1

Internal Audit Report for the quarer ending………….

1. Introductory:-

a) Name of the Unit ……………………………………………………………

i) Full postal address with pin code ………………………………………………………………

…………………………………………………………………………………………………..

b) Name of the head of the office with designation ………………………………………………

i) Telephone No. …………………

ii) Mobile No. …………………………

iii) Posted since ……………………….

c) Name & Designation of the Drawing & Disbursing Officer (DDO)……………………………

i) Telephone No.. …………………………………………….

ii) Mobile No. ………………………………………………

iii) Posted Since ……………………………………………

d) Date of commencement of audit:

e) Date of completion of audit:

f) Date of submission of the audit report to the Head of the institution for perusal & signature:

g) Name of the Audit Firm and Address with mobile number.

h) Name(s) of the partners / Audit Asstts. who have conducted audit during the quarter under report

& particulars of attendance:

2. Position of persisting irregularities:

Persisting Irregularities

(pointed out in the internal

audit reports for previous

quarter)

Whether

rectified or not

Reasons for not

rectifying

irregularities

pointed out in the

periodic report

If not, time limit

required for

rectification as assured

by the auditee unit.

Name(s) of the partner(s) /

Name(s) of the Audit Asstt.(s)

No. of days attended

1st month 2nd month 3rd month

2

3. Latest status of outstanding paragraphs of the Inspection Report of Pr. A.G. (Audit), WB

(a) Fill in the following table:

Total No. of outstanding paras

as on 1st April,………….

No. of paras added/settled

during the quarter under review

Total No. of outstanding

paras at the end of the

quarter

(A) (B) (C)

(b) Give the details of Column (C) above in the following table:

Period of IR Para No. Subject in Brief Present Position Memo No. & Date of last

reply

(c) Comment on delay in submitting reply and pursuing the paras for settlement.

(Partner of the firm is to discuss with the officials concerned about the replies to the above paras and to

assist for preparing the comprehensive replies. Replies to be furnished in separate sheets)

4. Whether cash book is written daily and closed on the same day with the proper certification by the DDO.

If No, Timegap days.

Reason(s) for non compliance:

5. Whether daily collection of hospital receipts is handed over to the cashier daily or by next working day.

If ‘No’, fill up the following table:

Period of

collection

Extent of delay Reason(s) for delay Name of collector(s)

holding cash

Amount involved

(Rs.)

Yes No

Yes No

3

6. Whether Govt. revenue / user charges collected is deposited to Bank(s) for crediting to Govt. A/c or

RKS A/c within 3(three) working days.

If ‘No’, fill up the following table:.

Extent of delay Reason(s) for delay Name of collector holding

cash (check if he is the

custodian)

Amount involved (Rs)

7. a) Maintenance of Register / Ledgers (Yes / No. If Yes, whether up-dated)

Names of registers/ledgers Whether maintained (Y/N) If maintained, whether updated

(Y/N)

i) Cash book.

ii) Subsidiary Cash Books

iii) Cash Book for RKS A/c

iv) Bill Register

v) Bill Transaction Register

vi) Allotment Register

vii) Contingent Register

viii) a) Stock A/c of DCR / Money Receipt

(Must be maintained by DDO and / or

officer-in-charge of cash section)

b) By whom maintained (Designation)

c) Whether physical verification was

conducted.

d) Date of last p.v. & results.

ix) Sanction Register for Withdrawal /

Advance from GPF A/c (for all

categories)

x) Loan Ledgers (HB Loan, Other

Loan)

Yes No

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b) Particulars of DCRs / Money Receipt Books in use during the quarter (Requisition for issue of book must

be duly approved by the DDO / Officer-in-charge of cash.

c) Particulars of consumed DCR / Money Receipt Books not return to issuing authority.

Book

No.

Containing

Pages

Name of the

Collector

with whom

lying

Since when

lying

Whether

fresh

book(s) are

issued to the

same

collector

Action taken if any to

receive back the consume

book(s)

From To

8. Position of Allotment of Fund and Expenditure in Rs.’000

G.O. No. &

Date

Head of

A/c

Closing balance

in last quarter

Fund

allotted

Purpose Expenditure

incurred

Balance (+ or -).

In case of (-)

balance, reasons

thereof & action

taken for

regularization

9. Whether there is any case of theft / defalcation of Govt. money.

If ‘Yes’, fill up the following table:

Date when the case was

registered or occurred

Status of case

(if not sub-

judice)

Action taken against offender, e.g.

(a) informed to higher authority/

finance department .

b) FIR lodged.

Amount involved

(Rs.)

Book

No.

Containing

Pages

From To

Date

of

Issue

Whether

approved

by DDO /

Officer-in-

charge of

cash

To

Whom

Issued

Total

Amount

Collected

Total

Amount

Deposited

/ Handed

Over

Amount

short

deposited

if any

Whether

pages of

the book

have been

fully

consumed /

Still in use

Yes No

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10. Whether physical verification of cash is conducted by the DDO every month as per rules and balance

position duly recorded in the cash book.

If ‘No’, fill in the following table:

Date when last verified Reasons for non-compliance

11. Whether cash verification (Main / Subsidiary / RKS Cash Books) is done by the DDO in presence of the

partners of the firm during the quarter and whether cash balances found tallied with that of the cash book(s). If

not, what is the difference and reasons for discrepancy? (Copies of cash verification reports are to be enclosed

to form a part of the report)

12 Whether Bank Reconciliation Statements (for all accounts including RKS A/c) have been checked &

verified by the audit firm or not. (Copies of the Bank Reconciliation Statement alongwith photocopies of

relevant pages of the Bank Pass Book duly attested are to be enclosed to form a part of the report.)

13. Whether statements in Proforma A & B regarding RKS A/c are being sent to the appropriate authority

every month and whether proportionate amount is being remitted to District / State RKS A/c. (Copies of

statements in Proforma ‘A’ & ‘B’ are to be enclosed to form a part of the report.)

(For CMOH office, Auditor will check & verify consolidated report in Proforma “A” & “B” with that of the

reports submitted by the units and submit the same along with the report)

14. Whether any irregularity noticed during vouching with the cash book.

. If ‘Yes’, fill up the following table

Since when Person responsible Type of irregularity

15. Whether all necessary transactions including monthly closing balance of different Subsidiary Cashbook

maintained are reflected in the main cash book at the end of each month.

If ‘No’, fill up the following table

Since when Person responsible Type of irregularity

Yes No

Yes No

Yes No

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16. Realization of Licence fee from Private Health Establishment (P.H.Estt.) of the Health District under

Clinical Establishment Act by CMOH office

(applicable to CMOH offices only)

a) Total number of P. H. Estt. in the Health District ................................

b) Number of P. H. Estt. from which Licence Fees for renewal have been realized during the current quarter

alongwith progressive figure .......................................

c) Amount of Licence Fee realized during the current quarter alongwith progressive amount

......................................................

(Auditor is to specify the amount separately on account of Clinical Establishment and PC & PNDT (Pre-

conception and Pre-natal Diagnostic Techniques).

d) Number of defaulting P. H. Estt. mentioning the quarter from when realization of Licence Fee is pending

......................

e) Action taken by the CMOH Office to realize the Licence Fee from the defaulting P. H. Estt.

.......................................................................................

Signature of auditor

(Partner / Proprietor)

with date & Seal

Signature of DDO

with date & stamp.

Signature of the

Head of the office.

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Establishment Matters

Establishment

a) Man-power position:-

Sl.No. Category Sanctioned

Strength

Men-in-position Excess/

Shortage

Own

establishment

Detailed in

other

establishment

Total

Medical Officer

Nurse

Clerks

Typist

GDA

Group-“D”

Lab Technician

Other categories

b) Man-power position of staff engaged on contractual basis

Sl.No. Category Nos. Engaged

period

Remuneration

(P.M)

Whether necessary permission / sanction was

obtained from the competent authority (latest

engagement order is to be attached )

c) Whether any employee is under suspension?

If ‘Yes’, fill up the following table:

Name of the employee Since when suspended Amount of subsistence

allowance drawn, if

any, and date of effect

Present position of the

case (whether sub-judice

or Departmental enquiry

initiated etc)

d) (i) Whether monthly salary bills of the staff are drawn properly (i.e. only for the employees in position or

detailed in other establishment).

Employees in position:-

Employees detailed in other establishment:-

(ii) Whether salary account is maintained in Computerized (COSA) system:

(iii) The mode of disbursement of salary through the Bank: Tick ( √ )

Yes No

Yes No

Yes No

Yes No

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ECS/RTGS/E-PRADAN

In case of ECS/RTGS mode, check salary disbursement certificates obtained from the bank and in

case of E-PRADAN mode, check the salary bills with reference to bank’s acknowledgement thereon.

e) Fill in the following table:

Whether deductions made through

proper schedule (Y/N)

Whether posted in the Pay Bill

Register monthly (Y/N)

Professional Tax

Income Tax

GPF & Group Insurance

contribution

Recovery of loan installment

f) Whether there is any case of excess payments due to wrong fixation of pay?

If ‘Yes’, fill up the following table:

Date of excess

payment

Amount of excess

payment (in Rs.)

Excess Payment

recovered till date

Time needed to recover

the balance of excess

payment, if any.

g) Whether annual increment is released to the member of staff timely?

If ‘No’, fill in the table for the sample (choose one from each category):

Name of the

post

Whether annual

incrmeent is released

to the staff timely?

(Yes/No)

Due date of

implementation of

increment

Date of release of

increment

Reasons for

deferment of

increment due to

EOL, if any.

Medical Officer

Nurse

Clerk

Typist

GDA

Group-“D”

Lab Technician

h) Whether declaration is obtained half-yearly from the staff drawing HRA?

Yes No

Yes No

Yes No

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If ‘No’, fill in the following

Name of staff Designation Defaulting since

i) Whether service books of the employees are maintained properly with updated service verification?

Fill in the table for the sample (choose one from each category):

Whether service books are

updated? (Yes/No)

Medical Officer

Nurse

Clerk

Typist

GDA

Group-“D”

Lab Technician

j) Whether leave records (EL, HPL, EOL etc) are maintained properly & up-dated?

If no, period of arrears.

k) Whether all the Leave Salary Bills including Leave Encashment Bills are drawn

correctly?

l) Whether there is any instance of disbursing salary to any employee who did not have

any leave to his credit?

If ’Yes’, fill in the following table:

Name of the employees Particulars of irregularity Action taken

m) Whether GPF Accounts of the Group “D” staff are maintained properly and closed

for the year including calculation of interest thereon?

A statement showing amount of GPF deposited and interest accrued thereon in respect of all the Gr. ‘D’

staff for the last year is to be attached. (Auditor is to verify the statement and comment)

As per rule, no GPF subscription can be realized during last 3 months of services.

Yes No

Yes No

Yes No

Yes No

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Whether there has been violation of the rule?

Check sample

n) Whether Statement of interest on GPF A/Cs of Group “D” employees is forwarded to the Head of the

Deptt (Addl. DHS, AA&V) for onward submission to the AG (A&E), W.B.

If ‘Yes’, memo no of the forwarding letter evidencing submission of the statement for the last year is to be

furnished.

o) Whether proper Head of A/c is debited and prescribed bill form is used?

Check sample records for verification

p) Whether financial sanction is always accorded as per delegation?

q) Particulars of Municipal / Corporation Tax Payments.

Properties for which

Municipal bodies have

raised & submitted bills

on Property /Holding tax

Amount of tax imposed Whether application has

been submitted to the

competent authority

seeking exemption from

paying Property /

Holding tax, by the

institution (Y/N)

Total Liability on

account of such tax

payment as on date (Rs.)

r) Whether HRA is being disbursed to any category of employee for whom there

is “Ear-marked” Govt. quarter?

Check sample records for verification

If ‘Yes’, fill in the table:

Name of employee Category of employee Total amount of HRA allowed

(in Rs.’000)

s) Whether electric meters have been installed at their own cost by the government employees occupying

government quarter?

If ‘No’ state reasons along with expected date of installation

(For installation of meters the matter is to be taken up by the Head / DDO of the institution)

If ‘No’, whether electricity charges at the following rates (effective from 01.03.2012) are being realized from

the concerned employees or not?

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

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CESC Area

(in Rs.)

SEB Area

(in Rs.)

Group A 772/- 715/-

Group C 475/- 440/-

Group D 313/- 290/-

(Auditor is to verify the relevant records and submit a report stating present position indicating any short

deduction of appropriate electricity charges and non-realization of arrears thereof)

t) Whether any government quarter is lying vacant?

If ‘Yes’, fill in the table below:

Type of government quarter/location Since when Vacant Reasons for such vacancy

and steps taken for

allotment

u) Whether any Govt. quarter has been occupied by unauthorized persons / outsiders / retired employees /

relatives of deceased employees etc.?

Yes No

If ‘Yes’, fill in the table below:

Type of government quarter/location Since when unauthorized

occupied and by whom occupied

Steps taken to evict

unauthorized occupants

v) Whether following deductions are being made from the Contractors’ Bill (for providing services) exceeding

Rs. 20,000/- & deposited to Govt. A/c (IT Deptt.)?

Yes No

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a. Income Tax @ 2%

b. Education surcharge (If applicable) at

the prescribed rate

Fill in the table for sample

Deductions from contractors’ bill

exceeding Rs.20,000/-

Income Tax @ 2%

Education surcharge at the

prescribed rate

If No’, reasons for non-compliance

w) Whether payment to parties (except to employees) exceeding Rs. 2500/- are made

through A/c payee cheque?

If not, furnish particulars of such payment.

Yes No

Yes No

Yes No

13

Hospital Receipts

a. Details of receipts

Name of item Whether daily

collection of

hospital receipts is

handed over to the

cashier? (Y/N)

If ‘No’, briefly

mention reasons

Amount

Collected

during last

quarter (in Rs.)

Receipts from OPD

Receipts from

pathological tests

Bed rent

X-Ray charges

USG charges

Others

b. Whether daily collection of hospital receipts is deposited into the Bank / Treasury next

working day.

In case where it is not practicable to observe this time limit, whether the deposit is made

upon the orders of the Head of the Department within 3 working days from the date of

receipt of such money.

Yes/No

Yes/No

c. Names of collectors

who have not handed

over the collected

amount next working

day

Period of retention of

cash

Reasons for not

handing over cash

timely

d. Whether money received on account of sale of disposable / unserviceable stores / stock

are deposited into the Treasury / Bank timely.

e. Whether diet charges are realised from the eligible patients and deposited into the Bank

Account/Treasury in the light of orders issued vide Nos. HF/O/MS/984/W-10/2001

dated 22.10.2014 and HF/MS/1124/W-55/2014 dated 21.9.2015.

f. Whether modified rates of Blood and its components are charged as per order.

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g. Cabin Paying

bed

Free

bed

Total

No. of sanctioned Strength (1)

No. of Cabins / Beds being used

during the quarter (2)

If (2)<(1), loss of Government

revenue (in Rs.) for non-utilization

of the beds. (Revenue collected to be

cross checked with the paying bed

register).

h. Whether free treatment is rendered to the patients not belonging to low income group as

per Government order?

If ‘Yes’, number of instances where such benefits have been provided to the patients

___________________________

Check records to find such evidence

Yes/No

i. If there is any after-noon pay-clinic?

A brief note on the functioning of the unit, collection of revenue, sharing etc. to be

provided as a part of the report.

Yes/No

j. In case of medical colleges fill in the following table for current year:

Amount

Collected

Amount deposited into

treasury / bank with date

of deposit

Collection of tuition fees

(in Rs )

Collection of admission

fees (in Rs.)

Collection of Caution

money (in Rs.)

Refund of Caution

money if any (in Rs.)

--------

Students strength

k. Observations of Bio-Medical Waste Management (in case of Hospitals)

(i) The name of the firm entrusted with the job (ii) Amount paid to the Firm in the last

quarter (iii) The rate per day as per agreement and (iv) Nature of waste and number of

occupied beds for which payment was made.

(Auditor is to provide information as above and to offer comments on performance of

the firm in separate sheet , if required. A copy of agreement and a copy of bill passed

recently are to be attached).

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l.

If there is any unit under Public Private Partnerships (PPP)?

If yes, give following information:

(i) The name of the Unit/s under PPP. (ii) Whether the register maintained for the

purpose is sufficient. (iii) Amount of electricity charges, water charges and sharing of

revenue realised from the unit/s. (iv) Whether the realisation is being made at the rate

included in the agreement. (v) Amount due, if any (vi) Mention the Account (Govt.

Account or RKS) where the amount is being deposited and whether it is as per with the

agreement.

(Auditor is to provide information as above and to offer comments mentioning amount

and the quarter from which due from each PPP Unit. Separate sheet may be used, if

required. A copy of agreement and a copy of bill passed in respect of each Unit are to be

attached).

Yes/No

Store / Stock items:

a. Whether the store is a decentralized unit? (The units which are empowered for procurement

through budgetary grants apart from DRS supply

If ’Yes’, whether Annual Budget for procurement of Drugs, Equipment, Miscellaneous items is

prepared?

Yes / No

Yes / No

b.

i)

Expenditure incurred on procurement :-

Expenditure incurred in previous

quarter (in Rs.)

Items Budget

allotment

(Rs.)

Catalogue

items

Non-

Catalogue

items

Total

Expenditure

(Rs.)

Excess / Short

(Rs.)

Drugs

Equipment

Other

items

b. ii) For procurement of Non-catalogue items, whether tender / quotation procedure is observed?

Whether necessary approval is obtained prior to purchase such type of items ?

Yes / No

Yes / No

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c. Whether CMS approved vendors are given orders for catalogue items at pre-determined rates

and proportionately?

Attach records of vendors’ names for 5 high-value and/or commonly used drugs and verify with

CMS approved list.

If ‘No’, reasons for placing order with one or two preferred vendors:

…………………………………………………………………………………………………

…………………………………………………………………………………………………

Yes / No

d. Whether the store maintains computerized Inventory Management System.

If not, reasons for not maintaining:

…………………………………………………………………………………………………..

Yes / No

e. If the manual Inventory Management is practiced, check whether the store ledger is up to date.

If ‘No’, mention period of back log from the ledger

Yes / No

f. (i) Whether physical verification of stores / stock is done periodically by the competent

authority?

Evidence to be attached.

(Auditor is to comment stating periodicity of physical verification, last date of verification,

discrepancy found, if any in the report and reasons for not conducting verification, if any.)

(ii) Whether joint verification by the auditor is done at least once in each half year.

(Auditor is attach a statement of verification report signed jointly showing discrepancy, if any,

with reference to stock register and remedial measures taken.)

Yes / No

g. (i) Whether the store / stock are issued to the indenting ward / section with the approval of the

competent authority?

Yes / No

(ii) Whether sub-stock is maintained by the indenting ward / section Yes / No

h. Whether store accounts are prepared annually? Yes / No

i. Whether there are any slow moving items lying in stock for a considerable period? Verify

whether sample of 5 slow moving drugs are in stock or not

If ‘Y’, fill in the table:-

Items lying in

stock

Source of

receipt

Date of receipt Value (in Rs.)

Yes / No

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j. Whether there is any expired stock of medicines?

If ’Yes’ fill in the table

Names of

medicines

Expired on Reasons that

led to expiry

Action taken/to be taken to

expose off the stock

Yes / No

k. Whether purchase of medicines / equipment is made based on the following criteria? Tick

whichever applicable

Consumption

Indent raised

Other criteria if any (mention)

l. Whether medicines / equipment are/have been issued to the various health units without having

any requisition or indent?

If ’Yes', fill in the table

Name of drug(s) and volume issued (cartons etc.)

Value (in Rs.)

Yes / No

m. Amount of committed liability for procurement of medicines / equipment / X-Ray films etc. in

excess of budget provisions and amounts lying outstanding for payment with year-wise

breakup. Action taken to regularise such expenditure.

n. Does the unit practise non-statutory control? Yes / No

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o. Does the Drug Controller collect statutory control samples?

If ‘Yes’, when was the last time samples were collected?

_______________________________________________________

When were the reports obtained?

Whether drugs were issued prior to receipt of reports?

Check records to verify

Has the unit received any complaint from facilities/wards regarding sub-standard quality of

drugs? Check records (when did such incident happen? Which facility reported? etc)

Action taken on receipt of such complaints

In case statutory control samples are not collected, attach list of drugs used without having

quality results during the quarter.

Yes / No

Yes / No

Yes / No

p. Has the unit rejected any consignment supplied by any vendor/s

If ‘Yes’ fill in the table:

Vendors from whom

consignment was rejected

Date of such

incidence

Reason(s) for

rejection*

Action taken (whether

blacklisted, warning

issued)

* - 1. Transit loss, 2. Breakage 3. Pilferage

Yes / No

q. Does the unit issue drugs as per FIFO/ order of the expiry date.

If ‘N’, reasons for non-compliance

Yes / No

r. Shelf life of drugs must be 5/6 th of the expiry dates i.e. whether drugs with nearing expiry

dates are not accepted. Whether this criteria is ensured when consignment of drugs are

received?

Yes / No

s. Whether accounts of unserviceable stories is maintained properly.

t. Whether repair register for repair of equipment / furniture etc. is maintained indicating the

number of times of a particular item repaired.

Verify records, check whether updated or not.

Yes / No

u. Whether repair works are done following the provision of WBDFPR'77 and as amended from

time to time (Delegation of Financial Power & Rules) Check records for verification.

Yes / No

v. Whether repair work is done within the allotted budget provision and observing tender

formalities. Check records of repairs exceeding Rs.10,000/-

19

w. Whether equipments of high value were purchased during the quarter. If yes, enclose a list of

such equipments and comment on their proper utilisation.

20

Other issues

a) Whether the condition of Labour room was fit for safe operation round the clock

(linen, basic infrastructure clean and proper).

Yes / No

b) Whether unavailability of any drug has ever been constraint for providing

adequate medical assistance to any patient(s).

Which type of

drug was

unavailable?

(Yes/No)

Period of

stock out

Reasons for

stock out

Action

taken to

overcome

the

situation (to

be obtained

in writing

from the

head of the

office)

Common use

Life saving

drug

Yes / No

c)

Whether out-of-

stock? (Yes/No)

If ‘Yes’, period

for which stock

out remained

Action taken by

the head of the

office for

emergency

procurement

X-ray film of

different sizes

Developer &

fixture

E.C.G. paper

d)

Machines Whether there has

been any instance

when machines

were out-of-order?

(Yes/No)

Period for which

out-of-order

condition

remained

Steps taken to

repair/replace such

machines

X-Ray

USG machine

Sucker machine

21

e) The use of X-ray film of different sizes and USG for free patients and paying patients as per following

proforma:

Month Quantity/No. used

No. of free

patients

No. of

paying

patients

Amount

realized

(Rs.’000)

X-ray film

used

12x12

12x10

10x8

USG

f) Details of transactions related to schemes:

Opening balance

(in Rs.’000)

Funds received (in

Rs.’000)

Expenditure

incurred in Rs.’000)

Remarks

JSY

Referral Transport

Compensation for

sterilisation

HSDI

g)

Whether charges

realized as per

schedule

(Yes/No) Check

records for

evidence

If ‘No’, extent

of violation

Amount of revenue

loss (in Rs.’000)

Bed charges

Charges for

pathological

test

h) Whether diet charges are realized from the patients in accordance with Govt. order

issued vide Nos. HF/O/MS/984/W-10/2001 dated 22.10.2014 and HF/MS/1124/W-

55/2014 dated 21.9.2015.

Yes / No

i) Whether indent for diet is placed daily to the suppliers in accordance with the Census

Register? Check records and fill in the table below:

Dates of

records

checked

No. of

patients as per

Census

Registers on

those dates

Nos. of

patients as per

indent

Whether bills

preferred were

as per indent

Discrepancies,

if any,

Yes / No

j) Whether rate for supply of diet / milk etc. is calculated and fixed as per the provisions

contained in Govt. order.

Yes / No

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k) Whether norms for inviting tenders for supply of diet / milk etc. are meticulously

followed?

Yes / No

l)

Post partum programmes Whether fund allotted to

CMOH within 60 days

from the date of drawal

of the amount? (Yes/No)

If ‘No’, actions taken

Sterilization

Pulse polio

Anti Malaria activities

m) Whether compensation for sterilization is made available to the concerned persons

on the spot?

If not, how the amount is paid to the acceptors subsequently may be enquired into and

commented upon suitably.

Yes / No

n) Brief note on the functioning of Rogi Kalyan Samiti (applicable to hospitals only).

i. Whether Cash Book and other records are being maintained for RKS?

ii. Whether cash book and records are updated regularly?

(Verify records as on date of visit.)

(iii) Whether User Charges are shared and remitted to District/State Samiti as per norms?

(Check records in the light of orders issued vide Nos. HF/O/MS/984/W-10/2001 dated 22.10.2014

and HF/MS/1124/W-55/2014 dated 21.9.2015).

Services provided

to patients/patient

parties out of RKS

fund (to be cross-

checked with

patients/patient

parties)

Expenditure

incurred (in Rs.)

Services that could

be made available

(to be discussed

with

Superintendent as

well as

beneficiaries)

Factors leading to

delay in carrying

out the proposed

services

Suggestion/Remarks

for better utilization

of RKS money

o) Whether log book of vehicle / ambulance and history sheet of each medical equipment installed in the

hospital is being maintained (Internal Auditor should check these items and report).

p) Brief note on the functioning of Nursing Training Institute (if applicable).

q) Rashtriya Swasthya Bima Yojana (RSBY) :

Whether the auditee unit is enlisted under RSBY. Yes / No

If yes, give the following information:

(i) No. of patients admitted in the Hospital under RSBY during the quarter.

(ii) Amount of RSBY Fund received and whether it is shown in RKS account.

(iii) Item-wise expenditure incurred from the fund.

Yes No

Yes No

23

(Comment on any diversion of RSBY Fund)

r) Scavenging and Security Services:

(i) The Name of the Firm engaged for the purpose.

(ii) Whether there was any excess payment in this regard (check the bills to

verify the number of labourers deployed as per agreement).

(iii) Whether deposits are being made regularly on account of ESI, EPF., etc.

(iv) Whether service taxes are being paid regularly.

(A copy of agreement is to be attached with the report).

Enclosures:

i) Photocopies of replies to the paras of Pr. A. G. (Audit), WB.

ii) Photocopies of physical verification reports in respect of cash, stock of DCR and Store.

iii) Photocopies of bank reconciliation statements alongwith photocopies of relevant pages of bank

passbook (duly attested).

iv) Photocopies of statements in Proforma ‘A’ & ‘B’ and / or FMR.

v) Photocopies of latest engagement orders of contractual staff.

vi) Photocopy of a list of high value equipments procured in the quarter.

vii) Photocopies of GPF statements in respect of Gr. ‘D’.

viii) Photocopies of agreement entered into with the agency engaged for lifting of bio-medical waste.

ix) Photocopies of agreement entered into with the Units functioning on PPP model.

x) Photocopies of a bill passed recently for payment to the agency engaged for lifting Bio-Medical

waste.

xi) Photocopies of agreement entered into with the Firm for scavenging and security services.

Signature of the authorized

representative of the Audit Firm

(Partner / Proprietor)

Signature of the Accounts Officer

or In-Charge of Accounts &

Establishment.

Signature of the

Head of the office.