Government of the People’s Republic of Bangladesh
                                                                       Directorate General of Health Services
                                                                              Mohakhali, Dhaka-1212

                                                                                Health Workforce Datasheet

                                                                                                     Warning

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                                                                                                 mZ¨ iÿvi †Nvlbv

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Z‡_¨i †Kvb weK…wZ _vK‡j ev ¸iæZ¡c~Y© Z_¨ †Mvcb Kiv n‡j Zvi Rb¨ Avwg `vqx _vK‡ev Ges GRb¨ KZ…
©cÿ Avgv‡K †h ‡Kvb kvw¯Í w`‡Z cvi‡eb|

                                                                                 I agree                     I don’t agree

..............................................................................................................................................................................................................
                                                                  Welcome to DGHS Personal Information Data Sheet
                                                            Click on the buttons below to enter or update your information
                                                                                                                                                             First
      Personal                           Family                       Information on               Educational              Registration                                             Posting, Transfer,
                                                                                                                                                        appointment &
    Information                       Information                       Current Job                Qualification            Information                                                 Promotion
                                                                                                                                                        Regularization
                                                                                                                                                                                       Miscellaneous
     Salary and                       Training                           Leave,                                             Disciplinary                 Retirement &
                                                                                                  DDOship & Audit                                                                      (publications,
      Benefits                    (Local & Foreign)                  Deputation, Lien                                         actions                      Pension
                                                                                                                                                                                          others)
                                                          Mouse over will show type of information each button will accept
Personal Information                                                                                         Living in urban or rural area:
ID No.     ...........................................                                                                   Urban (municipality or City Corporation) Rural
Code No. ...........................................                                                         If urban, which town or city? (Choose from the list): ............
Name (in English):           .................................................................               Type the detailed address here:
                                                                                                             District (choose from the list): ........................................
bvg (evsjvq)t              ..........................................................                        Thana/Upazila (choose from the list): ..............................
Sex:         Male Female                                                                                   Post office: ..................................Postal code.....................
Father’s name:             ................................................................                  Village (or Road and House No.) .............................................
Mother’s name:             ...............................................................                   Land phone (use , if more than 1): ...................................
Date of birth:    ........(day) ...........(month) ..............(year)                                      Mobile phone (use , if more than 1): ...............................
Religion:    Muslim Hindu Buddhist Christian Other                                                      Email address (use , if more than 1): ......................................
Marital status: Unmarried Married Widowed Divorced Not
             divorced but living separated Spouse died
Present address
Date updated

1 | Personal Data Sheet
Permanent address                                                                        Assistant to technician: Lab assistant, Dental assistant, Pharmaceutical
Urban or rural area:                                                                        assistant, etc.
            Urban (municipality or City Corporation) Rural                             Environment and public health worker: Environment officers,
If urban, which town or city? (Choose from the list): ............                          Environment public health officers, Sanitary officers, Sanitation
Type the detailed address here:                                                             worker, Hygienist, Public health technician, malaria technician,
District (choose from the list): ........................................                   meat inspector, public health supervisor, etc.
Thana/Upazila (choose from the list): ..............................                     Community health worker: assistant/community health education
                                                                                            worker, community health officer, family health worker, lady
Post office: ..................................Postal code.....................             health visitor, health extension package worker, community
Village (or Road and House No.) .............................................               midwife
Land phone (separate by , if more than 1): .............................                 Other health workers: dietician, nutritionist, occupational therapist,
Mobile phone (separate by , if more than 1): ........................                       operator of medical and dental equipment, optometrist, optician,
Email address (separate by , if more than 1): .........................                     podiatrist, prosthetic/orthetic engineer, psychologist, respiratory
                                                                                            therapist, speech pathologist, trainee
                                   Save Information
                                                                                         Health management and support worker (non-medical): health
                       ....................................................                 manager, health economist, health statistician, teaching
Family Information                                                                          professional, health policy lawyer, medical records and health
                                                                                            information technician, ambulance staff, cleaning staff, building
Spouse information                                                                          and engineering staff, general support staff, driver
Use a table to display following information:                                       Designation (choose from list)
   Sl. No.                              Your code:                                  Type of placement
   Date updated:                        Name of spouse:                                   Current charge In-charge Working Deputation Study
   Does s/he currently serve under DGHS? Yes/No                                           deputation OSD (working) OSD (punishment) Lien Against
   His/her code, if under DGHS          His/her occupation (choose from list)             the post Fixed pay Contract Service
   His/her designation                  His/her place of posting (detail address)
                                                                                          Remarks, if any: ...........................................
   His/her department/organization      Remarks, if any
                                                                                    Place of posting: ..............................................................................
                                                                                    Type of the posting place:
                                                                                          Community Clinic Union sub-center Rural health center
                                                                                          Urban dispensary TB Clinic Leprosy clinic TB hospital
                                                                                          Upazila Health Complex District/ Sadar Hospital General
Children’s information
                                                                                          Hospital Medical College Medical College Hospital
Use a table to display following information                                              Postgraduate Teaching Institute (non-clinical) Postgraduate
   Sl. No.                            Your code:                                          Teaching Institute (Clinical) Infectious disease hospital DGHS
   Date updated:                      Name of child:                                      Divisional Health Office CS Office Sadar Upazila Health Office
   Date of birth:                     Sex:                                                Other institute Trauma Center MATS IHT Nursing
   Schooling: Not started Studying Completed Stopped                                  Institute ....
   If schooling, level of education                                                 Location of your posting place:
   Marital status: Unmarried Married Widowed Divorced Not                            Urban or rural: Urban Rural
   divorced but living separated Spouse died                                             Name of thana/upazila (choose from list)
   Employment: Studying, does not earn Earns beside studying                            Name of district (choose from list)
                     Full time employment Unemployed Sick, not fit               Date of joining in current post: .............(day) ......... (month) .......(yr)
                     for employment                                                 Pay scale of present post (choose from list)
   Remarks, if any                    His/her occupation (choose from list)         Basic pay in Taka:
   His/her designation                His/her place of posting (detail              Next increment date: .........(day).........(month)............(year)
                                      address)                                      Drawing salary from same post: Yes/No
   His/her department/organization                                                  If not, mention from which post you currently draw salary:
                                   Save Information                                 Educational Qualification
                       ....................................................         Type exactly your highest educational qualification................
Information on current job                                                          Fill up this table
Your code:                                                                          Sl.    Your                 Level of   Actual                  Board/        Distinction,      Major
                                                                                                     Year                             Institute
Date updated:                                                                       No.    Code                education    level                 University        if any       subject(s)
                                                                                                                Choose     Choose                  Choose
Type of post: Cadre Regular Regular Temporary Development
Directorate: DGHS Nursing
Professional category (add a definition page):                                      Explanation:
     Physician Dentist Nurse Midwife Pharmacist Engineer                      Level of education:
     Laboratory scientist Physiotherapist Medical technologist                      Illiterate Below primary Below junior Junior Below secondary
     Technician Assistant to technician Environment and public                      Secondary Higher Secondary Graduate Masters PhD Post-doctoral
                                                                                       Undergraduate DiplomaOther
     health worker Community health worker Traditional Medicine
                                                                                    Total length of study: ..............years
     Practitioner (AMC practitioner) Birth attendant Medical Assistant            Actual level of education:
     Personal care worker Health management and support worker                       Illiterate Class I-IV Class V Class VI-VII Class VIII Class IX-X SSC
     Other health professional or worker                                              HSC BA/BSc/BCom/Fazil MA/MSc/MCom/Kamil MBBS BDS
Professional sub-category (add a definition page):                                     Undergraduate Diploma (nursing, paramedical, medical assistant, etc.)
     Physician: General, Internal medicine, General surgery,                           Postgraduate diploma MPhil/MD/MS PhD Post-doctoral
        Ophthalmology, etc.
     Dentist: General, maxillofacial surgery, Orthodontics, etc.                    Registration Information
     Nurse: Professional nurse, auxiliary nurse (nurse aid), enrolled nurse,                                                                                    First
                                                                                                            Regulatory       Degree          Regis-                              Last
        dental nurse, primary care nurse, cardiac nurse, nurse-midwife, etc.        Sl.       Your                                                             Regis-
                                                                                                               body        registered        tration                            Renewal
                                                                                    No.       code                                                             tration
     Midwife: Professional midwife, auxiliary midwife, enrolled midwife                                      (choose)       (choose)           No.                               Date
                                                                                                                                                                Date
     Physiotherapist: if there is any sub-category
     Medical technologist: Laboratory, Radiography, Physiotherapy,
        Radiotherapy, Dental, Sanitary inspector, Optometry, etc.
     Technician: Laboratory technician, dental technician, ECG technician,
        etc.                                                                        First appointment and Regularization
                                                                                    Internship Training
2 | Personal Data Sheet
Type                                                                                                                                          Date completed




                                                                                                                                                                                                                                                                                                                 CourseName of training




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           etc.Diploma, certificate,
                         Internship




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Duration (days)
                                                                                                                                                                          day-month-year




                                                                                                                                                                                                                                                                                                                                                                                                                                                               Organized by

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Begin date
                                                                                                                                                                                                                                                           Your code
                   or In-service Training




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Remarks
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   End date
                                                                                                                                                                                                                                           Sl. No.




                                                                                                                                                                                                                                                                                                                                                                                               Venue
Ad-hoc appointment, if any
 Ever appointed on
                              Date                                                                                                                                        G.O. No.                       Serial No.
   ad-hoc basis?
       Yes/No            day-month-year
                                                                                                                                                                                                                                          1
Has your job been regularized?                Yes/No                                                                                                                                                                                      2
If yes, give particulars in following table:                                                                                                                                                                                              3
                                     For post                                                                                                                                  Date of                                Serial
 Sl. No.       Authority                                                                                                                                                                                                                  Foreign training (outside country)
                                     (choose)                                                                                                                               regularization                             No.




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      etc.Degree, diploma, certificate,
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     Country
                                                                                 Assistant Surgeon




                                                                                                                                                                                                                                                                                                       Name of training Course
                                                                                 Assistant Professor




                                                                                                                                                                                                                                                                                                                                                                               Sponsoring organization
                                                                                 Associate Professor
                                                                                 Professor




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 Begin date
                                                                                                                                                                                                                                                          Your code




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         End date




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             Remarks
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Duration
                          MOHFW                                                  Assistant Director




                                                                                                                                                                                                                                           Sl. No.




                                                                                                                                                                                                                                                                                                                                                                                                                                                               Venue
                                                                                 Deputy Director
          1               PSC                                                    Director
                          DPC                                                    Additional Director General
                                                                                 Director General
                                                                                 ..............
                                                                                 Consultant
                                                                                 Senior Consultant
                                                                                                                                                                                                                                          1
          2
                                                                                                                                                                                                                                          2
          3
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Service confirmation following BCS
 Service confirmed    BCS Batch No.                                                                                                     G.O. No.                                                           Date                           Leave, Deputation, Lien
      Yes/NO                                                                                                                                                                                                                              Leave (except casual leave)




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     You joined after leave on date




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Purpose of taking leave
                                                                                                                                                                                                                                                                                                                         list)Type of Leave (choose from




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        G.O. No. & date granting leave
                                                                 Save Information




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               You enjoyed leave (length)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                 You started leave on date
                                                                                                                                                                                                                                                                                                                                                                                                   Length of approved leave
                                                     ....................................................




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             Remarks, if any
                                                                                                                                                                                                                                                          Your code
                                                                                                                                                                                                                                           Sl. No.

Posting, Transfer, Promotion
                                                                                                               First Posting, Transfer in same rank, Transfer in higher
                                                                                 G.O. Date

                                                                                             G.O. Serial




                                                                                                                                                                                                                                          1
                                                                                                           (choose)PunishmentPromotion, Demotion




                                                                                                                                                                                                                                          2
                          Designation (choose)

                                                 Posted as (choose)




                                                                                                                                                                                                                                          3
                                                                                                                                                                                      Place of posting




                                                                                                                                                                                                                           Release date
                                                                                                                                                                                                            Joining date
              Your Code




                                                                                                                                         status,
                                                                      G.O. No.
Sl. No.




                                                                                                                                                                                                                                          Deputation

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               You joined after deputation on date



                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 (length)You enjoyed after deputation




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Purpose & outcome of deputation
                                                                                                                                                                                                                                                                       list)Type of Deputation (choose from




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 deputationG.O. No. & date granting
                                                                                                                                                                                                                                                                                                                                                                                                                              You started deputation on date
                                                                                                                                                                                                                                                                                                                                                           Length of approved deputation




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Remarks, if any
                                                                                                                                                                                                                                                     Your code
                                                                                                                                                                                                                                           Sl. No.




1
2
3
4                                                                                                                                                                                                                                         1
                                                                                                                                                                                                                                          2
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                         Save Information
             ....................................................
Salary and Benefits
                                                                         Date                                                                                                                                                             Lien
                                                                        when a                What was                What was                                                      Why
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            deputationG.O. No. & date granting



                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         If you fail to follow any condition of
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             You joined after Lien on date




                                       Your
    Sl. No.                                                           new scale                 the                   the Basic                                                    scale                      Remarks
                                       code
                                                                      began or                 Scale?                   pay?                                                      changed
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      You enjoyed Lien(length)
                                                                                                                                                                                                                                                                                                                                                                                                                              You started Lien on date
                                                                                                                                                                                                                                                                                                                                                           Length of approved Lien




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Other Remarks, if any
                                                                                                                                                                                                                                                                       Purpose of taking Lien




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Lien, explain why?




                                                                       changed
          1
                                                                                                                                                                                                                                                     Your code
                                                                                                                                                                                                                                           Sl. No.




          2
          3

                                                                 Save Information
                                                     ....................................................
                                                                                                                                                                                                                                          1
Training (Local and Foreign)                                                                                                                                                                                                              2
Local training (within country)                                                                                                                                                                                                           3

                                                                                                                                                                                                                                                                                                                                                               Save Information
                                                                                                                                                                                                                                                                                                                                                   ....................................................
                                                                                                                                                                                                                                          DDOship and Audit objection


3 | Personal Data Sheet
outFinancial responsibility carried




                                                                                                                                                          Type of audit objection, if any




                                                                                                                                                                                                                                          What is the current status ?
                                                                                                                   In what capacity?




                                                                                                                                                                                                           Describe further
                                                                                    If yes, where?
                   Your code
  Sl. No.



                                                                                                                                                                                                                                                                                     Save Information
                                                                                                                                                                                                                                                                         ....................................................


    1
    2
    3

                                           Save Information
                               ....................................................
Disciplinary actions




                                                                                                                                                                                                                                                  Remarks, if any
                                                                                                                                        Inquiry Officer




                                                                                                                                                                                                                       Decision date
              Your code




                                                                                                        Complain




                                                                                                                                                                                            Decision
  Sl. No.




                                Year



                                                                             Date




   1
   2
   3

                                           Save Information
                               ....................................................
Retirement and Pension
Regular date of LPR: ............(day) ............... (month) ............. (year)
Regular date of Pension: ................ (day) ....................(month) ............... (year)
                                    Type of
                                   retirement
                                                                                                                                         Date of                                                 Reason for
                     Your            (Early/                                                          Date
 Sl. No.                                                                                                                               terminatio                                                terminatio                            Nominee
                     code           Forced/                                                          begins
                                                                                                                                           n                                                         n
                                      LPR/
                                    Pension)
      1
      2
      3

                                           Save Information
                               ....................................................
Miscellaneous (Publication, presentation, affiliation, etc.)
Publication
                                                                                     National or                                                                                               Authorship:
                 Your                                                                                                              Original or
Sl. No.                                      Title                                  Internationa                                                                                               Principal or                            Reference
                 code                                                                                                               Review
                                                                                          l                                                                                                    Co-author
    1
    2
    3
Presentation
                                                                                     National or
                 Your                                                                                                              Scientific
Sl. No.                                     Title                                   Internationa                                                                                                       Date, Venue, Country
                 code                                                                                                             or General
                                                                                          l
    1
    2
    3




Affiliation
                                                                                              Type of
              Your               Organizatio
Sl. No.                                                                                      Organizatio                                       Position                                                   Remarks, if any
              code                   n
                                                                                                 n
    1
    2
    3


Any other information
                                                                                               Memo box

4 | Personal Data Sheet
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GRb¨ Avgv‡K †h ‡Kvb kvw¯Í w`‡Z cvi‡eb|

                                         I agree, Submit




5 | Personal Data Sheet
Annual Credential Report
Code No.      .......................                                                 Performance to taking action and carry out order of superiors:
Name:        ...............................................................          Awareness about security:
Designation: ..............................................................           Behavior with people:

                                                                                                           Part IV: Work Performed
            Part I : Report on Health Examination
                                                                                      Professional knowledge:
Height: ......................... feet                                                Quality of work:
Weight: ........................ kilogram                                             Quantity of work performed:
Vision: ..........................                                                    Ability of monitoring and directing
Blood Group: O:........... Rh: ..................                                     Relation with colleagues
Blood Pressure: Systolic ................ Diastolic ...................               Competence for decision making:
X-ray report: .....................................................................   Ability for decision implementation:
ECG Report: ....................................................................      Interest and ability to train subordinates:
Medical Type: ..................................................................      Ability of expression (written):
Health problem/ Fitness problem: ...................................                  Ability of expression (verbal):
                                                                                      Initiative to complete ACR and taking countersign:
Health Officer who signed ................................................
                                                                                      Sincerity:
Date: .....................................                                           Total No. obtained: Extraordinary Excellent Best
                                                                                                             Average Below average
                             Part II : Biodata
         Grading on assessment (between 1 and 4)                                       Part V: Written Sketch about the officer on assessment

Additional information that is missing in PDS
Competence in foreign language:
      Speaking
      Reading
      Writing
Length of service under the officer who is writing this
ACR: .......................... Months/ Years                                                            Part VI: Recommendations
Performance of the staff during this ACR period
a.                                                                                    Special preference/qualification (administrative, official,
                                                                                      external, other):
b.
                                                                                      Honesty and reputation:
c.                                                                                        Moral
d.                                                                                        Intellectual
e.                                                                                        Material
                                                                                      Recommendations for on-job promotion
                Part III: Personal Characteristics                                        Fit for promotion
                            [Grade 1 to 4)                                                Not yet fit for promotion
Discipline:                                                                               Reached highest level for promotion
Judgment and sense of limit (jurisdiction):                                               Recently promoted; premature for new promotion
Intelligence:                                                                         Other recommendation (if any):
Pro-activeness and initiative:
Personality:                                                                                   Name of assessor: ...............................................
Cooperativeness:
Punctuality:                                                                                   Designation:              ................................................
Dependability:                                                                                 ID No.                    ...............................................
Responsibility:
                                                                                               Date:                     ...............................................
Interest to work:




6 | Personal Data Sheet

consumer

  • 1.
    Government of thePeople’s Republic of Bangladesh Directorate General of Health Services Mohakhali, Dhaka-1212 Health Workforce Datasheet Warning 1. Avcwb evsjv‡`‡ki bvMwiK Ges evsjv‡`‡ki miKvix ¯^v¯’¨ mvwf©‡m PvKzixiZ n‡j GB dig c~iY Kiv Ges †Kvb Z_¨ cwieZ©b n‡j †`ix bv K‡i h_vkxNÖ m¤¢e Zv nvjbvMv` Kiv Avcbvi Rb¨ eva¨Zvg~jK| 2. GKev‡i me Z_¨ c~iY Ki‡Z bv cvi‡j AvswkK c~iY Kiæb Ges ZvovZvwo me Z_¨ †hvMvo K‡i digwU KgwcøU Kiæb| 3. hLbB cÖ‡qvRb co‡e ZLbB GB dig Ly‡j Z_¨ ‡`‡L wb‡Z ev nvjbvMv` Ki‡Z cvi‡eb| Avcbvi BDRvi bvg ev cvmIqvW© Ab¨ KvD‡K †`‡eb bv| ‡Kbbv Zv n‡j ‡KD Avcbvi PvKzixi Z_¨ weK…Z K‡i Avcbvi me©bvk Ki‡Z cv‡i| 4. evsjv‡`‡ki miKvix ¯^v¯’¨ mvwf©‡m PvKzix bv Ki‡j GB dig c~iY Kivi cÖ‡qvRb †bB| 5. webv AbygwZ‡Z AevwÂZ e¨w³ GB dig c~iY Ki‡j Zvu‡K K‡Vvi kvw¯Í †fvM Ki‡Z n‡e| 6. Avcwb wg_¨v I fzj Z_¨ w`‡j ev Z_¨ †Mvcb Ki‡j wefvMxq kvw¯Íi mb¥yLxb n‡eb| mZ¨ iÿvi †Nvlbv Avwg GB g‡g© †Nvlbv KiwQ †h, Dc‡ii Warning c‡owQ| Avwg evsjv‡`‡ki miKvix ¯^v¯’¨ mvwf©‡m PvKzixiZ Ges Avwg GB di‡g †Kvb wg_¨v ev fyj Z_¨ †`‡ev bv ev †Kvb Z_¨ †Mvcb Ki‡ev bv| Avgvi e¨w³MZ WvUvkx‡U Z‡_¨i †Kvb weK…wZ _vK‡j ev ¸iæZ¡c~Y© Z_¨ †Mvcb Kiv n‡j Zvi Rb¨ Avwg `vqx _vK‡ev Ges GRb¨ KZ… ©cÿ Avgv‡K †h ‡Kvb kvw¯Í w`‡Z cvi‡eb| I agree I don’t agree .............................................................................................................................................................................................................. Welcome to DGHS Personal Information Data Sheet Click on the buttons below to enter or update your information First Personal Family Information on Educational Registration Posting, Transfer, appointment & Information Information Current Job Qualification Information Promotion Regularization Miscellaneous Salary and Training Leave, Disciplinary Retirement & DDOship & Audit (publications, Benefits (Local & Foreign) Deputation, Lien actions Pension others) Mouse over will show type of information each button will accept Personal Information Living in urban or rural area: ID No. ........................................... Urban (municipality or City Corporation) Rural Code No. ........................................... If urban, which town or city? (Choose from the list): ............ Name (in English): ................................................................. Type the detailed address here: District (choose from the list): ........................................ bvg (evsjvq)t .......................................................... Thana/Upazila (choose from the list): .............................. Sex: Male Female Post office: ..................................Postal code..................... Father’s name: ................................................................ Village (or Road and House No.) ............................................. Mother’s name: ............................................................... Land phone (use , if more than 1): ................................... Date of birth: ........(day) ...........(month) ..............(year) Mobile phone (use , if more than 1): ............................... Religion: Muslim Hindu Buddhist Christian Other Email address (use , if more than 1): ...................................... Marital status: Unmarried Married Widowed Divorced Not divorced but living separated Spouse died Present address Date updated 1 | Personal Data Sheet
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    Permanent address Assistant to technician: Lab assistant, Dental assistant, Pharmaceutical Urban or rural area: assistant, etc. Urban (municipality or City Corporation) Rural Environment and public health worker: Environment officers, If urban, which town or city? (Choose from the list): ............ Environment public health officers, Sanitary officers, Sanitation Type the detailed address here: worker, Hygienist, Public health technician, malaria technician, District (choose from the list): ........................................ meat inspector, public health supervisor, etc. Thana/Upazila (choose from the list): .............................. Community health worker: assistant/community health education worker, community health officer, family health worker, lady Post office: ..................................Postal code..................... health visitor, health extension package worker, community Village (or Road and House No.) ............................................. midwife Land phone (separate by , if more than 1): ............................. Other health workers: dietician, nutritionist, occupational therapist, Mobile phone (separate by , if more than 1): ........................ operator of medical and dental equipment, optometrist, optician, Email address (separate by , if more than 1): ......................... podiatrist, prosthetic/orthetic engineer, psychologist, respiratory therapist, speech pathologist, trainee Save Information Health management and support worker (non-medical): health .................................................... manager, health economist, health statistician, teaching Family Information professional, health policy lawyer, medical records and health information technician, ambulance staff, cleaning staff, building Spouse information and engineering staff, general support staff, driver Use a table to display following information: Designation (choose from list) Sl. No. Your code: Type of placement Date updated: Name of spouse: Current charge In-charge Working Deputation Study Does s/he currently serve under DGHS? Yes/No deputation OSD (working) OSD (punishment) Lien Against His/her code, if under DGHS His/her occupation (choose from list) the post Fixed pay Contract Service His/her designation His/her place of posting (detail address) Remarks, if any: ........................................... His/her department/organization Remarks, if any Place of posting: .............................................................................. Type of the posting place: Community Clinic Union sub-center Rural health center Urban dispensary TB Clinic Leprosy clinic TB hospital Upazila Health Complex District/ Sadar Hospital General Children’s information Hospital Medical College Medical College Hospital Use a table to display following information Postgraduate Teaching Institute (non-clinical) Postgraduate Sl. No. Your code: Teaching Institute (Clinical) Infectious disease hospital DGHS Date updated: Name of child: Divisional Health Office CS Office Sadar Upazila Health Office Date of birth: Sex: Other institute Trauma Center MATS IHT Nursing Schooling: Not started Studying Completed Stopped Institute .... If schooling, level of education Location of your posting place: Marital status: Unmarried Married Widowed Divorced Not Urban or rural: Urban Rural divorced but living separated Spouse died Name of thana/upazila (choose from list) Employment: Studying, does not earn Earns beside studying Name of district (choose from list) Full time employment Unemployed Sick, not fit Date of joining in current post: .............(day) ......... (month) .......(yr) for employment Pay scale of present post (choose from list) Remarks, if any His/her occupation (choose from list) Basic pay in Taka: His/her designation His/her place of posting (detail Next increment date: .........(day).........(month)............(year) address) Drawing salary from same post: Yes/No His/her department/organization If not, mention from which post you currently draw salary: Save Information Educational Qualification .................................................... Type exactly your highest educational qualification................ Information on current job Fill up this table Your code: Sl. Your Level of Actual Board/ Distinction, Major Year Institute Date updated: No. Code education level University if any subject(s) Choose Choose Choose Type of post: Cadre Regular Regular Temporary Development Directorate: DGHS Nursing Professional category (add a definition page): Explanation: Physician Dentist Nurse Midwife Pharmacist Engineer Level of education: Laboratory scientist Physiotherapist Medical technologist Illiterate Below primary Below junior Junior Below secondary Technician Assistant to technician Environment and public Secondary Higher Secondary Graduate Masters PhD Post-doctoral Undergraduate DiplomaOther health worker Community health worker Traditional Medicine Total length of study: ..............years Practitioner (AMC practitioner) Birth attendant Medical Assistant Actual level of education: Personal care worker Health management and support worker Illiterate Class I-IV Class V Class VI-VII Class VIII Class IX-X SSC Other health professional or worker HSC BA/BSc/BCom/Fazil MA/MSc/MCom/Kamil MBBS BDS Professional sub-category (add a definition page): Undergraduate Diploma (nursing, paramedical, medical assistant, etc.) Physician: General, Internal medicine, General surgery, Postgraduate diploma MPhil/MD/MS PhD Post-doctoral Ophthalmology, etc. Dentist: General, maxillofacial surgery, Orthodontics, etc. Registration Information Nurse: Professional nurse, auxiliary nurse (nurse aid), enrolled nurse, First Regulatory Degree Regis- Last dental nurse, primary care nurse, cardiac nurse, nurse-midwife, etc. Sl. Your Regis- body registered tration Renewal No. code tration Midwife: Professional midwife, auxiliary midwife, enrolled midwife (choose) (choose) No. Date Date Physiotherapist: if there is any sub-category Medical technologist: Laboratory, Radiography, Physiotherapy, Radiotherapy, Dental, Sanitary inspector, Optometry, etc. Technician: Laboratory technician, dental technician, ECG technician, etc. First appointment and Regularization Internship Training 2 | Personal Data Sheet
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    Type Date completed CourseName of training etc.Diploma, certificate, Internship Duration (days) day-month-year Organized by Begin date Your code or In-service Training Remarks End date Sl. No. Venue Ad-hoc appointment, if any Ever appointed on Date G.O. No. Serial No. ad-hoc basis? Yes/No day-month-year 1 Has your job been regularized? Yes/No 2 If yes, give particulars in following table: 3 For post Date of Serial Sl. No. Authority Foreign training (outside country) (choose) regularization No. etc.Degree, diploma, certificate, Country Assistant Surgeon Name of training Course Assistant Professor Sponsoring organization Associate Professor Professor Begin date Your code End date Remarks Duration MOHFW Assistant Director Sl. No. Venue Deputy Director 1 PSC Director DPC Additional Director General Director General .............. Consultant Senior Consultant 1 2 2 3 3 Service confirmation following BCS Service confirmed BCS Batch No. G.O. No. Date Leave, Deputation, Lien Yes/NO Leave (except casual leave) You joined after leave on date Purpose of taking leave list)Type of Leave (choose from G.O. No. & date granting leave Save Information You enjoyed leave (length) You started leave on date Length of approved leave .................................................... Remarks, if any Your code Sl. No. Posting, Transfer, Promotion First Posting, Transfer in same rank, Transfer in higher G.O. Date G.O. Serial 1 (choose)PunishmentPromotion, Demotion 2 Designation (choose) Posted as (choose) 3 Place of posting Release date Joining date Your Code status, G.O. No. Sl. No. Deputation You joined after deputation on date (length)You enjoyed after deputation Purpose & outcome of deputation list)Type of Deputation (choose from deputationG.O. No. & date granting You started deputation on date Length of approved deputation Remarks, if any Your code Sl. No. 1 2 3 4 1 2 3 Save Information .................................................... Salary and Benefits Date Lien when a What was What was Why deputationG.O. No. & date granting If you fail to follow any condition of You joined after Lien on date Your Sl. No. new scale the the Basic scale Remarks code began or Scale? pay? changed You enjoyed Lien(length) You started Lien on date Length of approved Lien Other Remarks, if any Purpose of taking Lien Lien, explain why? changed 1 Your code Sl. No. 2 3 Save Information .................................................... 1 Training (Local and Foreign) 2 Local training (within country) 3 Save Information .................................................... DDOship and Audit objection 3 | Personal Data Sheet
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    outFinancial responsibility carried Type of audit objection, if any What is the current status ? In what capacity? Describe further If yes, where? Your code Sl. No. Save Information .................................................... 1 2 3 Save Information .................................................... Disciplinary actions Remarks, if any Inquiry Officer Decision date Your code Complain Decision Sl. No. Year Date 1 2 3 Save Information .................................................... Retirement and Pension Regular date of LPR: ............(day) ............... (month) ............. (year) Regular date of Pension: ................ (day) ....................(month) ............... (year) Type of retirement Date of Reason for Your (Early/ Date Sl. No. terminatio terminatio Nominee code Forced/ begins n n LPR/ Pension) 1 2 3 Save Information .................................................... Miscellaneous (Publication, presentation, affiliation, etc.) Publication National or Authorship: Your Original or Sl. No. Title Internationa Principal or Reference code Review l Co-author 1 2 3 Presentation National or Your Scientific Sl. No. Title Internationa Date, Venue, Country code or General l 1 2 3 Affiliation Type of Your Organizatio Sl. No. Organizatio Position Remarks, if any code n n 1 2 3 Any other information Memo box 4 | Personal Data Sheet
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    †Nvlbv Avwg GB g‡g©†Nvlbv KiwQ †h, Avwg GB di‡g †Kvb wg_¨v ev fyj Z_¨ ‡`B bvB| Avgvi e¨w³MZ WvUvkx‡U Z‡_¨i †Kvb wePz¨wZ cwijwÿZ n‡j ev †Kvb ¸iæZ¡c~Y© Z_¨ Abycw¯’Z _vK‡j Avwg `vqx _vK‡ev Ges KZ…©cÿ GRb¨ Avgv‡K †h ‡Kvb kvw¯Í w`‡Z cvi‡eb| I agree, Submit 5 | Personal Data Sheet
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    Annual Credential Report CodeNo. ....................... Performance to taking action and carry out order of superiors: Name: ............................................................... Awareness about security: Designation: .............................................................. Behavior with people: Part IV: Work Performed Part I : Report on Health Examination Professional knowledge: Height: ......................... feet Quality of work: Weight: ........................ kilogram Quantity of work performed: Vision: .......................... Ability of monitoring and directing Blood Group: O:........... Rh: .................. Relation with colleagues Blood Pressure: Systolic ................ Diastolic ................... Competence for decision making: X-ray report: ..................................................................... Ability for decision implementation: ECG Report: .................................................................... Interest and ability to train subordinates: Medical Type: .................................................................. Ability of expression (written): Health problem/ Fitness problem: ................................... Ability of expression (verbal): Initiative to complete ACR and taking countersign: Health Officer who signed ................................................ Sincerity: Date: ..................................... Total No. obtained: Extraordinary Excellent Best Average Below average Part II : Biodata Grading on assessment (between 1 and 4) Part V: Written Sketch about the officer on assessment Additional information that is missing in PDS Competence in foreign language: Speaking Reading Writing Length of service under the officer who is writing this ACR: .......................... Months/ Years Part VI: Recommendations Performance of the staff during this ACR period a. Special preference/qualification (administrative, official, external, other): b. Honesty and reputation: c. Moral d. Intellectual e. Material Recommendations for on-job promotion Part III: Personal Characteristics Fit for promotion [Grade 1 to 4) Not yet fit for promotion Discipline: Reached highest level for promotion Judgment and sense of limit (jurisdiction): Recently promoted; premature for new promotion Intelligence: Other recommendation (if any): Pro-activeness and initiative: Personality: Name of assessor: ............................................... Cooperativeness: Punctuality: Designation: ................................................ Dependability: ID No. ............................................... Responsibility: Date: ............................................... Interest to work: 6 | Personal Data Sheet