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1.877.891.4286
Home
About
Professional Licensure
Payroll & Documents
Apply Now
Open Jobs
Contact
Home
About
Professional Licensure
Payroll & Documents
Apply Now
Open Jobs
Contact
Physical Therapist – Skills Checklist
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 Precision Nationwide Staffing.
0 = Not Applicable
1 = No Experience
2 = Some Experience
3 = Intermittent Experience
4 = Experienced
5 = Very Experienced
Setting
Acute
*
0
1
2
3
4
5
Rehab
*
0
1
2
3
4
5
Inpatient
*
0
1
2
3
4
5
Outpatient
*
0
1
2
3
4
5
Home Health
*
0
1
2
3
4
5
SNF
*
0
1
2
3
4
5
Schools
*
0
1
2
3
4
5
Adult Orthopedic
Neck Injuries/Surgeries
*
0
1
2
3
4
5
Back Injuries/Surgeries
*
0
1
2
3
4
5
Hip Fractures/Injuries
*
0
1
2
3
4
5
Total Hip Replacement
*
0
1
2
3
4
5
Knee Injuries
*
0
1
2
3
4
5
Total Knee Replacement
*
0
1
2
3
4
5
Upper Extremity Joint Replacements
*
0
1
2
3
4
5
Shoulder Injuries
*
0
1
2
3
4
5
Degenerative Joint Disease/Arthritis
*
0
1
2
3
4
5
Hand Injuries
*
0
1
2
3
4
5
Temporomandibular Joint (TMJ)
*
0
1
2
3
4
5
Post Operative Care
*
0
1
2
3
4
5
Amputations
*
0
1
2
3
4
5
Adult Neurologic
Stroke Rehabilitation
*
0
1
2
3
4
5
Cognitive Disorders
*
0
1
2
3
4
5
Head Trauma
*
0
1
2
3
4
5
Spinal Cord Injury
*
0
1
2
3
4
5
Functional Splinting
*
0
1
2
3
4
5
Adaptive Equipment - Wheelchair
*
0
1
2
3
4
5
Neuromuscular Diseases
*
0
1
2
3
4
5
Multiple Sclerosis
*
0
1
2
3
4
5
Adult Prosthetics/Orthotics
Upper Extremity Prosthetics
*
0
1
2
3
4
5
Above Knee Prosthetics
*
0
1
2
3
4
5
Below Knee Prosthetics
*
0
1
2
3
4
5
Sports Medicine
LIDO Machine
*
0
1
2
3
4
5
Nautilus Machine
*
0
1
2
3
4
5
Taping
*
0
1
2
3
4
5
Procedures/Treatments
Ankle/Foot Orthosis
*
0
1
2
3
4
5
Slings
*
0
1
2
3
4
5
Splints - Wrist/Hand
*
0
1
2
3
4
5
CPM Machine
*
0
1
2
3
4
5
Hydrotherapy
*
0
1
2
3
4
5
Whirlpool
*
0
1
2
3
4
5
Hubbard Tank
*
0
1
2
3
4
5
Therapeutic Pool
*
0
1
2
3
4
5
TENS
*
0
1
2
3
4
5
Electrical Stimulation
*
0
1
2
3
4
5
Ultrasound
*
0
1
2
3
4
5
Cryotherapy
*
0
1
2
3
4
5
Massage
*
0
1
2
3
4
5
Diathermy
*
0
1
2
3
4
5
Acupressure
*
0
1
2
3
4
5
Spinal Mobilization
*
0
1
2
3
4
5
Extremity Mobilization
*
0
1
2
3
4
5
Myofacial Release
*
0
1
2
3
4
5
Cranisacral Techniques
*
0
1
2
3
4
5
Cervical Traction
*
0
1
2
3
4
5
Lumbar Traction
*
0
1
2
3
4
5
Activites of Daily Living
*
0
1
2
3
4
5
Gait Training
*
0
1
2
3
4
5
Transfers
*
0
1
2
3
4
5
Sports Medicine
*
0
1
2
3
4
5
Athletic Injuries
*
0
1
2
3
4
5
Biodex
*
0
1
2
3
4
5
Cybex
*
0
1
2
3
4
5
Orthotron
*
0
1
2
3
4
5
Please List any Other Relevant Skills
Chest PT
0
1
2
3
4
5
Cardiac Rehab
0
1
2
3
4
5
ICU Procedures
0
1
2
3
4
5
CCU Procedures
0
1
2
3
4
5
SICU Procedures
0
1
2
3
4
5
Burn Management
0
1
2
3
4
5
Work Hardening - Work Site Eval
0
1
2
3
4
5
Work Capacity Eval
0
1
2
3
4
5
Functional Capacity Eval
0
1
2
3
4
5
Muscles Energy Techniques
0
1
2
3
4
5
Universal Precautions
0
1
2
3
4
5
Skilled Nursing Documentation
0
1
2
3
4
5
Medicare A
0
1
2
3
4
5
Medicare B
0
1
2
3
4
5
State Health Care
0
1
2
3
4
5
Electronic Documentation
0
1
2
3
4
5
Electronic Documentation - List Types
Age of Patient Cared For
Newborn (birth - 30 days)
*
0
1
2
3
4
5
Infant (30 days - 1 year)
*
0
1
2
3
4
5
Toddler (1 - 3 years)
*
0
1
2
3
4
5
Preschooler (3 - 5 years)
*
0
1
2
3
4
5
School Age (5 - 12 years)
*
0
1
2
3
4
5
Adolescents (12 - 18 years)
*
0
1
2
3
4
5
Young Adults (18 - 39 years)
*
0
1
2
3
4
5
Middle Adults (30 - 64 years)
*
0
1
2
3
4
5
Older Adults (over 64+ years)
*
0
1
2
3
4
5
Information & Agreement
Application ID
*
Please enter your application ID. This ID should be 15 characters long and have the format of PHNMS##########. You should have received an email containing your application ID when you submitted your initial application. If not, please contact our staff.
Applicant Name
*
First
Last
Applicant Email
*
Applicant Phone
*
I certify that the information provided above accurately reflects education received and my experience in each of the clinical areas identified within the last 2 years.
*
I agree to the terms below.
The information I have given is true and accurate to the best of my knowledge, and I hereby authorize Fusion Medical Staffing to release this Skills Checklist to staffing clients of Precision Nationwide Staffing. Submit this skills evaluation with your initial application. To be updated annually.
Signature
*