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HEALTHCARE
- Nursing
- Therapy
SCHOOLS
TELEPRACTICE

About Us
Employees
Employers
Contact
Blog

HEALTHCARE
- Nursing
- Therapy
SCHOOLS
TELEPRACTICE

Occupational Therapy Skills Checklist

Please rate your experience / frequency within the last year
0 = No Experience / Observed Only
1 = Limited Experience / Rarely Done (<6 times/year)
2 = May Need Some Review / Occasionally Done (1-2 times/month)
3 = Experienced / Frequently Done (daily or weekly)

Please rate your experience / frequency within the last year

0 = No Experience / Observed Only

1 = Limited Experience / Rarely Done (<6 times/year)

2 = May Need Some Review / Occasionally Done (1-2 times/month)

3 = Experienced / Frequently Done (daily or weekly)

"*" indicates required fields

Please rate your experience / frequency within the last year
0 = No Experience / Observed Only
1 = Limited Experience / Rarely Done (<6 times/year)
2 = May Need Some Review / Occasionally Done (1-2 times/month)
3 = Experienced / Frequently Done (daily or weekly)

Full Name*

Email*

Todays Date*

MM slash DD slash YYYY

Age Of Patients Cared For

Newborn/Neonate (birth to 30 days)

0

1

2

3

Infant (31 days to 12 months)

0

1

2

3

Toddler/Preschool (13 months to 5 years)

0

1

2

3

School Age Child/adolescent (6 years to 18 years)

0

1

2

3

Young Adults/ Middle Adult (19 years to 64 years)

0

1

2

3

Older Adults/Elderly (65+ years)

0

1

2

3

Settings

Acute Care/ Hospital

0

1

2

3

Sub Acute

0

1

2

3

Rehabilitation - Acute

0

1

2

3

Rehabilitation - Long Term

0

1

2

3

Home Health

0

1

2

3

Outpatient

0

1

2

3

Adults/ Adult ICU

0

1

2

3

Pediatrics/PICU

0

1

2

3

Psychiatric Hospital

0

1

2

3

Skilled Nursing Facility

0

1

2

3

School Setting

0

1

2

3

Early Intervention

0

1

2

3

Neurological

Adaptive Equipment

0

1

2

3

Alzheimer's/Dementia

0

1

2

3

CVA

0

1

2

3

Degenerative Diseases of the CNS

0

1

2

3

Functional Splinting

0

1

2

3

Head Trauma

0

1

2

3

Peripheral Nerve Injuries

0

1

2

3

Multiple Sclerosis

0

1

2

3

Parkinson's Disease

0

1

2

3

Spinal Cord Injury

0

1

2

3

Stroke Rehabilitation

0

1

2

3

Traumatic Brain Injury

0

1

2

3

Wheelchair Evaluation

0

1

2

3

Neurodevelopmental testing (NDT)

0

1

2

3

Orthopedics

Arthritis Programs

0

1

2

3

Joint protection

0

1

2

3

Hip Fractures

0

1

2

3

Mobilization Techniques

0

1

2

3

Total Joint Replacements upper extremities

0

1

2

3

Total Knee/Hip Replacement

0

1

2

3

Lower back/spinal surgery

0

1

2

3

Soft tissue Injury

0

1

2

3

Prosthetics/amputations

0

1

2

3

Pediatrics

Developmental Testing

0

1

2

3

Neurodevelopmental testing (NDT)

0

1

2

3

Feeding/swallowing/oral motor

0

1

2

3

Equipment Assessment

0

1

2

3

Orthotics

0

1

2

3

Sensory Integrative Testing

0

1

2

3

Visual Perceptual Skills Testing

0

1

2

3

Wheelchair Positioning Device

0

1

2

3

Muscular Dystrophy

0

1

2

3

Cerebral Palsy

0

1

2

3

Cystic Fibrosis

0

1

2

3

Birth Defects

0

1

2

3

Prosthetics/orthotics

Above/Below Knee Prosthetics

0

1

2

3

Dynamic Splints

0

1

2

3

UE Prosthetics

0

1

2

3

Orthoplast

0

1

2

3

Serial/inhibitory Casting

0

1

2

3

Static Splints

0

1

2

3

Adaptive Equipment

Assessment

0

1

2

3

Fabrication

0

1

2

3

Functional Activities:

ADL's

0

1

2

3

Home Environment

0

1

2

3

Pre-discharge Planning

0

1

2

3

Splinting

0

1

2

3

Wheelchair

0

1

2

3

Vocational Training

Cognitive Assessment

0

1

2

3

Functional Capacity Evaluation

0

1

2

3

Job Task Analysis

0

1

2

3

Perceptual Assessment

0

1

2

3

Work Hardening

0

1

2

3

BTE

0

1

2

3

Valpar

0

1

2

3

Modalities

Anodyne

0

1

2

3

Biofeedback

0

1

2

3

Community Re-Entry

0

1

2

3

Feeding Techniques

0

1

2

3

Fluidotherapy

0

1

2

3

Gait Training

0

1

2

3

Massage

0

1

2

3

Muscle Stimulation

0

1

2

3

Oral Motor Facilities

0

1

2

3

Paraffin Bath

0

1

2

3

TENS

0

1

2

3

Therapeutic Pool

0

1

2

3

Ultrasound

0

1

2

3

Wound Management

0

1

2

3

General Skills

Electronic Documentation

Allscripts

Care360

Cerner

eCLinicalWorks

EPIC

MACLAB

McKesson

Meditech

PACS

Soarian

N/A

Other Electronic Documentation:

Universal Precautions

0

1

2

3

Working with patients in isolation

0

1

2

3

Working with patients in restraints

0

1

2

3

Patient/Family teaching

0

1

2

3

Patient Identification

0

1

2

3

Specialty beds

0

1

2

3

End of life care/palliative care

0

1

2

3

Knowledge of "Do Not Use Abbreviations"

0

1

2

3

Do you have charge/supervisor experience?

Yes

No

Knowledge of current Joint Commission National Patient Safety Goals

0

1

2

3

Knowledge/familiarity with HCAHPS scores

0

1

2

3

awards updated 2022

SIA_CM_Member_2018

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