Occupational Therapy Skills Checklist
  Occupational 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  
General acute care  
Adult/adult ICU  
Pediatrics/PICU  
Children’s hospital  
Hand therapy  
Home health care  
Outpatient neuro  
Outpatient ortho  
Psychiatric hospital  
Rehabilitation hospital/inpatient rehabilitation unit  
Skilled care facility  
School setting  
Early intervention  
Subacute  
Rating Stars (Click) Orthopedics 1 2 3 4  
Hand injury  
Total joint replacement/upper extremities  
Lower back/spinal surgeries  
Arthritis programs  
Soft tissue injuries  
Knee injuries & total knee replacement  
Hip fractures & total hip replacement  
Mobilization techniques  
Prosthetics/amputations  
Rating Stars (Click) Neurologic 1 2 3 4  
Alzheimers/dementia  
Degenerative diseases of the CNS  
Multiple sclerosis  
Parkinson’s disease  
Spinal cord injury  
Adaptive equipment  
Neurodevelopmental testing (NDT)  
Wheelchair evaluation  
Stroke acute  
Stroke rehabilitation  
Functional splinting  
Traumatic brain injury  
Rating Stars (Click) Pediatric Assessments 1 2 3 4  
Neurodevelopmental testing  
Developmental screening  
Sensory-motor testing  
Visual perceptual testing  
Feeding/swallowing/oral motor  
Seating & positioning assessment (i.e. w/c)  
Rating Stars (Click) Other Assessments 1 2 3 4  
Physical capacity evaluation  
Home assessments/home accessibility  
Activities of daily living  
Driving evaluation  
Cognitive/perception  
Rating Stars (Click) Treatment Approaches 1 2 3 4  
ADL  
Cognitive retraining  
Community re-entry  
Energy conservation/work simplification techniques  
Functional transfer training  
Home safety  
Lymphedema management  
Orthotics/Prosthetics training  
Rating Stars (Click) Treatment Approaches - cont. 1 2 3 4  
Patient, family & staff training  
PNF  
SI  
Therapeutic exercises/activities  
Work hardening  
Splinting  
Neurodevelopmental testing (NDT)  
Incontinence management  
Rating Stars (Click) Modalities 1 2 3 4  
Anodyne  
Biofeedback  
Electrical stimulation  
Feeding techniques  
Fluidotherapy  
Oral motor facilities  
Paraffin bath  
TENS  
Therapeutic pool  
Ultrasound  
Rating Stars (Click) Prosthetics/Orthotics 1 2 3 4  
UE prosthetics  
Static splints  
Dynamic splints  
Serial casting  
Rating Stars (Click) Other 1 2 3 4  
Burn management  
Cardiac rehabilitation  
Cognitive retraining  
Computer skills  
FIM scoring  
Geriatrics  
Group dynamics  
IEP skills  
Rating Stars (Click) Other - cont. 1 2 3 4  
Inservice education  
Job task analysis  
Therapeutic media  
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  
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)  
Rating Stars (Click) Age Specific Competencies - cont. 1 2 3 4  
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)  
  Please list any Additional Skills:  
1  
2  
3  
4  
  Additional training:  
1  
2  
3  
4  
  Additional equipment:  
1  
2  
3  
4