course Outcomes CO Attainment Program Outcome Program Specific

Outcomes
PO1 PO2 PO3 PO4 PO5 PO6 PO7 PSO1 PSO2

CO1
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

CO2
CO3
CO4
Average

Note: Prepare similar PO –PSO Attainment (Direct method) calculation for all the courses of a program

…..CONTD
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H17
Attainment of Program Outcome (PO) and Program Specific Outcomes (PSO)
Indirect attainment based on student exit survey, alumni survey, and employer survey

Type of Survey Indirect PO and PSO Attainment

Student exit survey
Alumni survey
Employer survey
Average

Note- Prepare similar PO –PSO Attainment (Indirect method) for all PO and PSO

Tabulate the PO –PSO Attainment for all the courses of a program

Course Course Code Program Outcome Program Specific Outcomes

PO1 PO2 PO3 PO4 PO5 PO6 PO7 PSO1 PSO2

n
Direct PO Attainment
(Avrg of all courses)
Indirect PO Attainment
(Avrg of 3 surveys)
Overall PO Attainment
(80% direct+ 20% indirect)

Signature of course coordinator Signature of program coordinator Signature of IQAC Chairmen Signature of Principal wit seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H18
Details of the Remedial classes conducted for students
Name of Institution: Institution code:

Name of the Program: Academic year:

Semester Course Reg No Name of Concepts needs Date of Impact Signature of the
the Student Remedial class delivery Observed Course
Coordinator

Signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H19

Success Index without backlogs in any year of study

Name of Institution: Institution code:

Name of the Program: Academic year:

LYGm1 LYGm2
Item LYG

Total number of students admitted to the program including lateral

entry students
Number of students who have passed without backlogs in the
stipulated period of 3 years
Success index (SI)

Average Success index (SI)

SI= (Number of students who have passed from the program without backlog)/ (Number of students admitted in the first
year of that batch plus actually admitted in 2nd year via lateral entry

LYG- Latest year graduation batch

LYGm1- Latest year graduation batch minus 1
LYGm2- Latest year graduation batch minus 2

Signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H20

Success Index with backlogs in any year of study

Name of Institution: Institution code:

Name of the Program: Academic year:

LYGm1 LYGm2
Item LYG

Total number of students admitted to the program including lateral

entry students
Number of students who have passed with backlogs in the stipulated
period of 3 years
Success index (SI)

Average Success index (SI)

SI= (Number of students who have passed from the program with backlog)/ (Number of students admitted in the first
year of that batch plus actually admitted in 2nd year via lateral entry
LYG- Latest year graduation batch
LYGm1- Latest year graduation batch minus 1
LYGm2- Latest year graduation batch minus 2

Signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H21

Academic performance index for the year 1

Name of Institution: Institution code:

Name of the Program: Academic year:

Academic Performance CAYm1 CAYm2 CAYm3

Mean Percentage of all successful

students (X)

Total no. of successful students (Y)

Total no. of students appeared in the
examination (Z)
API = X* (Y/Z)

Average API = (AP1 + AP2 + AP3)/3

API = (Mean of the percentage of marks of all successful students in First Year/ 10)) x (successful students/number of students appeared
in the examination).
Successful students are those who are permitted to proceed to the second year.
CAYm1- Current Academic Year minus 1
CAYm2- Current Academic Year minus 2
CAYm3- Current Academic Year minus 3

Signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H22

Academic performance index for the year 2

Name of Institution: Institution code:

Name of the Program: Academic year:

Academic Performance CAYm2 CAYm3 CAYm4

Mean Percentage of all successful

students (X)

Total no. of successful students (Y)

Total no. of students appeared in the
examination (Z)

API = X* (Y/Z)

Average API = (AP1 + AP2 + AP3)/3

API = (Mean of the percentage of marks of all successful students in Second Year/ 10)) x (successful students/number of students
appeared in the examination)
Successful students are those who are permitted to proceed to the final year
CAYm2- Current Academic Year minus 2
CAYm3- Current Academic Year minus 3
CAYm4- Current Academic Year minus 4

Signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H23

Academic performance index for the year 3

Name of Institution: Institution code:

Name of the Program: Academic year:

Academic Performance LYG LYGm1 LYGm2

Mean Percentage of all successful students (X)

Total no. of successful students (Y)

Total no. of students appeared in the
examination (Z)

API = X* (Y/Z)

Average API = (AP1 + AP2 + AP3)/3

API = (Mean of the percentage of marks of all successful students in Final Year/10) x (successful students/number of students appeared
in the examination)
Successful students are those who passed in all the final year courses
LYG- Latest year graduation batch
LYGm1- Latest year graduation batch minus 1
LYGm2- Latest year graduation batch minus 2

Signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-H24

Placement index for 3 years

Name of Institution: Institution code:

Name of the Program: Academic year:

Item LYG LYGm1 LYGm2
Total No. of Final Year Students (N)
No. of students placed in companies or
Government Sector (X)
No. of students admitted to higher studies
(Y)
No. of students turned entrepreneur in the
respective field of engineering/technology
(Z)
1.25X + Y +Z

Placement Index (P) : (1.25X + Y +Z) /N

Avenage placement= (P1 + P2 + P3) /3

LYG- Latest year graduation batch
LYGm1- Latest year graduation batch minus 1
LYGm2- Latest year graduation batch minus 2

Signature of Placement officer with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS-FORMAT- H25

Result Analysis –Faculty wise

Name of Institution: Institution code: Academic Year:

Name of the Program: Semester: Exam held During:

Sl no Course Name of the Course No of students passed

Coordinator
Appeared for Exam Passed Percentage

Signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS-FORMAT- H26

Result Analysis –Program wise

Name of Institution: Institution code: Academic Year:

Name of the Program: Semester: Exam held During:

Semester No of No of No of No of Total % Of Passed Except In No Of Students %Age Of Smp/
Students Distinction I Class II Class No of Pass Promoted Promoted Withheld
Appeared Pass Including Total Including Cases
Pass Total Pass
ODD EVEN 1 2 3 4 TOTAL
SEM SEM course courses courses courses

2
4
6
Total % Total %
Avg% Avg%

Signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS-FORMAT-H27

Consolidated Attendance Register

Name of Institution: Institution code: Academic Year:

Name of the Program: Semester:

1 2 3 4 .. .. n Total Percentage Remarks

Course
No Of Classes Held

Minimum Attendance Required

[75% Of No of Classes Held]

Reg NO Name of the Student

Initials of the Concerned Staff

Initials Of Program Coordinator

Note: - 1. Shortage of attendance is to be Mentioned in remarks Column, [Less than 75%] either in Individual Subject or in aggregate.

2. No of Classes held should be cumulative.

Signature of Program coordinator with seal signature of IA Verifying officer Signature of the principal with seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS-FORMAT -H28

Shortage of Attendance to be announced at the end of every month

Name of Institution: Institution code: Academic Year:

Name of the Program: Semester: Date of announcement:

Minimum Attendance Required in Each Subject: -75%

Minimum Aggregate Attendance Required: -75%

Reg NO Course 1 2 3 n TOTAL %age

No of classes held. 100

Minimum Attendance 75
Required=75% No of
classes held.
Name of the Student

Signature of Program coordinator with seal Signature of the principal with seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS-FORMAT -H29

Final Attendance Report to be sent to BTE

Name of Institution: Institution code: Academic Year:

Name of the Program: Semester: Date:

SL NO Candidate Name Register No Percentage Of Attendance Obtained in Each Aggregate Remarks

Courses Percentage

1 2 3 4 .. .. n

Initial of the staff member in charge

Note :1) 01,02,03 etc. indicates Sl. No. of the subjects as per the BTE subject Dictionary
2) Attendance Details of all the students of each class Should be announced separately
3) If there is any shortage it should be mentioned in remarks column
4) To the Secretary BTE Bangalore for information
5) To be announced in the students Notice Board

Signature of Program coordinator with seal Signature of the principal with seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS-FORMAT- H30

Consolidated Internal Assessment Register

Name of the Institution Institute Code:

Program: semester:

Academic Year:

Continuous Internal Evaluation for Theory courses of year 1

CIE 1 CIE 2 CIE 3 CIE 4 CIE 5 CIE 6 Total CIE
Sl. Register No. Student Name Written Written Written Average MCQ/ Open Activity/ Average of
No. Test -1 Test -2 Test -3 of Three Quiz Book Assignment Three
written Test Assessment
tests

Max marks allotted 30 30 30 30 20 20 20 20 50

1
2

Signature of the Course coordinator

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

Continuous Internal Evaluation for Integrated courses of year 1

CIE 1 CIE 2 Average CIE 3 CIE 4 CIE 5 Average of CIE 6 Total CIE
of Two Three Skill
written Tests
Sl. Register No. Student Name Written Written tests Skill Test Skill Skill Activity/
No. Test -1 Test -2 Test Test Assignment
Max marks allotted 20 20 20 20 20 20 20 20 60
1
2

Continuous Internal Evaluation for Integrated courses of year 2

CIE 1 CIE 2 CIE 3 CIE 4 CIE 5 Average CIE 6 Total CIE
Average of Two
Sl. Register No. Student Name Written Written Written of Three Skill Skill Skill Tests Tutorial
No. Test -1 Test -2 Test -3 written Test Test (Portfolio
tests evaluation)
Max marks allotted 30 30 30 30 20 20 20 20 50
1
2
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

Signature of the Course coordinator

Continuous Internal Evaluation for Pathway courses of year 3

CIE 1 CIE 2 CIE 3 CIE 4 CIE 5 CIE 5 Online Profile Assignm Total CIE
Course ents
Sl. Register No. Student Name Written Written Written Written Written Written
No & & & & & &
. Practice Practice Practice Practice Practice Practice
Test Test Test Test Test Test
Max marks allotted 30 30 30 30 30 30 40 20 30 240
1
2

Note: Modifications can be made as per the needs of C 20 curriculum after approval from IQA

Signature of Program coordinator with seal Signature of IA Verification Officer Signature of the principal with seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS- FORMAT-H31

Faculty information of all Teaching and non-Teaching staff

Name of the Institution: Institute Code:

Program: semester:

Academic Year:

Distribution of Teaching
Name of the Faculty Qualification Designation Date of Load in %
(Teaching/Non- Joining a b c
Teaching)

a: Faculty of the specific program/ department considering fractional load

b: Faculty serving this program from another Program / department considering fractional load
c: Faculty of this program serving other program/ department considering fractional load

Signature of course coordinator Signature of program coordinator with Seal Signature of Principal wit seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS – FORMAT-H32
Facility and Technical Support

Name of the Institution: Institute Code:

Program: semester:

Academic Year:

Sl No Name of the No of student Name of the Weekly Technical man Power

lab/Workshop per batch major utilization
equipment’s
Lecturer Instructor Assistant Instructor

Signature of program coordinator with Seal Signature of Principal with seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS-FORMAT-H33

Statement Showing List of Lab/ workshop Equipment

Name of the Institution: Institute Code:

Program: Semester:

Academic Year: Lab/Workshop:

Sl. Name of instrument/Equipment/ Machine etc. Quantity as per Quantity Date of Working/ Reasons for not Remarks
No. syllabus actually purchase not working working
available

Note: Attach additional sheet if required

Signature of lab/workshop in charge Signature of Program coordinator with seal Signature of the principal with seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

Annexure‐III

Document to be Maintained by the Internal Quality Assurance Cell (IQAC)

Sl. Ref No Particulars INS – FORMAT No

No
1 Vision and Mission of the institute 1

2 Academic Calendar of The Institution 3

3 Academic Calendar of The Program (all Programs) 4

4 Approved Key List of The Students (all Programs) 9

st nd
5 CIE (written Test) Format (1 & 2 Year) 13
6 CIE (Skill Test) Format (1st & 2nd Year) 14

7 CIE (Pathway Courses) Format (5th semester) 15

8 Scheme of valuation with Model Answers for CIE-Tests ------

9 Attainment of Course Outcome 16

10 Attainment of Program Outcome (PO) and Program 17

Specific Outcomes (PSO)
11 Details of the remedial classes conducted for 18
students with weak academic performance
12 Success index without backlog. 19

13 Success index with backlog. 20

14 Academic performance Index for year-1 21

15 Academic performance Index for year-2 22

16 Academic performance Index for year-3 23

17 Placement Index. 24

18 Result analysis - Faculty wise 25

19 Result analysis – Program wise 26

20 Action plan to improve CO, PO, SI, API, and placement index 27
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

21 Student Mid Semester Feed Back Analysis Form 38

22 Student End Semester Feed Back Analysis Form 39

minutes of meeting Register and proceedings

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-1

Institution Name: Institution code:

Vision and Mission of the institute

Vision of the Institute:

Mission of the Institute:

Signature of the Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-3
Academic Calendar of the Institution
Institution Name: Institution code: Academic year:

Week Day Date Activities

Morning Session Afternoon Session

Monday
Tuesday
Wednesday
1
Thursday
Friday
Saturday
Sunday

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Note: All the Co-Curricular (Including Curriculum gap), Extra Curricular activities for odd & even Semester are to be planned at
the commencement the academic year in line with the BTE academic calendar of events.

Signature of the Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-4
Academic Calendar of the Program
Institution Name: Institution code: Academic year:

Week Day Date Activities

Morning Session Afternoon Session

Monday
Tuesday
Wednesday
1
Thursday
Friday
Saturday
Sunday

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Note: 1. All the Co-Curricular (Including Curriculum gap), Extra Curricular activities for odd & even Semester are to be planned at
the commencement the academic year in line with Institution academic calendar of events.

Signature of the HOD & Seal Signature of the Principal with Seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-9
Approved Key List of the Students for the Academic Year: 202_ -202__

Name Of Institution: Institution code:

Name Of the Program: Semester: Academic year:

Sl.No Register Number of the Student Name Of the Student Remarks

Signature of the Principal With seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-13
CIE (written Test) Format (1st & 2nd Year)

Name Of Institution: Institution code:

Name Of the Program: Academic year:

Course I/II/III/IV Date

CIE (written Test) I/II/III Sem
Name

Course 30
Duration 80 mins Marks
Code

Note: Answer one full question from each section. Each full question carries 10 marks.

Cognitive Course Program

Section Assessment Questions Marks
Levels Outcome Outcome

1
I
2

3
II
4

5
III
6

Note:

 Question should test the Knowledge attained during the course

 Each question may have one, two or three subdivisions.
 Choice questions in each section must carry the same weightage of marks, Cognitive level, and course outcomes.
 Institutions can modify the above format as per requirement of the course/program curriculum only after approval
from IQAC

Signature of Paper Setter Scrutinised by Approved by IQAC Chairmen Signature of the Principal with seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-14
CIE (Skill Test) Format (1st & 2nd Year)

Name of Institution: Institution code:

Name of the Program: Academic year:

Course I/II/III/IV Date

CIE (Skill Test) I/II/III Sem
Name

Course Conduct for 100

Duration 180 mins Marks
Code marks

Cognitive Course Program

Assessment Questions Marks
Levels Outcome Outcome

Note:

 Question should test the skill attained during the course

 Skill test must be conducted for 100 marks
 Number of questions are as mentioned in the curriculum
 Questions should be at same cognitive level as that of SEE
 Use the same scheme of valuation as that of SEE
 Institutions can modify the above format as per requirement of the course/program curriculum only after approval
from IQAC

Signature of Paper Setter Scrutinised by Approved by IQAC Chairmen Signature of the Principal with seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-15
CIE for Pathway Courses (5th semester)

Name of Institution: Institution code:

Name of the Program: Academic year:

Semester V
Partway Course Max Marks 30
Pathway Course Code Duration 4 hours
Name of the course Date
coordinator
Note: Answer one full question from each section
Q. No. Question CL CO PO Marks
L3/L4
Section-1 (Theory) – 10 marks
1.a)
b)
2.a)
b)
Section-2 (Practical) - 20 marks
3)
4)

Note:

 Question should test the Knowledge and skill attained during the course
 Questions should be at same cognitive level as that of SEE
 Use the same scheme of valuation as that of SEE 2

Signature of Paper Setter Scrutinised by Approved by IQAC Chairmen Signature of the Principal with seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-16
Attainment of Course Outcome
Name of the Institution: Institution code:
Program:
Semester: Session: July-Nov 202-
Course: Course code:
Course coordinator: Academic year:

Attainment Description
Level 1 60% of the students reached the target
Level 2 70% of the students reached the target
Level 3 80% of the students reached the target

Note: IQAC of the Institution can set the Attainment level based on the past data of Student performance in the program/course

Course Outcome Target

Continuous Internal Evaluation 60% of the marks
Semester End Examination Class Average

Note: IQAC of the Institution can set the Course Outcome Target based on the past data of Student performance in the program/course
Mapping of Course Outcome with the Questions in the CIE Test/practicals/Activities/Assignment/Workshops/Seminars/Industry visits/etc

CO CIE 1 CIE 2 CIE 3 CIE 4 CIE 5 Practical’s Activities Assignments Workshops Seminars Industry visits Any other
CO1
CO2
CO3
CO4
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

ntd
INS - FORMAT-16
Attainment of Course Outcome

Continuous Internal Evaluation (CIE)

CO 1 – Write the Course Outcome Statement
CO 1 Linked with POs and PSOs- Map the CO1 linked with the Program Outcomes (POs) and Program Specific Outcomes (PSO) Semester End Exams
Assessment Tools CIE1 CIE2 CIE3 CIE4 CIE5 CIE..n Activities, Total Total Target
etc.. Marks Marks marks
Map the allotted for scored by Achieved Marks Target
Question/responses CO 1 from the student (Y/N) Scored in marks
belongs to CO1 in CIE, All for CO 1 SEE Achieved
Activities, Assessments, Assessment from All (Y/N)
Workshops, seminars, Tools Assessment
industrial visits etc.. Tools
Allotted marks for
questions on CO1
Reg Name of the
No student
1

n
Number of Students Achieved the Target
Percentage of Students Achieved the Target
Attainment Level
Overall CO1 Attainment level considering 40% of CIE and 60% of SEE
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

Note:

 This format can be used for all COs of the Course

 This format can be modified depending upon Course/Program requirement after approval from IQAC as per the needs of the curriculum

Signature of course coordinator Signature of program coordinator Signature of IQAC Chairmen Signature of Principal wit seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS FORMAT-17
Attainment of Program Outcome (PO) and Program Specific Outcomes (PSO)
Name of the Institution: Institution code:
Program:
Semester: Session: July-Nov 202-
Course: Course code:
Course coordinator: Academic year:
Map Course Outcomes with PO and PSO using 1,2,3 Strengths (1-Low,2-Medium,3- High) in below Table

Course Outcomes Program Outcome Program Specific Outcomes

PO1 PO2 PO3 PO4 PO5 PO6 PO7 PSO1 PSO2

CO1
CO2
CO3
CO4

Calculate and Tabulate the PO and PSO Attainment using Strengths 1,2,3 (Direct Method) in below table
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

Course Outcomes CO Attainment Program Outcome Program Specific

Outcomes
PO1 PO2 PO3 PO4 PO5 PO6 PO7 PSO1 PSO2

CO1
CO2
CO3
CO4
Average

Note: Prepare similar PO –PSO Attainment (Direct method) calculation for all the courses of a program contd
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-17
Attainment of Program Outcome (PO) and Program Specific Outcomes (PSO)
Indirect attainment based on student exit survey, alumni survey, and employer survey

Type of Survey Indirect PO and PSO Attainment

Student exit survey
Alumni survey
Employer survey
Average
Note- Prepare similar PO –PSO Attainment (Indirect method) for all PO and PSO

Tabulate the PO –PSO Attainment for all the courses of a program

Course Course Code Program Outcome Program Specific Outcomes

PO1 PO2 PO3 PO4 PO5 PO6 PO7 PSO1 PSO2

n
Direct PO Attainment
(Avg of all courses)
Indirect PO Attainment
(Avg of 3 surveys)
Overall PO Attainment
(80% direct+ 20% indirect)

Signature of course coordinator Signature of program coordinator Signature of IQAC Chairmen Signature of Principal wit seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-18
Details of the Remedial classes conducted for students
Name Of Institution: Institution code:

Name Of the Program: Academic year:

Semester Course Reg No Name of Concepts needs Date of Impact Signature of the
the Student Remedial class delivery Observed Course
Coordinator

Signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-19

Success Index without backlogs in any year of study

Name of Institution: Institution code:

Name of the Program: Academic year:

LYGm1 LYGm2
Item LYG

Total number of students admitted to the program including lateral

entry students
Number of students who have passed without backlogs in the
stipulated period of 3 years
Success index (SI)

Average Success index (SI)

SI= (Number of students who have passed from the program without backlog)/ (Number of students admitted in the first
year of that batch plus actually admitted in 2nd year via lateral entry

LYG- Latest year graduation batch

LYGm1- Latest year graduation batch minus 1
LYGm2- Latest year graduation batch minus 2

Signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-20

Success Index with backlogs in any year of study

Name of Institution: Institution code:

Name of the Program: Academic year:

LYGm1 LYGm2
Item LYG

Total number of students admitted to the program including lateral

entry students
Number of students who have passed with backlogs in the stipulated
period of 3 years
Success index (SI)

Average Success index (SI)

SI= (Number of students who have passed from the program with backlog)/ (Number of students admitted in the first
year of that batch plus actually admitted in 2nd year via lateral entry

LYG- Latest year graduation batch

LYGm1- Latest year graduation batch minus 1
LYGm2- Latest year graduation batch minus 2

Signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-21

Academic performance index for the year 1

Name of Institution: Institution code:

Name of the Program: Academic year:

Academic Performance CAYm1 CAYm2 CAYm3

Mean Percentage of all successful

students (X)

Total no. of successful students (Y)

Total no. of students appeared in the
examination (Z)
API = X* (Y/Z)

Average API = (AP1 + AP2 + AP3)/3

API = (Mean of the percentage of marks of all successful students in First Year/ 10)) x (successful
students/number of students appeared in the examination).
Successful students are those who are permitted to proceed to the second year.

CAYm1- Current Academic Year minus 1

CAYm2- Current Academic Year minus 2
CAYm3- Current Academic Year minus 3

Signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-22

Academic performance index for the year 2

Name of Institution: Institution code:

Name of the Program: Academic year:

Academic Performance CAYm2 CAYm3 CAYm4

Mean Percentage of all successful

students (X)

Total no. of successful students (Y)

Total no. of students appeared in the
examination (Z)

API = X* (Y/Z)

Average API = (AP1 + AP2 + AP3)/3

API = (Mean of the percentage of marks of all successful students in Second Year/ 10)) x (successful
students/number of students appeared in the examination)
Successful students are those who are permitted to proceed to the final year

CAYm2- Current Academic Year minus 2

CAYm3- Current Academic Year minus 3
CAYm4- Current Academic Year minus 4

Signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-23

Academic performance index for the year 3

Name of Institution: Institution code:

Name of the Program: Academic year:

Academic Performance LYG LYGm1 LYGm2

Mean Percentage of all successful students (X)

Total no. of successful students (Y)

Total no. of students appeared in the
examination (Z)

API = X* (Y/Z)

Average API = (AP1 + AP2 + AP3)/3

API = (Mean of the percentage of marks of all successful students in Final Year/10) x (successful
students/number of students appeared in the examination)
Successful students are those who passed in all the final year courses

LYG- Latest year graduation batch

LYGm1- Latest year graduation batch minus 1
LYGm2- Latest year graduation batch minus 2

Signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-24

Placement index for 3 years

Name of Institution: Institution code:

Name of the Program: Academic year:

Item LYG LYGm1 LYGm2

Total No. of Final Year Students (N)
No. of students placed in companies or
Government Sector (X)
No. of students admitted to higher studies
(Y)
No. of students turned entrepreneur in the
respective field of engineering/technology
(Z)
1.25X + Y +Z

Placement Index (P) : (1.25X + Y +Z) /N

Avenage placement= (P1 + P2 + P3) /3

LYG- Latest year graduation batch

LYGm1- Latest year graduation batch minus 1
LYGm2- Latest year graduation batch minus 2

Signature of Placement officer with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS-FORMAT- 25

Result Analysis –Faculty wise

Name of Institution: Institution code: Academic Year:

Name of the Program: Semester: Exam held During:

Sl no Course Name of the Course No of students passed

Coordinator
Appeared for Exam Passed Percentage

Signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS-FORMAT- 26

Result Analysis –Program wise

Name of Institution: Institution code: Academic Year:

Name of the Program: Semester: Exam held During:

Semester No of No of No of No of Total % Of Passed Except In No Of Students %Age Of Smp/

Students Distinction I Class II Class No of Pass Promoted Promoted Withheld
Appeared Pass Including Total Including Cases
Pass Total Pass

ODD EVEN 1 2 3 4 TOTAL

SEM SEM course courses courses courses

6
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

Total % Total %
Avg% Avg%

Signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS-FORMAT -27

Action plan for Continuous improvement

Name of the Institution: Institution Code:

Program: Semester:

Academic Year

POs & PSOs Attainment Levels and Actions for improvement

PO Set Target Level Attained Attainment Level Observations

PO1: Statement

PO 1

Action 1:

Action n:

PO 2

Action 1:

Action n:

PO 3

Action 1:

Action n:

PO 4

Action 1:

Action n:

PO 5

Action 1:
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

Action n:

PO 5

Action 1:

Action n:

PO 6

Action 1:

Action n:

PO 7

Action 1:

Action n:

PSO1

Action 1:

Action n:

PSO2

Action 1:

Action n:

Success Index
(without
backlog)

Action 1:

Action n:

API- year 1

Action 1:

Action n:

API- year 2

Action 1:
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

Action n:

API- year 3

Action 1:

Action n:

Placement
Index

Action 1:

Action n:

Signature of the IQAC Chairmen Signature of the Principal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS-FORMAT -38
INTERNAL QUALITY ASSURANCE CELL

Student mid Semester Feed Back Analysis Form

Name of the Institution: Institution Code:

Program: Semester:

Academic Year:

Rating: A: Excellent (4), B: Very Good (3), C : Good(2), D : 1 2 3 4

Satisfactory(1),
2 How well did the teachers prepare for the classes

3 How well were the teachers able to communicate in the class

4 The teacher’s approach to teaching can best be described as

5 How well the teachers identify your strengths and encourage you
with providing right level of challenges
6 How well the Teachers can identify your weaknesses and help
you to overcome them
7 How well the teacher Encourages the class room discussions

9 Rate the Use ICT tools such as LCD projector, Multimedia, KLMS,
etc. by teacher while teaching
10 Rate the Fairness of the internal evaluation process by the
teachers
11 How well Was your performance in assignments discussed with
you
12 How well did the teacher conducts remedial classes

13 Rate the Regularity in checking of laboratory log books/ practical

records/work shop records/activities.
16 How well Your mentor does a necessary follow-up with an
assigned task to you
17 Rate the Availability of portable Drinking water in the college
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

18 Rate the Availability of learning resources – Textbooks, e-

contents, ets
20 Rate Access to computers, internet, KLMS, in the institute

21 Rate the Availability and quality of equipment’s in the lab

22 Rate the Maintenance of class rooms, labs, workshops, Toilets

Note: The Institutions can slightly modify the feedback form after approval from IQAC

Signature of the IQAC Chairmen

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS-FORMAT -39
INTERNAL QUALITY ASSURANCE CELL

Student End Semester Feed Back Analysis Form

Name of the Institution: Institution Code:

Program: Semester:

Academic Year

Rating: A: Excellent (4), B: Very Good (3), C : Good(2), D : 1 2 3 4

Satisfactory(1),
1 How well did the teacher completed the syllabus in the class

2 How well did the teachers prepare for the classes

3 How well were the teachers able to communicate in the class

4 The teacher’s approach to teaching can best be described as

5 How well the teachers identify your strengths and encourage you
with providing right level of challenges
6 How well the Teachers can identify your weaknesses and help
you to overcome them
7 How well the teacher Encourages the class room discussions

8 Rate the Efforts made by the institute/ teachers to inculcate soft

skills, life skills and employability skills
9 Rate the Use ICT tools such as LCD projector, Multimedia, KLMS,
etc. by teacher while teaching
10 Rate the Fairness of the internal evaluation process by the
teachers
11 How well Was your performance in assignments discussed with
you
12 How well did the teacher conducts remedial classes
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

13 Rate the Regularity in checking of laboratory log books/ practical

records/work shop records/activities.
14 How well Teachers inform you about your expected
competencies, course outcomes and programme
15 How well the curriculum supports in achieving expected
competencies, course outcomes and programme
16 How well Your mentor does a necessary follow-up with an
assigned task to you
17 Rate the Availability of portable Drinking water in the college

18 Rate the Availability of learning resources – Textbooks, e-

contents, ets
19 How well the institute takes active interest in promoting
internship
20 Rate Access to computers, internet, KLMS, in the institute

21 Rate the Availability and quality of equipment’s in the lab

22 Rate the Maintenance of class rooms, labs, workshops, Toilets

23 How well the institution provides multiple opportunities to learn

and grow
24 Rate The overall quality of teaching-learning process in your
institute

Note: The Institutions can slightly modify the feedback form after approval from IQAC

Signature of the IQAC Chairmen

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

Annexure‐IV

Documents to be Maintained by the Industry Institute Interaction Cell (III) Cell

Sl. Ref No Particulars INS - FORMAT No

No
1 Vision and Mission of the institute 1

2 Academic Calendar of The Institution 3

3 Academic Calendar of The Program 4

4 Placement Index. 24

5 Details of Carrier guidance Programs 40

6 Details of skill enhancement programs 41
7 Details of Delivery of appropriate Course work by Industry experts 42
8 Details of Industrial training/ internship 43
9 Details of Student Placement in an industry 44
10 Details of Student Placement in a higher education institution 45
11 Details of Professional societies / student chapters and ----
organizing technical events
12 Details of Minutes of meeting and Proceedings ------
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-1

Institution Name: Institution code:

Vision and Mission of the institute

Vision of the Institute:

Mission of the Institute:

Signature of the Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-3

Academic Calendar of the Institution

Institution Name: Institution code: Academic year:

Week Day Date Activities

Morning Session Afternoon Session

Monday
Tuesday
Wednesday
1
Thursday
Friday
Saturday
Sunday

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Note:All the Co-Curricular (Including Curriculum gap), Extra Curricular activities for odd & even Semester are to be
planned at the commencement the academic year in line with the BTE academic calendar of events.

Signature of the Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-4
Academic Calendar of the Program
Institution Name: Institution code: Academic year:

Week Day Date Activities

Morning Session Afternoon Session

Monday
Tuesday
Wednesday
1
Thursday
Friday
Saturday
Sunday

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Saturday
Sunday

Note: 1. All the Co-Curricular (Including Curriculum gap), Extra Curricular activities for odd & even Semester are
to be planned at the commencement the academic year in line with Institution academic calendar of events.

Signature of the HOD & Seal Signature of the Principal with Seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-24

Placement index for 3 years

Name of Institution: Institution code:

Name of the Program: Academic year:

Item LYG LYGm1 LYGm2

Total No. of Final Year
Students (N)
No. of students placed in
companies or Government
Sector (X)
No. of students admitted to
higher studies (Y)
No. of students turned
entrepreneur in the
respective field of
engineering/technology (Z)
1.25X + Y +Z
Placement Index (P) : (1.25X
+ Y +Z) /N
Avenage placement= (P1 +
P2 + P3) /3

LYG- Latest year graduation batch

LYGm1- Latest year graduation batch minus 1
LYGm2- Latest year graduation batch minus 2

Signature of Placement officer with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-40

Details of Carrier guidance Programs

Name of Institution: Institution code:

Name of the Program: Academic year:

Sl No Reg No Name of the Topic Resource Designation Date

Student Person

Signature of Placement officer with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-41

Details of Skill enhancement programs

Name of Institution: Institution code:

Name of the Program: Academic year:

Sl No Reg No Name of the Skill Resource Designation Date

Student Enhancement Person
Training

Signature of Placement officer with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-43

Details of Delivery of appropriate Course work by Industry experts

Name of Institution: Institution code:

Name of the Program: Academic year:

Sl No Reg No Name of the Concept Resource Designation Date

Student Person

Signature of Placement officer with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-44

Details of Industrial training/ internship

Name of Institution: Institution code:

Name of the Program: Academic year:

Sl No Reg No Name of the Industrial Name and Address of From -- To

Student Training/Internship the Industry

Signature of Placement officer with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-45

Details of Student Placement in an industry

Name of Institution: Institution code:

Name of the Program: Academic year:

Sl Reg No Name of the Mobile Number and Name and Address of Annual CTC
No Student email id of the student the Industry

Signature of Placement officer with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-46

Details of Student Placement in a Higher education institution

Name of Institution: Institution code:

Name of the Program: Academic year:

Sl No Reg No Name of the Mobile Number and Name of the higher CET Rank
Student email id of the student education institution

Signature of Placement officer with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

Annexure‐V

Document to be Maintained by The Principal

Sl Ref Number Particulars INS - Format No.

no.

1 Vision and Mission of the institute 1

2 Vision, Mission, And Program Education Objectives of the 2
Program (for all Programs)
3 Academic Calendar of The Institution 3
4 Academic Calendar of The Program (for all Programs) 4
5 Class Time Table (for all Programs) 5
6 Lab Time Table (for all Programs) 6
7 Personnel Time Table of all the faculties 7
8 Master Time Table (for all Programs) 8
9 Approved Key List of all The Students 9
10 Lesson Plan of all the faculties 10
11 Details Of Concepts Covered by all the Course coordinator 12
at the end every month
12 Course outcome Attainment (for all Programs) 16

13 Program outcome Attainment (for all Programs) 17

14 Details of the remedial classes conducted for students 18
15 Success index without backlog. 19
16 Success index with backlog. 20
17 Academic performance Index for year-1 21
18 Academic performance Index for year-2 22
19 Academic performance Index for year-3 23
20 Placement Index. 24
21 Result analysis - Faculty wise 25
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

22 Result analysis – semester wise 26

23 Shortage of attendance at the end of every month. 28
24 Final attendance report sent to SBTE 29
25 Faculty information of all Teaching and non-Teaching staff 31

26 Facility and Technical support 32

27 Lab- wise Equipment List 33
28 Student Enrolment ratio for all the programs 34
29 Class Room Inspection Report Of all the Programs 35
30 Details of Administrative 36
32 Library & Information Centre 37
33 C‐09, and C20 Curriculum document ---
34 Attendance registers of Teaching, Non-Teaching, ---
Administrative, work shop and part‐Time staff.
35 Profile of the all Teaching, Non-Teaching, Administrative, ----
work shop and part‐Time staff.
36 Verified and uploaded Consolidated I.A. Marks List of all ---
the semesters of all the programs.
37 Meeting minutes Register of the institution. ----
38 Records of Meeting & Discussions held with all the Stake ----
holders.
39 Record Of additional Duties entrusted to faculty (NSS, NCC, ----
CCTEK, etc.)
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-1

Institution Name: Institution code:

Vision and Mission of the institute

Vision of the Institute:

Mission of the Institute:

Signature of the Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-2

Institution Name: Institution code:

Program:

Vision, Mission, And Program Education Objectives of the Program

Vision of the Program:

Mission of the program:

Program Education Objectives (PEO)

PEO 1 -

PEO 2 -

PEO 3 -

PEO n -

Establish consistency of PEOs with Mission of the Department

PEO M1 M2 Mn

PEO 1

PEO 2

PEO 3

PEO n

Signature of the Program coordinator Signature of the Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-3

Academic Calendar of the Institution

Institution Name: Institution code: Academic year:

Week Day Date Activities

Morning Session Afternoon Session

Monday
Tuesday
Wednesday
1
Thursday
Friday
Saturday
Sunday

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Note:All the Co-Curricular (Including Curriculum gap), Extra Curricular activities for odd & even Semester are to be
planned at the commencement the academic year in line with the BTE academic calendar of events.

Signature of the Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-4
Academic Calendar of the Program
Institution Name: Institution code: Academic year:

Week Day Date Activities

Morning Session Afternoon Session

Monday
Tuesday
Wednesday
1
Thursday
Friday
Saturday
Sunday

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Note: 1. All the Co-Curricular (Including Curriculum gap), Extra Curricular activities for odd & even Semester are
to be planned at the commencement the academic year in line with Institution academic calendar of events.

Signature of the HOD & Seal Signature of the Principal with Seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-5

Class Time Table For The Year 202 __ - 202 _

Name of Institution: Institution code: Academic year: With effect from:

Name of the Program: Semester: L.H./DH No:

DAY PERIOD 1 2 3 4 5 6 7

TIME

MON

TUE

WED

THU

FRI

SAT

Note :1) Duration of each period is one hour.

8) Monday to Friday contact hours - 7 Hours
9) Saturday Contact Hours – 5 hours
10) Total Contact Hours / week – 40 Hours.

Signature of program the Program coordinator with Seal Signature of Principal with Seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-6
Lab/workshop Time Table for The Year: 202 __- 202 _
Name of Institution: Institution code: Academic year: With effect from:
Name of the Program: Semester: Name of the Lab In charge:

DAY PERIOD 1 2 3 4 5 6 7

TIME

MON

TUE

WED

THU

FRI

SAT

Note :1) Display lab Time Table in all the LABORATORIES. indicating name of the lab conducted & Batches as per Scheme of Studies.
8) Monday to Friday contact hours - 7 Hours
9) Saturday Contact Hours – 5 hours
10) Total Contact Hours / week –40 hours

Signature of lab in charge/Foreman Signature of program coordinator with Seal Signature of Principal with Seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-7
Personnel Time Table For The Ye: 202 _ - 202 __

Name of Institution: Institution code: With effect from:

Name of the Program: Semester: Academic year:
Name of the Course Co Coordinator: Designation: .

Time-
Sl. No. of Week Room
Course Class Time
No. Students Day No.
Day

Mon

Tue

Wed

Thur

Fri
Sat
Note: 1) Shade the hours engaged with different pattern for different courses
4) Where a class is handled jointly with other staffs indicate the name of the joint staff in ‘Subject” column.

Theory Practical Drawing Total in contact hours

……… hrs. ……….. hrs. ……….. hrs. ……… hrs.

Signature of course coordinator Signature of program coordinator with Seal Signature of Principal with Seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-8

Master Section Time Table for the Year: 202_-202_

Name of Institution: Institution code: With effect from:

Name of the Program: Semester: Academic year:

PERIOD 1 2 3 4 5 6 7
DAY CLASS
TIME

I / II Sem

MON III/IVSem

V/VISem

I / II Sem

TUE III/IVSem

V/VISem

I / II Sem

WED III/IVSem

V/VISem

I / II Sem

THU III/IVSem

V/VISem
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

I / II Sem

FRI III/IVSem

V/VISem

I / II Sem

SAT III/IVSem

V/VISem

Signature of program coordinator with Seal Signature of Principal with seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-9
Approved Key List of the Students for the Academic Year: 202_ -202__

Name of Institution: Institution code:

Name of the Program: Semester: Academic year:

Sl.No Register Number of the Student Name Of the Student Remarks

Signature of the Principal with seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-10
Lesson Plan the year: 201 _ - 201 __
Name of Institution: Institution code: With Effect from:
Name of the Program: Semester: Academic year:
Name of course coordinator: Course:

Session CO PO Concepts Planned Time Concept Covered Teacher Student Pedagogy Teaching Learning outcomes Remarks by
No Planned date Allotted Activity Activity Adopted aids used achieved Program
Week coordinator

1
1
2

13 n

Signature of course coordinator Signature of program coordinator with Seal Signature of Principal with Seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-12

Details of the Concepts Covered by the Course Coordinator at the end every month

Name of Institution: Institution code: Academic year:

Name of the Program: Semester:

Sl. Name of the Course Semester No. of sessions No. of sessions No. of sessions Percentage of Signature of the
No. Course Coordinator Taken as per syllabus taken to be taken concepts Covered Course coordinator

Signature of course coordinator Signature of program coordinator with Seal Signature of Principal with Seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-16
Attainment of Course Outcome

Name of the Institution: Institution code:

Program:
Semester: Session: July-Nov 202-
Course: Course code:
Course coordinator: Academic year:

Attainment Description
Level 1 60% of the students reached the target
Level 2 70% of the students reached the target
Level 3 80% of the students reached the target

Note: IQAC of the Institution can set the Attainment level based on the past data of Student performance in the program/course

Course Outcome Target

Continuous Internal Evaluation 60% of the marks
Semester End Examination Class Average

Note: IQAC of the Institution can set the Course Outcome Target based on the past data of Student performance in the
program/course

Mapping of Course Outcome with the Questions in the CIE Test/practicals/Activities/Assignment/Workshops/Seminars/Industry visits/etc
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

CO CIE 1 CIE 2 CIE 3 CIE 4 CIE 5 Practical’s Activities Assignments Workshops Seminars Industry visits Any other
CO1
CO2
CO3
CO4
Contd
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-16
Attainment of Course Outcome

Continuous Internal Evaluation (CIE)

CO 1 – Write the Course Outcome Statement
CO 1 Linked with POs and PSOs- Map the CO1 linked with the Program Outcomes (POs) and Program Specific Outcomes Semester End Exams
(PSO)
Assessment Tools CIE1 CIE2 CIE3 CIE4 CIE5 CIE..n Activities, Total Total Target
etc.. Marks Marks marks
Map the allotted for scored by Achieved Marks Target
Question/responses CO 1 from the student (Y/N) Scored in marks
belongs to CO1 in CIE, All for CO 1 SEE Achieved
Activities, Assessments, Assessment from All (Y/N)
Workshops, seminars, Tools Assessment
industrial visits etc.. Tools
Allotted marks for
questions on CO1
Reg Name of the
No student
1

n
Number of Students Achieved the Target
Percentage of Students Achieved the Target
Attainment Level
Overall CO1 Attainment level considering 40% of CIE and 60% of SEE
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

Note:

 This format can be used for all COs of the Course

 This format can be modified depending upon Course/Program requirement after approval from IQAC as per the needs of the curriculum

Signature of course coordinator Signature of program coordinator Signature of IQAC Chairmen Signature of Principal wit seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS FORMAT-17
Attainment of Program Outcome (PO) and Program Specific Outcomes (PSO)
Name of the Institution: Institution code:
Program:
Semester: Session: July-Nov 202-
Course: Course code:
Course coordinator: Academic year:
Map Course Outcomes with PO and PSO using 1,2,3 Strengths (1-Low,2-Medium,3- High) in below Table

Course Outcomes Program Outcome Program Specific Outcomes

PO1 PO2 PO3 PO4 PO5 PO6 PO7 PSO1 PSO2

CO1
CO2
CO3
CO4

Calculate and Tabulate the PO and PSO Attainment using Strengths 1,2,3 (Direct Method) in below table

Course Outcomes CO Attainment Program Outcome Program Specific

Outcomes
PO1 PO2 PO3 PO4 PO5 PO6 PO7 PSO1 PSO2

CO1
CO2
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

CO3
CO4
Average

Note: Prepare similar PO –PSO Attainment (Direct method) calculation for all the courses of a program contd
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-17
Attainment of Program Outcome (PO) and Program Specific Outcomes (PSO)
Indirect attainment based on student exit survey, alumni survey, and employer survey

Type of Survey Indirect PO and PSO Attainment

Student exit survey
Alumni survey
Employer survey
Average
Note- Prepare similar PO –PSO Attainment (Indirect method) for all PO and PSO

Tabulate the PO –PSO Attainment for all the courses of a program

Course Course Code Program Outcome Program Specific Outcomes

PO1 PO2 PO3 PO4 PO5 PO6 PO7 PSO1 PSO2

n
Direct PO Attainment
(Avg of all courses)
Indirect PO Attainment
(Avg of 3 surveys)
Overall PO Attainment
(80% direct+ 20% indirect)

Signature of course coordinator Signature of program coordinator Signature of IQAC Chairmen Signature of Principal wit seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-18
Details of the Remedial classes conducted for students
Name of Institution: Institution code:

Name of the Program: Academic year:

Semester Course Reg Name of Concepts needs Date of delivery Impact Signature of
No the Remedial class Observed the Course
Student Coordinator

Signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-19

Success Index without backlogs in any year of study

Name of Institution: Institution code:

Name of the Program: Academic year:

LYGm1 LYGm2
Item LYG

Total number of students admitted to the program including lateral

entry students
Number of students who have passed without backlogs in the
stipulated period of 3 years
Success index (SI)

Average Success index (SI)

SI= (Number of students who have passed from the program without backlog)/ (Number of students admitted in the first
year of that batch plus actually admitted in 2nd year via lateral entry
LYG- Latest year graduation batch
LYGm1- Latest year graduation batch minus 1
LYGm2- Latest year graduation batch minus 2

i signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-20

Success Index with backlogs in any year of study

Name of Institution: Institution code:

Name of the Program: Academic year:

LYGm1 LYGm2
Item LYG

Total number of students admitted to the program including lateral

entry students
Number of students who have passed with backlogs in the stipulated
period of 3 years
Success index (SI)

Average Success index (SI)

SI= (Number of students who have passed from the program with backlog)/ (Number of students admitted in the first
year of that batch plus actually admitted in 2nd year via lateral entry

LYG- Latest year graduation batch

LYGm1- Latest year graduation batch minus 1
LYGm2- Latest year graduation batch minus 2

Signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-21
Academic performance index for the year 1
Name of Institution: Institution code:

Name of the Program: Academic year:

Academic
CAYm1 CAYm2 CAYm3
Performance
Mean Percentage of all
successful students (X)
Total no. of successful
students (Y)
Total no. of students
appeared in the
examination (Z)
API = X* (Y/Z)
Average API = (AP1 + AP2
+ AP3)/3
API = (Mean of the percentage of marks of all successful students in First Year/ 10)) x (successful students/number of students
appeared in the examination).
Successful students are those who are permitted to proceed to the second year.
CAYm1- Current Academic Year minus 1
CAYm2- Current Academic Year minus 2
CAYm3- Current Academic Year minus 3

Signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-22

Academic performance index for the year 2

Name of Institution: Institution code:

Name of the Program: Academic year:

Academic
CAYm2 CAYm3 CAYm4
Performance
Mean Percentage of all
successful students (X)
Total no. of successful
students (Y)
Total no. of students
appeared in the examination
(Z)

API = X* (Y/Z)

Average API = (AP1 + AP2 +

AP3)/3
API = (Mean of the percentage of marks of all successful students in Second Year/ 10)) x (successful students/number of students
appeared in the examination)
Successful students are those who are permitted to proceed to the final year
CAYm2- Current Academic Year minus 2 CAYm3- Current Academic Year minus 3 CAYm4- Current Academic Year minus 4

Signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-23

Academic performance index for the year 3

Name of Institution: Institution code:

Name of the Program: Academic year:

Academic Performance LYG LYGm1 LYGm2

Mean Percentage of all

successful students (X)
Total no. of successful students
(Y)
Total no. of students appeared in
the examination (Z)

API = X* (Y/Z)

Average API = (AP1 + AP2 +

AP3)/3
API = (Mean of the percentage of marks of all successful students in Final Year/10) x (successful students/number of students
appeared in the examination)
Successful students are those who passed in all the final year courses
LYG- Latest year graduation batch
LYGm1- Latest year graduation batch minus 1
LYGm2- Latest year graduation batch minus 2

Signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS - FORMAT-24

Placement index for 3 years

Name of Institution: Institution code:

Name of the Program: Academic year:

Item LYG LYGm1 LYGm2
Total No. of Final Year Students
(N)
No. of students placed in
companies or Government
Sector (X)
No. of students admitted to
higher studies (Y)
No. of students turned
entrepreneur in the respective
field of engineering/technology
(Z)
1.25X + Y +Z
Placement Index (P) : (1.25X + Y
+Z) /N
Avenage placement= (P1 + P2 +
P3) /3
LYG- Latest year graduation batchLYGm1- Latest year graduation batch minus 1LYGm2- Latest year graduation batch minus 2
Signature of Placement officer with Seal Signature of Principal with Seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS-FORMAT- 25

Result Analysis –Faculty wise

Name of Institution: Institution code: Academic Year:

Name of the Program: Semester: Exam held During:

Sl no Course Name of the Course No of students passed

Coordinator
Appeared for Exam Passed Percentage

Signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS-FORMAT- 26

Result Analysis –Program wise

Name of Institution: Institution code: Academic Year:

Name of the Program: Semester: Exam held During:

Semester No of No of No of No of Total % Of Passed Except In No Of Students %Age Of Smp/

Students Distinction I Class II Class No of Pass Promoted Promoted Withheld
Appeared Pass Including Total Including Cases
Pass Total Pass
ODD EVEN 1 2 3 4 TOTAL
SEM SEM course courses courses courses

Total % Total %
Avg% Avg%

Signature of program coordinator with Seal Signature of Principal with Seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS-FORMAT -28

Shortage of Attendance to be announced at the end of every month

Name of Institution: Institution code: Academic Year:

Name of the Program: Semester: Date of announcement:

Minimum Attendance Required in Each Subject: -75%

Minimum Aggregate Attendance Required: -75%

Reg NO Course 1 2 3 n TOTAL %age

No of classes held. 100

Minimum Attendance 75
Required=75% No of
classes held.
Name of the Student

Signature of Program coordinator with seal Signature of the principal with seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS-FORMAT -29
Final Attendance Report to be sent to BTE
Name of Institution: Institution code: Academic Year:

Name of the Program: Semester: Date:

SL NO Candidate Name Register No Percentage Of Attendance Obtained in Each Aggregate Remarks

Courses Percentage

1 2 3 4 .. .. n

Initial of the staff member in charge

Note :1) 01,02,03 etc. indicates Sl. No. of the subjects as per the BTE subject Dictionary

2) Attendance Details of all the students of each class Should be announced separately
3) If there is any shortage it should be mentioned in remarks column
4) To the Secretary BTE Bangalore for information
5) To be announced in the students Notice Board

Signature of Program coordinator with seal Signature of the principal with seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS- FORMAT-31

Faculty information of all Teaching and non-Teaching staff

Name of the Institution: Institute Code:
Program: semester:
Academic Year:

Distribution of Teaching
Name of the Faculty Qualification Designation Date of Load in %
(Teaching/Non- Joining a b c
Teaching)

a: Faculty of the specific program/ department considering fractional load

b: Faculty serving this program from another Program / department considering fractional load
c: Faculty of this program serving other program/ department considering fractional load

Signature of course coordinator Signature of program coordinator with Seal Signature of Principal wit seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS – FORMAT-32

Facility and Technical Support

Name of the Institution: Institute Code:

Program: semester:

Academic Year:

Sl No Name of the No of student Name of the Weekly Technical man Power

lab/Workshop per batch major utilization
equipment’s
Lecturer Instructor Assistant Instructor

Signature of program coordinator with Seal Signature of Principal with seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS-FORMAT-33

Statement Showing List of Lab/ workshop Equipment

Name of the Institution: Institute Code:

Program: Semester:

Academic Year: Lab/Workshop:

Sl. Name of instrument/Equipment/ Machine etc. Quantity as per Quantity Date of Working/ Reasons for not Remarks
No. syllabus actually purchase not working working
available

Note: Attach additional sheet if required

Signature of lab/workshop in charge Signature of Program coordinator with seal Signature of the principal with seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS-FORMAT-34

Student Enrolment Ratio

Name of the Institution: Institute Code:

Academic Year:

Sl No Description Sanctioned Intake Including SNQ Total Number of Student admitted Enrolment Ratio

1 Program1

2 Program2

3 Program3

4 Program4

5 Program5

6 Program6

7 Program7

8 Program ….n

Enrolment Ratio = Sanctioned Intake Including SNQ / Total Number of Student admitted

Signature of the principal with seal

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS‐FORMAT‐35

CLASS ROOM INSPECTION REPORT FOR THE YEAR: 202_ ‐ 202_

1.Name of the Institution:

2.Name of the Programme:

3.Name of the Course-Coordinator:

4. Date & Time of inspection:

5. Class

a) Strength:

b) Number of students Present:

6. a) Class Attendance Register : Maintained /Not Maintained.

b) Students attendance : Marked/ Not Marked.

8 a) Name of the courses being thought:

b) Concept Being taught :

9 Type of Pedagogy adopted :

10 Teaching aids Used :

11. Effectiveness of Teaching:

a) Student’s Involvement : Satisfactory/Good

 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

b) Presentation : Satisfactory/Good

c) Interaction with the students. : Satisfactory/Good

12. Lesson Plan : Maintained /Not Maintained.

13.Valuation of lab Records, Blue Books,

Test, Assignments, Drawing sheets etc.

(If applicable). : Done /Not Done

14.Communicating of CIE Marks

to students, discussion & It’s documentation: Done /Not Done

15.Remarks of the Principal:

Place: SIGNATURE OF THE PRINCIPAL

Date:
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS- FORMAT-36

Information of all administrative staff

Name of the Institution: Institute Code:

Academic Year:

Sl
No Name of the administrative staff Qualification Designation Date of Joining

Signature of the Registrar with seal Signature of the principal with seal
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

INS -FORMAT-37

LIBRARY & INFORMATION CENTRE

Name of the Institution: Inst. Code:

Name of the Library/Information Centre:

Date of Inspection:
1 Date of establishment
2. Working Hours
3. Name of the Librarian In-charge,
Qualification
4 Name and Designation of supporting staff in
the library:

5 Total No. of active members

6 No of readers/clientele
7 Automated Library Yes/No
8 Technical Services:
a. Book stock Classified or Not Yes/No
b. Classification Scheme used DDC/CC/Automation
c. Catalogue Scheme used AACR/CCC/Others
9 Circulation:
a. Charging System Card/Other system
b. No. of Books Issued Weekly/Fortnightly/Others
c. Over Due Charges Yes/No
10 Stock Verification: Yes/No
a. Loss
b. Worn out
c. Weeded out
d. Bounded Volumes
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

11. Stock Room –

Whether a) Open Access System.
b) Closed Access System.
12 Budget: (per annum)
a. Government/DTE
b. SC ST Fund
c. MHRD
d. Endowments
e. Others
13 Vacancy position Details: Sanctioned Working Vacant

14 Library Dimension/Space Adequate/inadequate

1

15 Other services: a) Reference, Yes/No

b) Referral. Yes/No
c)Reprographic service. Yes/No
d)Internet etc. Yes/No
16 Stock
ABSTRACT
No of volumes at No. of volumes added No of volumes Total no of volumes
the beginning of during the year withdrawn during at the close of the
the year the year year

17 Branch wise Titles,Volumes

Titles Volumes Titles Volumes

1.Civil 7.. Commercial

Practice
2 E&E 8. ADFT
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
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E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

3 ME 9.Textile

4 E&C 10.Science/
Maths
5 Auto 11.English

6 CSE 12.Others

TOTAL:

18 a. Periodicals/Journals/Magazines/
. Newspapers/Technical/Non-
Technical
b. Other resources:
Computers/DVD/Projector/
Digital library.

REMARKS OF THE SUBJECT INSPECTOR/ASST. DIRECTOR

Note: DDC: Dewey decimal classification CC: Colon classification.

AACR: Anglo American Cataloguing Rules. CCC Classified Catalogue Code.

Signature of the librarian with seal Signature of the principal with seal

2
 GOVERNMENT OF KARNATAKA Form No:
Department of Collegiate and Technical Education Revision:
GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
- 00000 Date:
E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

Annexure-4
ಕಚೇರಿಯ ವಿವಿಧ ವಿಭಾಗದವರು ಈ ಕೆಳಕಂಡ ದಾಖಲೆಗಳನ್ನು ನಿವವಹಿಸಿ, ಆಡಳಿತಾತಾಾ ಕ
ಪರಿವಿೀಕ್ಷಣೆಯ ವೇಳೆಯಲ್ಲಿ ಪರಿಶೀಲನೆಗೆ ಸಲ್ಲಿ ಸಬೇಕೆೆಂದು ಸೂಚಿಸಲಾಗಿದೆ.

1. ಸಿಬ್ಬ ೆಂದಿ ವಿಭಾಗ:

 ಆರ್.ಆರ್. ವಹಿ
 ಹಾಜರಾತಿ ಪುಸ್ತ ಕಗಳು
 ಬಯೋಮೆಟ್ರಿ ಕ್ ಹಾಜರಾತಿ ವಹಿ.
 ಲೋವ್ ರಿಸ್ಟ ರ್ (ಸಾಂದರ್ಭಿಕ/ನಿಬಿಾಂಧಿತ ರಜೆ ವಹಿ)
 ಕಡತ ಪದದ ತಿ – ಕೇಸ್ ರಿಜಿಸ್ಟ ರ್/ವೈಯಕ್ತತ ಕ ರಿಜಿಸ್ಟ ರ್
 ವಾರ್ಷಿಕ ವೇತನ ಬಡ್ತತ ಕಡತ.
 ವೇತನ ಮಾಂಬಡ್ತತ ವಹಿ.
 ಹುದ್ದದ ಮಂಜೂರಾತಿ, ಕತಿವಯ ನಿರತ ಹಾಗೂ ಖಾಲ ಹುದ್ದದ ಗಳ ವಿವರ.
 ಸೇವಾ ಪುಸ್ತ ಕಗಳು.
 ಅರೆಕಾಲಕ ಅತಿಥಿ ಉಪನ್ಯಯ ಸ್ಕರ ನೇಮಕಾತಿ ವಿವರದ ವಹಿ.
 ಅರೆಕಾಲಕ ಅಕುಶಲ ಕೆಲಸ್ದಾಳುಗಳ / ಸೆಕ್ಯಯ ರಿಟ್ರ ಗಾರ್ಡಿಗಳ ನೇಮಕಾತಿ ವಿವರದ ವಹಿ.
 ಚಲನವಲನ ವಹಿ.
 ಇತರೆ ಮಾಹಿತಿಗಳು.

2. ಪರ ವೇಶ ಮತ್ತು ವಿದಾಾ ರ್ಥವ ವೇತನ ವಿಭಾಗ:

 ಎಐಸಿಟ್ರಇಯಾಂದ ಸಂಸೆೆ ಗೆ ಕೋಸ್ಿವಾರು ಮತ್ತತ ವಿದಾಯ ಥಿಿಗಳ ಸಂಖ್ಯಯ ನಿಗಧಿಪಡ್ತಸಿರುವುದಕೆೆ ಆದೇಶ

 ಸ್ಕಾಿರದಾಂದ ಸಂಸೆೆ ಗ ಕೋಸ್ಿವಾರು ಮಂಜೂರಾಗಿರುವ ಪಿ ವೇಶ ಸಂಖ್ಯಯ ಆದೇಶ.
 ಪಿ ಥಮ ವರ್ಿದ ಪಿ ವೇಶಾನುಮೋದನೆ ಕಡತ.
 ವಿದಾಯ ಥಿಿಗಳ ಪಿ ವೇಶ ದಾಖಲಾತಿ ವಹಿ.
 ವಿದಾಯ ಥಿಿ ಪಿ ವೇಶ ದಾಖಲಾತಿಗಳ ಕಡತ
 ವಿದಾಯ ಥಿಿಗಳ ಅಾಂಕ್ತ-ಅಾಂಶ ಮೋಸ್ಲಾತಿವಾರು.
 ವಿದಾಯ ಥಿಿವೇತನ ಮಂಜೂರಾತಿ ಕಡತಗಳು (ಪ.ಜಾ/ಪ.ಪಂ, ಹಿಾಂದುಳಿದ ವಗಿ, ಇತರೆ)
 ವಿದಾಯ ಥಿಿವೇತನ ಬಟವಾಡೆ ತಃಖ್ಯತ .
 ವಿದಾಯ ಥಿಿವೇತನ ಬ್ಯ ಾಂಕ್ ಪಾಸ್ ಬುಕ್ ಮತ್ತತ ಚೆಕ್ ಪುಸ್ತ ಕ.
 ಗುರುತಿನ ಚೋಟ್ರ ವಿತರಣೆ ವಹಿ.

1
 GOVERNMENT OF KARNATAKA Form No:
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E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

 ವಗಾಿವಣೆ ಪಿ ಮಾಣ ಪತಿ ಸಿವ ೋಕೃತಿ ಮತ್ತತ ವಿವರಣೆ.

 ಇತರೆ ಮಾಹಿತಿಗಳು.

3. ಪರಿೀಕ್ಷಾ ಮತ್ತು ಲೇಖನ ಸಾಮಾಗಿರ ವಿಭಾಗ:

 ಪರಿೋಕಾಾ ಸಮಾಗಿಿ ದಾಸತ ನು ಕಡತ.

 ವಿದಾಯ ಥಿಿಗಳ ಡ್ತಪ್ಲ ೋಮಾ ಪಿ ಮಾಣ ಪತಿ ಮತ್ತತ ಅಾಂಕಪಟ್ರಟ ಗಳ ವಿತರಣಾ ವಹಿ.
 ನಕಲು ಅಾಂಕಪಟ್ರಟ ಗಳನುು ವಿತರಿಸುವ ಪುಸ್ತ ಕ, ತಾಂತಿಿ ಕ ಪರಿೋಕಾಾ ಮಂಡಳಿಯು ಆದೇಶಿಸಿರುವಂತೆ
ಪರಿೋಕೆಾ ಗೆ ಸಂಬಂಧಿಸಿರುವ ಎಲಾಲ ಕಡತಗಳು.
 ವಿದಾಯ ಥಿಿ ಪರಿೋಕಾಾ ದುರಾಚಾರ ಪಿ ಕರಣ ಕಡತ.
 ಪರಿೋಕಾಾ ಹಾಜರಾತಿ ಪುಸ್ತ ಕ (ಕತಿವಯ ನಿರತ ಕಠಡ್ತ ಮೇಲವ ಚಾರಕರು, ಕಛೇರಿ ಸಿಬಬ ಾಂದ) ಇತರೆ
ಮಾಹಿತಿಗಳು.

4. ಕಟ್ಟ ಡ ಮತ್ತು ಉಗ್ರರ ಣ ವಿಭಾಗ:

 ಯೋಜನೆ ಮತ್ತತ ಯೋಜನೇತರ ಅನುದಾನದ ಬಳಕೆಯ ಬಗೆೆ ವಿವರ.

 ಪೋಠೋಪಕರಣಗಳು, ಯಂತ್ಿ ೋಪಕರಣಗಳು, ಇತರೆ ಸಧನ ಸಮಾಗಿಿ ಗಳ ದಾಸತ ನು ಪುಸ್ತ ಕ.
 ವಿವಿಧ ಸಮಾಗಿಿ ಗಳ ದಾಸತ ನು ಪುಸ್ತ ಕ.
 ಸಂಸೆೆ ಯ ವಸ್ತಿನಿಲಯಗಳ ಭೂಮ ಮತ್ತತ ಕಟಟ ಡಗಳ ದಾಖಲೆ, ಇನ್ವಾಯ್ಸ್ ರಿಜಿಸ್ಟ ರ್.
 ಸಂಸೆೆ ಯ ಅನುಪಯುಕತ ಪೋಠೋಪಕರಣಗಳ, ಯಂತ್ಿ ೋಪಕರಣಗಳ, ಇತರೆ ಸಧನ ಸಮಾಗಿಿ ಗಳ ಕಡತ,
ಇತರೆ ಮಾಹಿತಿಗಳು.

5. ಲೆಕಕ ಮತ್ತು ನಗದು ವಿಭಾಗ: (ಎಲಾಿ ವಹಿಗಳು As per Art.330 of KFC ನಲ್ಲಿ ನಮೂದಿಸಿರುವಂತೆ)

 ರಶಿೋದ ಪುಸ್ತ ಕ ದಾಸತ ನು ವಹಿ

 ನಗದು ಪುಸ್ತ ಕ.
 ಸದಲಾವ ರು ಬಿಲುಲ ಗಳ ವಹಿ
 ದನ ವಹಿ (Day Book)
 ಬೋಧನ್ಯ ಶುಲೆ , ಪರಿೋಕಾಾ ಶುಲೆ , ಇತರೆ ಶುಲೆ ಗಳ ಜಮಾ ಪುಸ್ತ ಕ/ಇರಸಲು ವಹಿ (Remittance Register)
 ಅನುದಾನ ಬಿಡುಗಡೆ ಪುಸ್ತ ಕ.
 ಕೇಾಂದಿ ಅನುದಾನ ವಿವರಗಳ ವಹಿ.
 ಖಾಯಂ ಮಾಂಗಡ ವಹಿ
 UDC (Un disbursed cash register)
 ಬ್ಯ ಾಂಕ್ ಖಾತೆ ಪಾಸ್ ಪುಸ್ತ ಕ / ಸೆಟ ೋಾಂಟ್ಮೆಾಂಟ್್ ಗಳು ಚೆಕ್ ಪುಸ್ತ ಕ ಕಾಂಟರ್ ಫಾಯಲ್ಸ್ ನಾಂದಗೆ
 ಬಟವಾಡೆ ವಹಿಗಳು.

2
 GOVERNMENT OF KARNATAKA Form No:
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GOVERNMENT/ AIDED/PRIVATE POLYTECHNIC, __________
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E-Mail: -Institute /Dept. / Faculty (Official ID). Phone:

 HRMS ಮೂಲಕ ಹಣ ಬಟವಾಡೆ ಮಾಡ್ತದ ವಹಿಗಳು.

 ಇತರೇ ಬಟವಾಡೆ ವಹಿಗಳು.
 ಪ.ಡ್ತ ಖಾತೆ (ಪಾಿ ಚಾಯಿರ ವೈಯಕ್ತತ ಕ ಖಾತೆ ಪುಸ್ತ ಕ).
 ಗಿ ಾಂಥಾಲಯ ಠೇವಣಿ ಬಟವಾಡೆ ವಿವರ.
 ವಸ್ತಿನಿಲಯಕೆೆ ಸಂಬಂಧಪಟಟ ಬ್ಯ ಾಂಕ್ ಖಾತೆ ಮತ್ತತ ಇತರೆ ದಾಖಲೆಗಳು.
 ವಿದಾಯ ಥಿಿ ಕಲಾಯ ಣ ನಿಧಿ ವಂತಿಗೆ ಪಾವತಿ, ಶಿಕ್ಷಕರ ಕಲಾಯ ಣ ನಿಧಿ ವಂತಿಗೆ ಪಾವತಿಯ ವಿವರ.
 ರಾಜಯ ಮಟಟ ದ ಅಾಂತರ ಪಾಲಟೆಕ್ತು ಕ್ ಕ್ತಿ ೋಡಾಕ್ಯಟ ನಿಧಿಗೆ ವಂತಿಗೆ ಪಾವತಿಯ ವಿವರ.
 ಸೈನಿಕರ ಕಲಾಯ ಣ ನಿಧಿಗೆ ವಂತಿಗೆ ಪಾವತಿಯ ವಿವರ.
 ಸೇನ್ಯ ಧವ ಜ ದನ್ಯಚರಣೆಯ ಫಾಲ ಯ ಗ್ ಗಳನುು ಮಾರಾಟ ಮಾಡ್ತದ ವಿವರ
 ಇತರೆ ಮಾಹಿತಿಗಳು.

6. ಇತರೆ ವಿಷಯಗಳು:

 ಹಿಾಂದನ ಶೈಕಚ ಣಿಕ ಮತ್ತತ ಆಡಳಿತ ಪರಿವಿೋಕ್ಷಣೆಯ ಸ್ಮಯದಲಲ ನಿೋಡ್ತರುವ ಸೂಚನೆಗಳಿಗೆ

ಅನುಪಾಲನ್ಯ ವರದ.
 AICTE ಮಾನಯ ತೆ ನವಿೋಕರಣದ ಬಗೆೆ ವಿಧಿಸಿರುವ ರ್ರತ್ತತ ಗಳಿಗೆ ಅನುಪಾಲನ ವರದ (Compliance Report).
 ಸಿ.ಡ್ತ.ಟ್ರ.ಪ ಚಟುವಟ್ರಕೆಗಳ ಬಗೆೆ ಸಂಕ್ತಾ ಪತ ಮಾಹಿತಿ.
 ಸಿ.ಸಿ.ಟೆಕ್ ಚಟುವಟ್ರಕೆಗಳ ಬಗೆೆ ಸಂಕ್ತಾ ೋಪತ ಮಾಹಿತಿ .
 ಮಾಹಿತಿ ಹಕುೆ ಪಿ ಕರಣಗಳ ಬಗೆೆ ಮಾಹಿತಿ.
 ನ್ಯಯ ಯಾಲಯದಲಲ ರುವ ದಾವೆಗಳ ಬಗೆೆ ಮಾಹಿತಿ.