PT/PTA Skills Checklist
  PT/PTA 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) ADULT 1 2 3 4  
  Orthopedic    
Neck Injuries / Surgeries  
Back Injuries / Surgeries  
Hip Fractures / Injuries  
Total Hip Replacement  
Knee Injuries  
Total Knee Replacement  
Upper Extrem Joint Replacements  
Shoulder Injuries  
Degen. Joint Disease / Arthritis  
Hand Injuries  
Temporomandibular Joint (TMJ)  
Post Operative Care  
Amputations  
  Neurologic    
Stroke Rehabilitation  
Cognitive Disorders  
Head Trauma  
Spinal Cord Injury  
Functional Splinting  
Adaptive Equipment-Wheelchair  
Neuromuscular Diseases  
Multiple Sclerosis  
Rating Stars (Click) ADULT 1 2 3 4  
  Prosthetics / Orthotics    
Upper Extremity Prosthetics  
Above Knee Prosthetics  
Below Knee Prosthetics  
Rating Stars (Click) Sports Medicine 1 2 3 4  
LIDO  
Nautilus / Eagle  
Taping  
  Prosthetics / Orthotics    
Other  
Chest PT  
Cardiac Rehab  
ICU Procedures  
CCU Procedures  
SICU Procedures  
Burn Management  
Work Hardening - Work Site Eval  
Work Capacity Eval  
Rating Stars (Click) Procedures / Treatments: 1 2 3 4  
Ankle / Foot Orthosis  
Slings  
Splints - Wrist / Hand  
  Procedures / Treatments  
CPM Machine  
Hydrotherapy  
Whirlpool  
Hubbard Tank  
Therapeutic Pool  
TENS  
Electrical Stimulation  
Ultrasound  
Cryotherapy  
Massage  
Diathermy  
Acupressure  
Spinal Mobilization  
Extremity Mobilization  
Myofacial Release  
Craniosacral Techniques  
Cervical Traction  
Lumbar Traction  
Activities of Daily Living  
Gait Training  
transfers  
Sports Medecine  
Athletic Injuries  
Biodex  
Cybex  
Orthotron  
Rating Stars (Click) Other 1 2 3 4  
Functional Capacity Eval  
Muscle Energy Techniques  
Activities of Daily Living  
Universal Precautions  
Skilled Nursing Documentation  
Medicare A  
Medicare B  
State Healthcare  
Skilled Nursing Documentation  
Rating Stars (Click) AGE 1 2 3 4  
Newborn (birth-30 days)  
Infant (30 days - 1 year)  
Toddler (1 - 3 years)  
Preschooler (3 - 5 years)  
School Age (5 - 12 years)  
Rating Stars (Click) AGE 1 2 3 4  
Adolescents (12 - 18 years)  
Young Adults (18 - 39 years)  
Middle Adults (39 - 64 years)  
Older Adults (64+ years)