Physical Therapist Self Assessment

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.

Proficiency Scale

1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
Work Settings Rating Stars (Click) 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
Orthopedics Rating Stars (Click) 1 2 3 4
Upper Extremities
Arthritis Programs
Back Syndrome
Cervical Injuries
Chronic Fatigue Syndrome
Fibromyalgia
Halo Traction
Hand Injury
Hip Fracture
Kyphoplasty
Orthopedics - cont. Rating Stars (Click) 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
Pediatrics Rating Stars (Click) 1 2 3 4
Activities of Daily Living
Adaptive
Developmental Disability
Equipment Assessment
Individualized Education Programs
Neurodevelopmental Testing (NDT)
Orthotics
Sequencing Testing
Sports Medicine Rating Stars (Click) 1 2 3 4
Biodex
Bracing/Joint
Cybex
Immobilization
Lido
Medical Expenses (Norwegian)
Nautilus/Eagle
Orthotron/Kinetron
Stabilization Techniques
Swiss Ball
Taping/Strapping
Prosthetics/Orthotics Rating Stars (Click) 1 2 3 4
Dynamic Splints
LE Prosthetics
Protonics
Removable Rigid Dressings
Serial Casting
Static Splints
UE Prosthetics
Modalities Rating Stars (Click) 1 2 3 4
Anodyne
Biofeedback
Edema Massage
Fluidotherapy
Iontophoresis
JOBST Compression Pump
Muscle Stimulation
Paraffin Bath
Phonophoresis
TENS
Therapeutic Pool
Ultrasound
Age Specific Competencies Rating Stars (Click) 1 2 3 4
Infant (Birth - 1 year)
Preschooler (ages 2-5 years)
Childhood (ages 6-12 years)
Adolescents (ages 13-21 years)
Young Adults (ages 22-39 years)
Adults (ages 40-64 years)
Older Adults (ages 65-79 years)
Elderly (ages 80+ years)