Physical Therapist 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. Admission/Initial Evaluation

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

2) Self-Assessment

2. Care coordination/discharge planning

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

3) Self-Assessment

3. Transfer of patient

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

4) Self-Assessment

4. Documentation

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

5) Self-Assessment

5. Other

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

Assessment/Evaluation

1) Self-Assessment

1. Cognition/Communication

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

2) Self-Assessment

2. Musculoskeletal

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

3) Self-Assessment

3. Neuro-muscular function

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

4) Self-Assessment

4. Sensation

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

5) Self-Assessment

5. Endurance

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

6) Self-Assessment

6. Functional

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

7) Self-Assessment

7. Environment evaluation / barriers

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. Proprioceptive training

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

6) Self-Assessment

6. Bed mobility training

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

7) Self-Assessment

7. Gait training

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

8) Self-Assessment

8. Transfer training

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

9) Self-Assessment

9. Stair climbing skills training

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

10) Self-Assessment

10. Postural control training

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

11) Self-Assessment

11. Neuromuscular re-education

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

12) Self-Assessment

12. Energy conservation techniques

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

13) Self-Assessment

13. Breathing techniques

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

14) Self-Assessment

14. Prosthetics:

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

15) Self-Assessment

15. Pain assessment and management

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

16) Self-Assessment

16. Miscellaneous Skills

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

17) Self-Assessment

17. 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. Splints

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

5) Self-Assessment

5. AFO

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

6) Self-Assessment

6. Back brace

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

7) Self-Assessment

7. Cervical collar

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

8) Self-Assessment

8. Knee immobilizer

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

9) Self-Assessment

9. Pulse oximeter

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

10) Self-Assessment

10. Massage

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

11) Self-Assessment

11. 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. Determines patient / family learning needs

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

2) Self-Assessment

2. Sets measurable objectives

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

3) Self-Assessment

3. Develops/implements teaching plan

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

4) Self-Assessment

4. Evaluates effectiveness of teaching

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

5) Self-Assessment

5. Revises teaching plan based on patient needs

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

6) Self-Assessment

6. Documents response to teaching

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

Other