PT/PTA Skills Checklist

Personal Information

Please fill the Recruiter Email correctly for successful application submission.

Candidate Name

Email of Recruiter / POC

Select Submission Date

SSN (Last 4 digits)

Instructions\r\n\r\n• For each item, rate your proficiency by selecting the corresponding star rating (1 = Novice, 4 = Expert).\r\n\r\n• If the item does not apply, leave it blank.

Proficiency Scale & Legend

1 Novice

2 Able to perform with supervision

3 Need Training

4 Expert

Orthopedic

Neck Injuries / Surgeries

Back Injuries / Surgeries

Hip Fractures / Injuries

Total Hip Replacement

Knee Injuries

Total Knee Replacement

Shoulder Injuries

Degenerative Joint Disease / Arthritis

Hand Injuries

Temporomandibular Joint (TMJ)

Post-Operative Care

Amputations

Neurologic

Prosthetics / Orthotics

Sports Medicine

Other

Procedures / Treatments

Activities Of Daily Living (adl)

Gait Training

Transfers

Sports Medicine Equipment

Assessment

Equipment And Devices

Home Exercise Program

Design and Implementation of Custom Programs

Progress Monitoring and Adjustments

Other Skills

Age Groups

I have filled out this skills checklist to the best of my knowledge and agree that all the information provided is correct, and that any misrepresentation or falsification of fact may be considered sufficient cause for immediate dismissal from the agency.