Skills Checklist:
Physical Therapist

Skills Checklist - Physical Therapist

Upper Extremity Prosthetics*

Above Knee Prosthetics*

Below Knee Prosthetics*

This self-evaluation is for assessing your experience in specific clinical areas. This self-evaluation will not be a determining factor in accepting your application to become an employee of Connected Health Care.

0 = Not Applicable
1 = No Experience
2 = Some Experience
3 = Intermittent Experience
4 = Experienced
5 = Very Experienced

SETTING:(Required)

Orthopedic:(Required)

	0	1	2	3	4	5
Neck Injuries/ Surgeries*
Back Injuries / Surgeries*
Hip Fractures / Injuries*
Total Hip Replacement*
Knee Injuries*
Total Knee Replacement*
Upper Extremity Joint Replacements*
Shoulder Injuries*
Degenerative Joint Disease / Arthritis*
Hand Injuries*
Temporomandibular Joint (TMJ)*
Post Operative Care*
Amputations*

Neurologic(Required)

Prosthetics/Orthotics:(Required)

Sports Medicine:(Required)

Procedures/Treatments:(Required)

	0	1	2	3	4	5
Ankle / Foot Orthosis*
Slings*
Splints – Wrist/ Hands*
CPM Machine*
Corticosteroids*
Hydrotherapy*
Whirlpool*
Hubbard Tank*
Therapeutic Pool*
TENS*
Electric Stimulation*
Ultrasound*
Cryotherapy*
Message*
Diathermy*
Acupressure*
Spinal Mobilization*
Extremity Mobilization*
Myofacial Release*
Craniosacral Techniques*
Cervical Traction*
Lumbar Traction*
Activities of Daily Living*
Gait Training*
Transfers*
Sports Medicine*
Athletic Injuries*
Biodex*
Cybex*
Orthotron*

Other:(Required)

	0	1	2	3	4	5
Chest PT*
Cardiac Rehab*
ICU Procedures*
CCU Procedures*
SICU Procedures*
Burn Management*
Work Hardening – Work Site Eval*
Work Capacity Eval*
Functional Capacity Eval*
Muscle Energy Techniques*
Universal Precautions*
Skilled Nursing Documentation*
Medicare A*
Medicare B*
State Healthcare*
Skilled Nursing Documentation*

AGE(Required)

	0	1	2	3	4	5
Newborn (birth-30 days)*
Infant (30 days – 1 year)*
Toddler (1-3 years)*
Preschooler (3-5 years)*
School Age ( 5 -12 years)*
Adolescents (12-18 years)
Young Adults (18-39 years)
Middle Adults (39-64 years)
Older Adults (64+ years)*

Name

First Last

Date

Specialty

By Signing this, I am authorizing that the information I have given is true and accurate to the best of my knowledge. I hereby authorize Connected Health Care to release this Skills Checklist to staffing clients of Connected Health Care. Submit this skills evaluation with your initial application.

Signature(Required)

	0	1	2	3	4	5
Acute*
Rehab*
Inpatient*
Outpatient*
Home Health*
SNF*
Schools*

	0	1	2	3	4	5
Stroke Rehabilitation*
Cognitive Disorders*
Head Trauma*
Spinal Cord Injury*
Functional Splinting*
Adaptive Equipment-Wheelchair*
Neuromuscular Diseases*
Multiple Sclerosis*