Occupational Therapy Skills Checklist

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This profile is for use by Occupational Therapy Professionals with more than one year experience in their discipline and specialty. It will not be a determining factor for employment but it may aid in promoting yourself at the Interview.

Please enter your full legal name as it appears on your Social Security Card.

First name *

_______________________________
Last name *

____________________________

Social Security number
_____ - _____ - _____ 		 Date
____ / ____ / ____
 

Email:  __________________________________________
Please indicate your level of experience by checking the applicable box below:
A. Theory, no practice C. One - two years experience
B. Intermittent experience D. Two plus years experience

A. ORTHOPEDIC
  1. Arthritis programs
    a. Energy conservation | A |    | B |     | C |     | D |
    b. Joint protection | A |    | B |     | C |     | D |
  2. Hand injury | A |    | B |     | C |     | D |
  3. Hip fractures | A |    | B |     | C |     | D |
  4. Mobilization techniques | A |    | B |     | C |     | D |
  5. Therapeutic exercise | A |    | B |     | C |     | D |
  6. Total hip/knee replacement | A |    | B |     | C |     | D |
  7. Total joint replacement/upper extremities | A |    | B |     | C |     | D |

B. NEUROLOGICAL
  1. CVA | A |    | B |     | C |     | D |
  2. Head trauma | A |    | B |     | C |     | D |
  3. Peripheral nerve injuries | A |    | B |     | C |     | D |
  4. Spinal cord injury | A |    | B |     | C |     | D |
    a. Adaptive equipment | A |    | B |     | C |     | D |
    b. Functional splinting | A |    | B |     | C |     | D |
    c. Wheelchair evaluation | A |    | B |     | C |     | D |
  5. Stroke rehabilitation | A |    | B |     | C |     | D |

C. PSYCHIATRIC
  1. Acute disorders | A |    | B |     | C |     | D |
  2. Chronic disorders | A |    | B |     | C |     | D |
  3. Community re-entry | A |    | B |     | C |     | D |
  4. Crisis intervention | A |    | B |     | C |     | D |
  5. Group treatment | A |    | B |     | C |     | D |
  6. Standardized assessment tools | A |    | B |     | C |     | D |
  7. Substance abuse | A |    | B |     | C |     | D |

D. PROSTHETICS/ORTHOTICS/FUNCTIONAL TRAINING
  1. Above knee prosthetics | A |    | B |     | C |     | D |
  2. Below knee prosthetics | A |    | B |     | C |     | D |
  3. Dynamic splints | A |    | B |     | C |     | D |
  4. Myofascial release (MFR) | A |    | B |     | C |     | D |
  5. Orthoplast | A |    | B |     | C |     | D |
  6. Serial/inhibitory casting | A |    | B |     | C |     | D |
  7. Static splints | A |    | B |     | C |     | D |
  8. Upper extremity prosthetics | A |    | B |     | C |     | D |

E. ADAPTIVE EQUIPMENT
  1. Assessment | A |    | B |     | C |     | D |
  2. Fabrication | A |    | B |     | C |     | D |
  3. Functional activities
    a. ADLs | A |    | B |     | C |     | D |
    b. Home environment | A |    | B |     | C |     | D |
    c. Pre-discharge planning | A |    | B |     | C |     | D |
    d. Splinting | A |    | B |     | C |     | D |
  4. Wheelchair | A |    | B |     | C |     | D |

F. VOCATIONAL TRAINING
  1. Cognitive assessment | A |    | B |     | C |     | D |
  2. Functional capacity evaluation | A |    | B |     | C |     | D |
  3. Job task analysis | A |    | B |     | C |     | D |
  4. Perceptual assessment | A |    | B |     | C |     | D |
  5. Work hardening
    a. BTE | A |    | B |     | C |     | D |
    b. Valpar | A |    | B |     | C |     | D |

G. PEDIATRICS
  1. Developmental testing | A |    | B |     | C |     | D |
  2. Discharge planning (referral & resources) | A |    | B |     | C |     | D |
  3. Equipment assessment | A |    | B |     | C |     | D |
    a. Activities of daily living | A |    | B |     | C |     | D |
    b. Wheelchair positioning device | A |    | B |     | C |     | D |
  4. Neurodevelopmental testing | A |    | B |     | C |     | D |
  5. Orthotics | A |    | B |     | C |     | D |
  6. Sensory integrative testing | A |    | B |     | C |     | D |
  7. Visual perceptual skills testing | A |    | B |     | C |     | D |

H. MODALITIES
  1. Biofeedback | A |    | B |     | C |     | D |
  2. Edema massage | A |    | B |     | C |     | D |
  3. Feeding techniques | A |    | B |     | C |     | D |
  4. Fluidotherapy | A |    | B |     | C |     | D |
  5. Muscle stimulation | A |    | B |     | C |     | D |
  6. Oral motor facilities | A |    | B |     | C |     | D |
  7. Paraffin bath | A |    | B |     | C |     | D |
  8. Therapeutic pool | A |    | B |     | C |     | D |

A. Newborn/Neonate (birth - 30 days)
F. Adolescents (12 - 18 years)
B. Infant (30 days - 1 year) G. Young adults (18 - 39 years)
C. Toddler (1 - 3 years) H. Middle adults (39 - 64 years)
D. Preschooler (3 - 5 years) I. Older adults (64+)
E. School age children (5 - 12 years)  
Experience with Age Groups: Using the chart above, check mark the applicable boxes. A B C D E F G H I
Able to adapt care to incorporate normal growth and development.
Able to adapt method and terminology of patient instructions to their age, comprehension and maturity level.
Can ensure a safe environment reflecting specific needs of various age groups.

My experience is primarily in: (Please indicate number of years)
  Practice area: _______________________ Year(s) ______

Certification:
Please check the boxes below and indicate the expiration date for each certificate that you have. If you do not know the exact date, please use the last date of the specific month (e.g., 08/31/2003).
BCLS Exp. date: ___________ (mm/dd/yyyy)
CPR Exp. date: ___________  (mm/dd/yyyy)
Other (type): ____________ Exp. date: _________(mm/dd/yyyy)
Computerized charting system: ____________ Exp. date: _________(mm/dd/yyyy)

The information I have given is true and accurate to the best of my knowledge.

Signature: _______________________________  Date:______________