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Physical Therapy Skills Checklist

 

My responses in this checklist represent a true reflection of my experience and comfort level.

 

Please self-rate your comfort level in performing tasks in connection with the below checklist.  Rate your level of comfort for each line item by following the below ranking system.  Simply fill in the appropriate option immediately following the rating number.

 

Typed Name (Typing your name below serves as an electronic signature) *      Date*

                                                         

 

Phone*

             

 

Recruiter

 

Level of Comfort/Experience

N/A=Non-applicable

1=Inexperienced in this area

2=Limited comfort/experience in this area

3=Comfortable/experienced in this area

4=Very comfortable/highly experienced in this area

Area

Not Applicable

Inexperienced

Limited

Experienced

Highly Experienced

TREATMENT/PROCEDURES

Hot Packs

N/A  

1

2

3

4

Fluidotherapy

N/A  

1

2

3

4

Hydrotherapy

N/A  

1

2

3

4

Whirlpool

N/A  

1

2

3

4

Hubbard tank

N/A  

1

2

3

4

Therapeutic pool

N/A  

1

2

3

4

Biofeedback

N/A  

1

2

3

4

Cervical traction (Manual)

N/A  

1

2

3

4

           mechanical

N/A  

1

2

3

4

Lumbar Traction (Manual)

N/A  

1

2

3

4

            mechanical

N/A  

1

2

3

4

Ultrasound

N/A  

1

2

3

4

Diathermy

N/A  

1

2

3

4

TENS

N/A  

1

2

3

4

Cryothermy

N/A  

1

2

3

4

Massage

N/A  

1

2

3

4

Paraffin

N/A  

1

2

3

4

Vasopneumatic devices

N/A  

1

2

3

4

Muscle stimulators

N/A  

1

2

3

4

Oral/motor stimulators

N/A  

1

2

3

4

 

ASSESSMENTS

Circulation

N/A  

1

2

3

4

Range of Motion

N/A  

1

2

3

4

Skin Integrity

N/A  

1

2

3

4

Pain Management Techniques

N/A  

1

2

3

4

ADLs

N/A  

1

2

3

4

 

ORTHOPEDIC

Neck/back syndrome -surgeries

N/A  

1

2

3

4

Hip fractures

N/A  

1

2

3

4

Total joint replacement

N/A  

1

2

3

4

Hip/knees

N/A  

1

2

3

4

Hand injuries

N/A  

1

2

3

4

Arthritis programs and treatments

N/A  

1

2

3

4

 

NEUROLOGIC

Stroke rehabilitation

N/A  

1

2

3

4

Multiple sclerosis

N/A  

1

2

3

4

Head trauma

N/A  

1

2

3

4

Spinal cord injury

N/A  

1

2

3

4

 

SPORTS MEDICINE

Athletic injuries

N/A  

1

2

3

4

Biodex

N/A  

1

2

3

4

Cybex

N/A  

1

2

3

4

Orthotron

N/A  

1

2

3

4

LIDO

N/A  

1

2

3

4

Nautilus/eagle

N/A  

1

2

3

4

Taping

N/A  

1

2

3

4

 

PROSTHETICS/ORTHOTICS