Physical Therapist Self Assessment Skills Checklist
   NAME  
   Email-Id
   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
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
Cerner
EPIC
McKesson
Meditech
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)