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HEALTHCARE
- Nursing
- Therapy
SCHOOLS
TELEPRACTICE

About Us
Employees
Employers
Contact
Blog

HEALTHCARE
- Nursing
- Therapy
SCHOOLS
TELEPRACTICE

Physical 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 ICU

0

1

2

3

General Acute Care

0

1

2

3

Rehabilitation

0

1

2

3

Home Health

0

1

2

3

Outpatient

0

1

2

3

Psychiatric Hospitals

0

1

2

3

Skilled Nursing Facility

0

1

2

3

Pediatrics/PICU

0

1

2

3

School

0

1

2

3

Early Intervention

0

1

2

3

Children's Hospital

0

1

2

3

Orthopedics

Arthritis

0

1

2

3

Cervical/thoracic, lumbar spine treatment

0

1

2

3

Chronic Fatigue

0

1

2

3

Fibromyalgia

0

1

2

3

Elbow,wrist,hand injury

0

1

2

3

Halo Traction

0

1

2

3

Kyphoplasty

0

1

2

3

Pelvic Fractures

0

1

2

3

Post operative conditions ( ACL,rotator cuff repair, hip arthroscopy)

0

1

2

3

Shoulder,hip,knee,ankle arthroscopy

0

1

2

3

Total Joint Replacement

0

1

2

3

Temporomandibular Dysfunction

0

1

2

3

Neurologic

Adaptive Equipment

0

1

2

3

ALS

0

1

2

3

Brain Tumors

0

1

2

3

Cerebral palsy

0

1

2

3

Functional Splinting/Bracing

0

1

2

3

Glasgow coma scale

0

1

2

3

Traumatic Brain Injury

0

1

2

3

Multiple Sclerosis

0

1

2

3

Muscular Dystrophy

0

1

2

3

Postoperative Neurosurgery Rehabilitation

0

1

2

3

Neurodevelopment testing (NDT)

0

1

2

3

Spinal Cord Injury

0

1

2

3

Stroke Rehabilitation

0

1

2

3

Wheelchair prescription

0

1

2

3

Pediatrics

Activities of Daily Living

0

1

2

3

Adaptive Equipment

0

1

2

3

Cerebral palsy

0

1

2

3

Developmental Disability

0

1

2

3

Gross Motor Assessment Tools

0

1

2

3

Special Needs Patient

0

1

2

3

Neurodevelopmental testing (NDT)

0

1

2

3

Orthotics

0

1

2

3

Spina Bifida

0

1

2

3

Sequencing testing

0

1

2

3

Other

Aquatic Therapy

0

1

2

3

Burn Management

0

1

2

3

Cardiac Rehabilitation

0

1

2

3

Chest Physiotherapy

0

1

2

3

DME Ordering

0

1

2

3

FIM scoring

0

1

2

3

Functional Capacity Evaluation

0

1

2

3

Job Task Analysis

0

1

2

3

Lymphedema Management

0

1

2

3

OASIS assessment for home health

0

1

2

3

Obstetrics in Physical Therapy

0

1

2

3

Tone Management /Spasticity

0

1

2

3

Wheelchair/Equipment Assessment

0

1

2

3

Wound care

0

1

2

3

Sports Medicine

Biodex/BTE Testing

0

1

2

3

Bracing/Casting/Splinting

0

1

2

3

Functional Movement Screening

0

1

2

3

Immobilization

0

1

2

3

Injury Prevention Programs

0

1

2

3

Nautilus/Eagle

0

1

2

3

Physical Performance Testing

0

1

2

3

Strength/Endurance Training

0

1

2

3

Stabilization techniques

0

1

2

3

Taping/Strapping

0

1

2

3

Prosthetics/orthotics

Above Knee Prosthetics

0

1

2

3

Ankle Foot Orthosis

0

1

2

3

Below Knee Prosthetics

0

1

2

3

Dynamic Splints

0

1

2

3

Gait Analysis

0

1

2

3

LE Prosthetics

0

1

2

3

Orthoplast/Aquaplast

0

1

2

3

Protonics

0

1

2

3

Removable Rigid Dressings

0

1

2

3

Serial/ Inhibitory Casting

0

1

2

3

Static Splints

0

1

2

3

UE Prosthetics

0

1

2

3

Modalities

Anodyne

0

1

2

3

Biofeedback

0

1

2

3

Continuous Passive Motion Machine

0

1

2

3

Craniosacral Therapy

0

1

2

3

Cryotherapy

0

1

2

3

Diathermy

0

1

2

3

Edema massage

0

1

2

3

Fluidotherapy

0

1

2

3

Ionotophoresis

0

1

2

3

JOBST Compression Pump

0

1

2

3

Massage

0

1

2

3

Muscle Stimulation

0

1

2

3

Myofascial Release Techniques

0

1

2

3

Neuro Probe

0

1

2

3

Paraffin

0

1

2

3

Phonophoresis

0

1

2

3

Strain/Counter Strain Techniques

0

1

2

3

TENS

0

1

2

3

Traction

0

1

2

3

Ultrasound

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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