DURHAM

COLLEGE
SUCCESS MATTERS

Clinical Skills Passport OTA & PTA Program2022-2023

Student Name: Vladyslav Martynchuk

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

Please note NOTALLskills willbe achieved in each placement, the curriculumprovides teaching
and learning in these areas —some skills willbe more applicable to PTAplacements and others,
OTAplacements.

SkillLevel Legend:

I = Independent A= Assisted (not yet independent) 0= Observed

Direct Client Care: Field Placement 1 Field Placement 2 Block Placement

Interventions Identify Skill Level Identify Skill Level Identify Skill
related to: & include & include Level & include
preceptor initials preceptor initials preceptor initials
as authorization as authorization as authorization
Bathing
Communication
Dressing
Eating
ADLs
Grooming
Life skill training
Meal prep
Toileting
Cane/canes O
Crutches
Quad cane
Stair practice
Ambulation
Walker —standard o
Walker— wheeled o
Walking endurance
Walking practice
Assisting with Balance Inventories
collection of (eg. BERG)
Objective Goniometry
Data Timed activities

Version 1.3 Revised June 20, 2022

 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 —Sp02
Communication
Devices
Assistive Computer
Technology Training/support
Dressing aids
Feeding aids
Assisted coughing
Breathing exercises
Cardio- Incentive Spirometry
respiratory Percussion
Postural drainage
Vibration
Attention process
training
Cognitive behavioural
therapy
Cognitive intervention
Cognition and sessions
Perception Cognitive training
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

Version I .3 Revised June 20, 2022

Independent Meal planning
Community Medication routine
Living Skills Money management
Public
transport/travelling
Vocational skills
Biofeedback
Electrical muscle
stimulation
Hot packs
Ice packs
Interferential
Modalities
Laser
Mechanical traction
Other (specify)
Paraffin wax
TENS
Ultrasound
Bilateral motor
coordinator
Fine motor
Paediatric Gross motor
activities Proprioceptive
Tactile
Vestibular balance
Visual motor
At a table for eating
For an activity
Positioning In a bed
and In a chair or
Repositioning wheelchair
On a bed and/or mat
Standing frame
Equipment education
—reinforcement
Family education
Providing
Pain control strategies
education
Relaxation strategies
Splint education o
Wheelchair education
Attendance at
Inservices/Education
events
Receiving
Chart review
education
Consulting with other
team members
Rounds
Bandages

Version 1.3 Revised June 20, 2022

 Splints/ Casting for orthotics —
splinting assistance
Putting on/off o
Splint cleaning
Splint
fabrication/assistance
Splint finishing
Active Assisted ROM

Active Assisted ROM

Active ROM LE
Active ROM UE
Balance
practice/training
Coordination training
Core stabilization
Exercise tubing
Falls prevention
exercises
Therapeutic
Free weights
Exercise
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
Transfers Toilet transfer
Transfer belt
Transfer board
Tub transfer
Manual wheelchair o
maintenance
Manual wheelchair set o
Wheelchairs
up
Manual wheelchair o
training

Version 1.3 Revised June 20, 2022

 Power wheelchair o
maintenance
Power wheelchair set o
up
Power wheelchair o
training
Other:

I Indirect Client Care Field Placement 1 Field Placement 2 Block Placement

Identify Skill Level Identify Skill Level Identify Skill
& include & include Level & include
preceptor initials preceptor initials preceptor initials
as authorization as authorization as 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 Field Placement 1 Field Placement 2 Block Placement
Identify Skill Level Identify Skill Level Identify Skill
& include & include Level & include
preceptor initials preceptor initials preceptor initials
as authorization as authorization as authorization
Attendance at Inservices/Education
Event/Presentations
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

Version 1.3 Revised June 20.2022

 Other Activities Field Field Block
Placement 1 Placement 2 Placement
Identify Skill Identify Skill Identify Skill
Level & Level & Level & include
include include preceptor
preceptor preceptor initials as
initials as initials as authorization
authorization authorization

Field Placement 1

Name of clinical site.

Date:

Preceptor Signature.

Field Placement 2

Name of clinical site.

ThZl A-FTC(U
Date:

Preceptor Signature:

Block Field Placement

Name of clinical site:

Date:

Preceptor Signature:

Version 1.3 Revised June 20, 2022