Personal Information

*Please fill the email ID correctly for successful submission

Instructions

• For each item, rate your proficiency by selecting the corresponding star rating (1 = Novice, 4 = Expert).

• If the item does not apply, leave it blank.

Legends

1 = Novice

2 = Need Training

3 = Able to perform with supervision

4 = Expert

Activities of Daily Living (ADL)

Gait Training

Transfers

Home Exercise Program

Design and Implementation of Custom Programs

Progress Monitoring and Adjustments

I hereby certify that ALL information I have provided to Tricehealthcare on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

I have filled out this skills checklist to the best of my knowledge and agree that all the information provided is correct.

Personal Information

Instructions

Legends

Orthopedic

Neurologic

Prosthetics / Orthotics

Sports Medicine

Other

Procedures / Treatments

Activities of Daily Living (ADL)

Sports Medicine Equipment

Assessment

Equipment and Devices

Home Exercise Program

Other Skills

Age Groups