Physical Therapist Assistant Initial Competency

Name(Required)

Date of Hire(Required)

Date Completed(Required)

Demonstrates ability to process paperwork and associated tasks related to:

1) Self-Assessment

1. Documentation

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

2) Self-Assessment

2. Care coordination

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

3) Self-Assessment

3. Documents and reports key information to physician, physical therapist, supervisor, care team

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

4) Self-Assessment

4. Coordinates community resources

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

5) Self-Assessment

5. Other

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

Skilled Treatments/Interventions:

1) Self-Assessment

1. Therapeutic exercise

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

2) Self-Assessment

2. Balance training

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

3) Self-Assessment

3. Functional mobility training

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

4) Self-Assessment

4. Fall prevention/safety

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

5) Self-Assessment

5. TUG/Tinetti

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

6) Self-Assessment

6. Proprioceptive training

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

7) Self-Assessment

7. Bed mobility training

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

8) Self-Assessment

8. Gait training

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

9) Self-Assessment

9. Transfer training

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

10) Self-Assessment

10. Stair climbing skills training

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

11) Self-Assessment

11. Postural control training

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

12) Self-Assessment

12. Neuromuscular re-education

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

13) Self-Assessment

13. Energy conservation techniques

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

14) Self-Assessment

14. Breathing techniques

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

15) Self-Assessment

15. Prosthetics:

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

16) Self-Assessment

16. Pain assessment and management

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

17) Self-Assessment

17. Wound care

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

18) Self-Assessment

18. Ace/compression wraps

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

19) Self-Assessment

19. Miscellaneous Skills

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

20) Self-Assessment

20. Other

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

Use of Equipment/Modalities:

1) Self-Assessment

1. Ultrasound

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

2) Self-Assessment

2. Hot/cold packs

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

3) Self-Assessment

3. TENS/FES

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

4) Self-Assessment

4. Orthotics/Splints/Immobilizers

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

5) Self-Assessment

5. CPM

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

6) Self-Assessment

6. Pulse oximeter

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

7) Self-Assessment

7. Massage

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

8) Self-Assessment

8. Other

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

Infection Control

1) Self-Assessment

1. Hand hygiene technique

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

2) Self-Assessment

2. Proper bag technique

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

3) Self-Assessment

3. Personal protective equipment

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

4) Self-Assessment

4. Exposure control plan

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

5) Self-Assessment

5. TB exposure control plan

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

6) Self-Assessment

6. Reporting of infections for patient and personnel

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

7) Self-Assessment

7. Standard precautions

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

Safety

1) Self-Assessment

1. Assessment of patient safety risks and home safety

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

2) Self-Assessment

2. Emergency preparedness

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

3) Self-Assessment

3. Fire extinguishers

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

4) Self-Assessment

4. Hazardous materials

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

Patient Education

1) Self-Assessment

1. Implements teaching per plan of care

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

2) Self-Assessment

2. Documents response to teaching

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

Other