Clinical Skills Passport OTA & PTA Program 2019-2020

____________________________________________________________________________________

Student Name:____________________ Placement Dates:_________________

Placement Site:___________________

Placement: Level 1 Level 2 Block

Instructions: Students are to indicate the level of skill demonstrated and initial when a skill has
been experienced in placement. Preceptors are to review the form and validate at the end of the
student placement.

Please note NOT ALL skills will be achieved in each placement, the curriculum provides teaching
and learning in these areas – some skills will be more applicable to PTA placements and others,
OTA placements.

Skill Level Legend:

I = Independent A= Assisted (not yet independent) O= Observed

Direct Client Care: Interventions related to: Skill Level Student Preceptor
Initials Initials
(authorization)
Bathing
Communication
Dressing
Eating
ADLs
Grooming
Life skill training
Meal prep
Toileting
Cane/canes
Crutches
Quad cane
Stair practice
Ambulation
Walker – standard
Walker – wheeled
Walking endurance
Walking practice
Assisting with Balance Inventories (eg. BERG)
collection of Goniometry
Objective Data (unclear)

Version 1.1 Revised May 31, 2018

 Timed activities
Timed up and go (TUG)
Pain Scales
Rating of Perceived Exertion
Vital signs – Blood pressure
Vital signs – Heart rate
Vital signs – respiratory rate
Vital signs – SpO2
Communication Devices
Assistive Computer Training/support
Technology Dressing aids
Feeding aids
Assisted coughing
Breathing exercises
Inspirometry
Cardiorespiratory
Percussion
Postural drainage
Vibration
Skill Level Student Preceptor
Initials Initials
(authorization)
Attention process training
Cognitive behavioural therapy
Cognitive intervention sessions
Cognition and
Cognitive training
Perception
Perceptual intervention
Perceptual Training
Visual perceptual intervention
GRASP intervention
Hand Exercises
Fine motor
Handwriting Program
Handwriting Training
Active ROM
Desensitization
Edema control
Exercise devices
Hand therapy
Goniometry
Hand activities
Passive ROM
Sensory re-education
Leisure skills
Meal planning
Independent
Medication routine
Community Living
Money management
Skills
Public transport/travelling
Vocational skills
Biofeedback
Modalities
Electrical muscle stimulation

Version 1.1 Revised May 31, 2018

 Hot packs
Ice packs
Interferential
Laser
Mechanical traction
Other (specify)
Paraffin wax
TENS
Ultrasound
Bilateral motor coordinator
Fine motor
Gross motor
Paediatric
Proprioceptive
activities
Tactile
Vestibular balance
Visual motor
At a table for eating
For an activity
Positioning and In a bed
Repositioning In a chair or wheelchair
On a bed and/or mat
Standing frame
Equipment education –
reinforcement
Family education
Providing
Pain control strategies
education
Relaxation strategies
Splint education
Wheelchair education
Attendance at
Inservices/Education events
Receiving Chart review
education Consulting with other team
members
Rounds
Bandages
Casting for orthotics –
assistance
Splints/splinting Putting on/off
Splint cleaning
Splint fabrication/assistance
Splint finishing
Active Assisted ROM LE
Active Assisted ROM UE
Therapeutic Active ROM LE
Exercise Active ROM UE
Balance practice/training
Coordination training

Version 1.1 Revised May 31, 2018

 Core stabilization
Exercise tubing
Falls prevention exercises
Free weights
Hydrotherapy
Joint protection
Large fixed exercise equipment
Managing spasticity
Passive ROM LE
Passive ROM UE
Pulleys
Slings
Strengthening
Stretching
Work conditioning/hardening
Mechanical lift
Standing pivot transfer
Toilet transfer
Transfers
Transfer belt
Transfer board
Tub transfer
Manual wheelchair
maintenance
Manual wheelchair set up
Wheelchairs Manual wheelchair training
Power wheelchair maintenance
Power wheelchair set up
Power wheelchair training
could add in spaces here for
other once deletions accepted
and have indirect care start on
next page
Indirect Client Care Skill Level Student Preceptor
Initials Initials
(authorization)
Documentation – Client Chart or Record
Equipment Preparation – Vendor
Setup/Assistive Devices Setup
Group planning
Group set up/take down
Intervention/assessment Preparation/set up
Shadowing Other Professionals
Team meeting (regarding a client)
Non Client Care Skill Level Student Preceptor
Initials Initials
(authorization)
Attendance at Inservices/Education
Event/Presentations

Version 1.1 Revised May 31, 2018

 CAOT Activities
CPA Activities
Filing
Gathering/organizing resources
Inventory
Maintenance of assessment
kitchen/bathroom
Maintenance of equipment
Photocopying/Printing
Reading/Reviewing Resources
Record keeping
Resource development
Sewing
Statistics
Student Project/presentation

Preceptor Name____________________________

Preceptor Signature_________________________ Date:________________

Version 1.1 Revised May 31, 2018