Therapy Skill Mastery Checklist Form
Track and document therapy skill practice and mastery in a clear, streamlined format.
Participant Name
*
First Name
Last Name
Date of Session
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Therapy Skill Practiced
*
Practice Frequency
*
Please Select
Once
2-3 times
Daily
Weekly
Other
Level of Independence
*
Independent
With verbal prompts
With physical assistance
Not attempted
Confidence in Skill
*
1
2
3
4
5
Challenges Observed
Progress Notes
Skill Mastered?
*
Yes
No
Next Steps or Recommendations
Submit
Should be Empty: