Physical Therapy Clinical Skills Exam Evaluation Form

Physical Therapy Clinical Skills Exam Evaluation Form
Evaluate a physical therapy clinical skills exam using structured ratings for clinical performance, reasoning, safety, communication, professionalism, and overall outcome.
Examinee and Exam Details
Examinee Name
First NameLast Name
Program or Cohort
Evaluator Name
Exam Date
MonthDayYear
Date
Exam Time
Hour Minutes
AM/PM Option
Clinical Setting or Station Name
Exam Version or Case Scenario Name
Core Clinical Skills Evaluation
Patient Assessment Technique

1
2
3
4
1 is Unsatisfactory, 4 is Excellent
Therapeutic Exercise Demonstration

1
2
3
4
1 is Unsatisfactory, 4 is Excellent
Manual Therapy Technique

1
2
3
4
1 is Unsatisfactory, 4 is Excellent
Gait or Mobility Training

1
2
3
4
1 is Unsatisfactory, 4 is Excellent
Patient Safety and Body Mechanics

1
2
3
4
1 is Unsatisfactory, 4 is Excellent
Infection Control

1
2
3
4
1 is Unsatisfactory, 4 is Excellent
Communication with Patient

1
2
3
4
1 is Unsatisfactory, 4 is Excellent
Professionalism

1
2
3
4
1 is Unsatisfactory, 4 is Excellent
Clinical Reasoning

1
2
3
4
1 is Unsatisfactory, 4 is Excellent
Outcome and Comments
Overall Outcome
Overall Score (%)
Strengths
Areas for Improvement
Evaluator Comments / Remediation Plan
Should be Empty:

Select theme:

Default
Blue
Red
Brown
Green
Black
Pink
Dark Blue
Purple