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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)

MM slash DD slash YYYY

AGE OF PATIENTS CARED FOR

Newborn/ Neonate (birth to 30 days)(Required)
Infant (31 days to 12 months)(Required)
Toddler/Preschool (13 months to 5 years)(Required)
School Age Child/adolescent (6 years to 18 years)(Required)
Young Adults Middle Adult (19 years to 64 years)(Required)
Older Adults/Elderly (65+ years)(Required)

SETTINGS

Acute Care/ Hospital ICU(Required)
General Acute Care(Required)
Rehabilitation(Required)
Home Health(Required)
Outpatient(Required)
Psychiatric Hospitals(Required)
Skilled Nursing Facility(Required)
Pediatrics/PICU(Required)
School(Required)
Early Intervention(Required)
Children's Hospital(Required)

ORTHOPEDICS

Arthritis(Required)
Cervical/thoracic, lumbar spine treatment(Required)
Chronic Fatigue(Required)
Fibromyalgia(Required)
Elbow,wrist,hand injury(Required)
Halo Traction(Required)
Kyphoplasty(Required)
Pelvic Fractures(Required)
Post operative conditions ( ACL,rotator cuff repair, hip arthroscopy)(Required)
Shoulder,hip,knee,ankle arthroscopy(Required)
Total Joint Replacement(Required)
Temporomandibular Dysfunction(Required)

NEUROLOGIC

Adaptive Equipment(Required)
ALS(Required)
Brain Tumors(Required)
Cerebral palsy(Required)
Functional Splinting/Bracing(Required)
Glasgow coma scale(Required)
Traumatic Brain Injury(Required)
Multiple Sclerosis(Required)
Muscular Dystrophy(Required)
Postoperative Neurosurgery Rehabilitation(Required)
Neurodevelopment testing (NDT)(Required)
Spinal Cord Injury(Required)
Stroke Rehabilitation(Required)
Wheelchair prescription(Required)

PEDIATRICS

Activities of Daily Living(Required)
Adaptive Equipment(Required)
Cerebral palsy(Required)
Developmental Disability(Required)
Gross Motor Assessment Tools(Required)
Special Needs Patient(Required)
Neurodevelopmental testing (NDT)(Required)
Orthotics(Required)
Spina Bifida(Required)
Sequencing testing(Required)

OTHER

Aquatic Therapy(Required)
Burn Management(Required)
Cardiac Rehabilitation(Required)
Chest Physiotherapy(Required)
DME Ordering(Required)
FIM scoring(Required)
Functional Capacity Evaluation(Required)
Job Task Analysis(Required)
Lymphedema Management(Required)
OASIS assessment for home health(Required)
Obstetrics in Physical Therapy(Required)
Tone Management /Spasticity(Required)
Wheelchair/Equipment Assessment(Required)
Wound care(Required)

SPORTS MEDICINE

Biodex/BTE Testing(Required)
Bracing/Casting/Splinting(Required)
Functional Movement Screening(Required)
Immobilization(Required)
Injury Prevention Programs(Required)
Nautilus/Eagle(Required)
Physical Performance Testing(Required)
Strength/Endurance Training(Required)
Stabilization techniques(Required)
Taping/Strapping(Required)

PROSTHETICS/ORTHOTICS

Above Knee Prosthetics(Required)
Ankle Foot Orthosis(Required)
Below Knee Prosthetics(Required)
Dynamic Splints(Required)
Gait Analysis(Required)
LE Prosthetics(Required)
Orthoplast/Aquaplast(Required)
Protonics(Required)
Removable Rigid Dressings(Required)
Serial/ Inhibitory Casting(Required)
Static Splints(Required)
UE Prosthetics(Required)

MODALITIES

Anodyne(Required)
Biofeedback(Required)
Continuous Passive Motion Machine(Required)
Craniosacral Therapy(Required)
Cryotherapy(Required)
Diathermy(Required)
Edema massage(Required)
Fluidotherapy(Required)
Ionotophoresis(Required)
JOBST Compression Pump(Required)
Massage(Required)
Muscle Stimulation(Required)
Myofascial Release Techniques(Required)
Neuro Probe(Required)
Paraffin(Required)
Phonophoresis(Required)
Strain/Counter Strain Techniques(Required)
TENS(Required)
Traction(Required)
Ultrasound(Required)

GENERAL SKILLS

Electronic Documentation

SETTINGS

Universal Precautions(Required)
Working with patients in isolation(Required)
Working with patients in restraints(Required)
Patient/Family teaching(Required)
Patient Identification(Required)
Specialty beds(Required)
End of life care/palliative care(Required)
Knowledge of "Do Not Use Abbreviations"(Required)
Do you have charge/supervisor experience?(Required)
Knowledge of current Joint Commission National Patient Safety Goals(Required)
Knowledge/familiarity with HCAHPS scores(Required)

OTHER SKILLS

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