Certified Occupational Therapist Assistant (COTA) Skills Checklist

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First Name: *

Last Name: *

Mobile Phone Number: *

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CLINICAL SETTINGS (OT experience in the following settings)

Rank each of the following sections on a scale of 1 to 4:

1) No Experience

2 )Limited Experience

3) Experienced

4 )Very Experienced

Adult - Acute Care Hospital	1234
Pediatrics - Acute Care Hospital	1234
Skilled Nursing Facility	1234
Subacute/Rehabilitation Facility	1234
Sports medicine	1234
School-based	1234
Outpatient Clinic	1234
Home Health	1234

MEDICAL DIAGNOSES (Caring for patients diagnosed with or history of)

Rank each of the following sections on a scale of 1 to 4:

1) No Experience

2 )Limited Experience

3) Experienced

4 )Very Experienced

Joint injuries (knee, hand, ankle, shoulder, hip)	1234
Joint replacements (knee, ankle, shoulder, hip)	1234
Arthritis	1234
Brain injury	1234
CVA	1234
Fall risk and/or balance issues	1234
Fractures and/or trauma	1234
Amputations	1234
Multiple sclerosis	1234
Osteoporosis	1234
Rotator cuff injuries	1234
Spinal cord injuries	1234
Spinal fractures	1234
Spina bifida	1234
Fibromyalgia	1234
Cystic fibrosis	1234
Cerebral palsy	1234
Plantar fasciitis	1234
Parkinson's disease	1234
ALS	1234
Alzheimer's disease	1234

MEDICAL DIAGNOSES (Procedures - assist or management of)

Rank each of the following sections on a scale of 1 to 4:

1) No Experience

2 )Limited Experience

3) Experienced

4 )Very Experienced

Active and passive ROM	1234
Transfer activities	1234
Mobilization	1234
Prosthetic training	1234
Assistive devices (fit, training, safety, strengthening, endurance)	1234
Functional splinting	1234
Fabrication of orthotic device(s)	1234
Education - energy conservation, perceptual motor training, fine motor, dexterity, etc.)	1234
Arranges orthotics/splints	1234
Chest physiotherapy	1234
Lymphedema management	1234
Driving evaluation	1234
Arranges adaptive equipment	1234
Cognitive retraining	1234
ADLs	1234

MEDICAL DIAGNOSES (Assessment and interpretation of)

Rank each of the following sections on a scale of 1 to 4:

1) No Experience

2 )Limited Experience

3) Experienced

4 )Very Experienced

Neurological system (memory, judgement, sequencing, etc.)	1234
Pain (location, intensity, duration, relief)	1234
Musculoskeletal status (ROM, strength, coordination, etc.)	1234
Reflexes (e.g. deep, postural, primitive, superficial, etc.)	1234
Sensation	1234
Neuro-muscular function (motor control, strength, coordination, tone)	1234
Cognition/Mental status (oriented, alert, etc.)	1234
Cranial and peripheral nerves	1234
Endurance	1234
Functional findings (e.g. bed mobility, gait, transfers, equipment, etc.)	1234
Ergonomic performance	1234
Environmental evaluation (e.g. home environment, barriers, and community access)	1234

CLINICAL/PROFESSIONAL SKILLS (Experience in performing these clinical skills/tasks)

Rank each of the following sections on a scale of 1 to 4:

1) No Experience

2 )Limited Experience

3) Experienced

4 )Very Experienced

Systems review screening	1234
Vital signs (manual and electronic)	1234
Oxygen saturation	1234
Functioning assessment/screening (eating, dressing, hygiene, toileting, etc.)	1234
Participates in care coordination process/team meetings	1234
Assistance in developing plan of care, assess response to treatment	1234
Therapeutic massage	1234
Documentation of services (e.g. OASIS-follow-up, status change, discharge, etc.)	1234
Knowledge of medical/state regulations (e.g. criteria for participation, reimbursement, etc.)	1234
Whirlpool and/or therapeutic pool	1234
Assess for abuse/neglect	1234
Wound care	1234
Paraffin bath	1234
Strain/counter strain techniques	1234
Hydrotherapy (e.g. contrast bath, whirlpool tanks, pools, etc.)	1234
Electrical stimulation	1234
Fluidotherapy	1234
Biofeedback therapy	1234
Prosthetic testing (e.g. alignment, fit, ability to care for, use, safety, etc.)	1234
Anodyne therapy	1234
FIM scoring	1234
Burn management	1234
Dressing changes (wet, wet to dry, hydrogels, topic creams/ointments, etc.)	1234
Education ( e.g. injury prevention/reduction, use of adaptive devices, etc.)	1234
Work simplification and energy conservation	1234
Perceptual motor training	1234
Neuro-developmental training	1234
Adaptive equipment assessment	1234
Group treatment/therapy	1234
Postural education	1234
Feeding techniques	1234

EQUIPMENT (Set-up, use of, and documenting response to)

Rank each of the following sections on a scale of 1 to 4:

1) No Experience

2 )Limited Experience

3) Experienced

4 )Very Experienced

Ultrasound	1234
TENS unit	1234
Hot and cold packs	1234
Swiss ball	1234
Therapeutic pool	1234
Biodex	1234
Isokinetic machine	1234
Mechanical lifts	1234
Specialty beds	1234
Orthotic devices (e.g. prefabricated braces, shoe inserts, splints, etc.)	1234
Traction (e.g. intermittent, positional, sustained, etc.)	1234
Supportive devices (e.g. neck collar, sling, elastic wraps, corsets, etc.)	1234
Protective devices (e.g. braces, cushions, helmets, etc.)	1234
Gravity-assisted compression devices (e.g. standing frame, tilt table)	1234
Continuous passive motion device	1234
Adaptive equipment training	1234

INFECTION CONTROL (Implementation and management of)

Rank each of the following sections on a scale of 1 to 4:

1) No Experience

2 )Limited Experience

3) Experienced

4 )Very Experienced

Hand hygiene	1234
Precautions and associated PPE (contact, airborne, droplet)	1234
Prevention and protocols for HAIs (CAUTI, CLABSI, VAP)	1234
Prevention and protocols for MRSA, C.Diff, Sepsis, etc.	1234
Prevention of SSIs	1234
Negative-pressure room	1234

GENERAL & OTHER (Experience in these tasks and/or documenting them)

Rank each of the following sections on a scale of 1 to 4:

1) No Experience

2 )Limited Experience

3) Experienced

4 )Very Experienced

Therapeutic communication with patient/resident/client	1234
Proper body mechanics and positioning	1234
Skilled visit notes	1234
Knowledge of ICD-10 and CPT codes	1234
Knowledge of Medicare Oasis	1234
Communicate with insurance companies	1234
Knowledge of common ethical issues for OTAs and how to solve	1234
Cultural competence	1234
EMR - McKesson	1234
EMR - Meditech	1234
EMR - Epic	1234
EMR - Cerner	1234

AGE SPECIFIC (Care of the following age groups)

Rank each of the following sections on a scale of 1 to 4:

1) No Experience

2 )Limited Experience

3) Experienced

4 )Very Experienced

Infant (birth to 1 year)	1234
Toddler (ages 1-3 years)	1234
Preschooler (ages 4-5 years)	1234
Childhood (ages 6-12 years)	1234
Adolescent (ages 13-21 years)	1234
Young Adults (ages 22-39 years)	1234
Adult (ages 40-64 years)	1234
Older Adults (ages 65-79 years)	1234
Elderly (ages 80+ years)	1234

Attestation

ATTESTATION: *

I certify that the information provided above accurately reflects my experience in each of the clinical areas identified within the past three years.

If you agree with the Attestation above, please electronically sign your name. *