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