Skill Checklists
OT/COTA
Name
Email
LAST 4 OF SSN
This checklist was electronically signed on (Today’s date)
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
Acute
Rehab
Inpatient
Outpatient
Home Health
SNF
Schools
Fractures
Total Joint Replacements
Osteoarthritis-Frozen Shoulder
Hand Injuries
Post Operative Care
Amputations
Stroke Rehabilitation
Cognitive Disorders
Head Trauma
Spinal Cord Injury
Neuromuscular Diseases
Alzheimer’s/Dementia
Adaptive Equipment-Wheelchair
Upper Extremity Prosthetics
Splinting - Wrist
Splinting - Hand
Splinting - Elbow
Functional - Dynamic Splinting
Adaptive Equipment
Joint Mobilization
Myofacial Release
Soft Tissue Manipulation
Iontophoresis
TENS
Hydrotherapy - Whirlpool
Sterilization Techniques
Cryotherapy
Wound Management
Debridement
Ultrasound
Phonophoresis
Cognitive Techniques
Vision Therapy
Neurodevelopmental Techniques
Adaptive Equipment Assessment
Adaptive Equipment Training
Feeding Techniques
Exercise Programs
Postural Education
Home Safety Evaluation
Community Re-entry
Group Treatment
Medicare A
Medicare B
State Healthcare
Cardiac Rehab
ICU Procedures
CCU Procedures
SICU Procedures
Burn Management
Work Hardening - Work Site Eval
Functional Capacity Eval
Transfers
Gait Training
Muscle Energy Techniques
Activities of Daily Living
Electronic Documentation
GERIATRIC - OTHER - TYPES OF ELECTRONIC DOCUMENTATION
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)
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.
