Physical Therapy Skills Checklist

		Physical Therapy Skills Checklist
NAME

LAST 4 OF SSN

DATE

	I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.
Proficiency Scale:	1 = No Experience 2 = Need Training 3 = Able to perform with supervision 4 = Able to perform independently

Rating Stars (Click)	Work Settings		1	2	3	4
	Adult/adult ICU
	Children’s hospital
	General acute care
	Home health care
	Outpatient neuro
	Outpatient ortho
	Pediatrics/PICU
	Psychiatric hospital
	Rehabilitation hospital
	School setting
	Early intervention
	Skilled care facility
	Subacute
Rating Stars (Click)	Orthopedics		1	2	3	4
	Upper extremities
	Arthritis programs
	Back syndrome
	Cervical injuries
	Chronic fatigue syndrome
	Fibromyalgia
	Halo traction
	Hand injury
	Hip fracture
	Kyphoplasty
Rating Stars (Click)	Orthopedics - cont.		1	2	3	4
	Manual therapy
	Mobilization techniques
	Pelvic fracture
	Postpolio syndrome
	Shoulder injuries
	TMJ dysfunction
	Total hip/total knee
	Total joint replacement
	Total shoulder/CPM
Rating Stars (Click)	Neurologic		1	2	3	4
	ALS
	Brain tumors
	Cerebral palsy
	Multiple sclerosis
	Muscular dystrophy
	Polio/post polio syndrome
	Spinal cord injury
	Adaptive equipment
	Functional splinting
	Neurodevelopmental testing (NDT)
	Head trauma
	Glasgow coma scale
	Stroke rehabilitation
	Wheelchair prescription
Rating Stars (Click)	Pediatrics		1	2	3	4
	Activities of daily living
	Adaptive
	Developmental disability
	Equipment assessment
	Individualized education programs
	Neurodevelopmental testing (NDT)
	Orthotics
	Sequencing testing
Rating Stars (Click)	Sports Medicine		1	2	3	4
	Biodex
	Bracing/joint
	Cybex
	Immobilization
	Lido
	Medical expenses (Norwegian)
	Nautilus/eagle
	Orthotron/kinetron
	Stabilization techniques
	Swiss ball
	Taping/strapping
Rating Stars (Click)	Prosthetics/Orthotics		1	2	3	4
	Dynamic splints
	LE prosthetics
	Protonics
	Removeable rigid dressings
	Serial casting
	Static splints
	UE prosthetics
Rating Stars (Click)	Modalities		1	2	3	4
	Anodyne
	Biofeedback
	Edema massage
	Fluidotherapy
	Iontophoresis
	JOBST compression pump
	Muscle stimulation
	Paraffin bath
	Phonophoresis
	TENS
	Therapeutic pool
	Ultrasound
Rating Stars (Click)	Other		1	2	3	4
	Burn management
	Cardiac rehabilitation
	Chest physical therapy
	DME ordering
	FIM scoring
	Job task analysis
	Lymphedema management
	OASIS assessment for home care
	Obstetrics in physical therapy
	Tone management/spasticity
	Wheelchair ordering for SCI patients
	Work capacity evaluation
	Work hardening
	Wound care
	Knowledge of payment sources:
	Medicare
	Medicaid
	MDS
Rating Stars (Click)	General Skills		1	2	3	4
	Patient/family teaching
	Patients in isolation
	Patients in restraints
	Initial evaluation
	Lift/transfer devices
	Specialty beds
	End of life care/palliative care
	Computerized Charting:
	Cerner
	EPIC
	McKesson
	Meditech
	National Patient Safety Goals:
	Accurate patient identification
	Effective communication
Rating Stars (Click)	General Skills - cont.		1	2	3	4
	Pain assessment & management
	Infection control
	Universal precautions
	Care of patients in isolation
	Minimize risk of falls
	Prevention of pressure ulcers
Rating Stars (Click)	Age Specific Competencies		1	2	3	4
	Infant (birth to 1 year)
	Toddler (ages 1-3 years)
	Preschooler (ages 3-5 years)
	Childhood (ages 6-12 years)
	Adolescents (ages 12-21 years)
	Young Adults (ages 21-39 years)
	Adults (ages 40-64 years)
	Older Adults (ages 65-79 years)
	Elderly (ages 80+ years)
Rating Stars (Click)	Please list any Additional Skills:		1	2	3	4
1
2
3
4
	Additional training:
1
2
3
4
	Additional equipment:
1
2
3
4