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(These forms & resources have been shared by your fellow colleagues across the state!)

  • PT Satisfaction Survey (pdf) (doc) – provided by Durham Public Schools
  • PT Pink Sheet | Durham (pdf) (doc) – provided by Durham Public Schools
  • PT Parent Contact Form (pdf) (doc– provided by Durham Public Schools
  • PT MD Contact Form (pdf) (doc) – provided by Durham Public Schools
  • PT Orthotic Referral (pdf) (doc– provided by Durham Public Schools
  • PT Intro Letter (pdf) (doc)– provided by Durham Public Schools
  • PT Consult (pdf) (doc)– provided by Durham Public Schools
  • PT Pamphlet (pdf) (doc) – provided by Durham Public Schools
  • Parent Questionnaire (pdf) (doc) – provided by Durham Public Schools

APTA Pediatric Resource-Management of Equipment Used by Physical Therapists in School-Based Practice

  • Student Equipment Log (pdf) (doc) – provided by Winston-Salem/Forsyth County Schools
  • LMN Log (pdf) (doc) – provided by Winston-Salem/Forsyth County Schools
  • Protective Device Form (pdf) (doc) – provided by Durham Public Schools
  • PT Loan Agreement (pdf) (doc) – provided by Durham Public Schools
  • PT Waiver of Liability (pdf) (doc) – provided by Durham Public Schools
  • Student Equipment Log (pdf) (doc) – Winston-Salem/Forsyth County Schools
  • Section 504 Individualized Eligibility Report provided by Weldon City
  • Bruininks Evaluation (pdf) (doc) – provided by Durham Public Schools
  • Re-evaluation (pdf) (doc) – Winston-Salem/Forsyth County Schools
  • Generic OT Evaluation (pdf) (doc)
  • Peabody 2 Evaluation (pdf) (doc) – provided by Durham Public Schools
  • Peabody Form (pdf) (doc) – provided by Durham Public Schools
  • Physical Therapy Evaluation Form (pdf) (doc)
  • Preschool Functional Inventory (pdf) (doc) – Maryland
  • PT-Gross Motor Checklist (pdf) (doc) – provided by NYC
  • PT Functional Evaluation – Nonambulatory (pdf) (doc) – provided by Cumberland County Schools
  • PT Functional Evaluation (pdf) (doc) – provided by Cumberland County Schools
  • PT Functional Evaluation (pdf) (doc) – provided by Durham Public Schools
  • PT School Function Evaluation – Middle & HS (pdf) (doc) – provided by NYC
  • PT School Function Evaluation Appendices Middle and HS (pdf) (doc) – provided by NYC
  • PT School Function Evaluation – Pre-K & Elementary (pdf) (doc) – provided by NYC
  • PT School Function Evaluation Appendices – Pre-K and Elementary (pdf) (doc) – provided by NYC
  • SFA Eval SFA (pdf) (doc) – provided by Durham Public Schools
  • Summary Score Form (pdf) (doc) – provided by Durham Public Schools
  • Student Functional Inventory (pdf) (doc) – Maryland
  • Tests & Measures Cheat Sheetprovided by NYC
  • An Example of language for a contingency plan – “Physical therapist will provide guidance and instruction to facilitate progress of foundational skills necessary for functional mobility goal attainment during direct virtual physical therapy services.” – Newton Conover City Schools
  • Documentation of Body Mech Training (pdf) (doc) – provided by CMS
  • Grid Game, Submitted by Rockingham Co Schools
  • List of Therapy Activities in Video Library – permission was not granted for the original videos to be posted publicly, however this list will give you ideas of videos you can create on your own. – Pitt County Schools
  • I Am Here: A Booklet About Mindfulness, by Eleanor Cole
  • School Start up Checklist (pdf) (sheet) – provided by Durham Public Schools
  • Goal Achievement Analysis (pdf) (doc) – provided by New Hanover County Schools
  • Gross Motor Skills in Sensory Diet (pdf) – provided by New Hanover County Schools
  • PT Discharge from Services (pdf) (doc) – provided by Durham Public Schools
  • PT Do the Math (pdf) (doc)
  • PT Peer Review Checklist Sample (pdf) (doc) – provided by Durham Public Schools
  • PT Service Levels (pdf) (doc) – Winston-Salem/Forsyth County Schools 
  • Documentation of Wheelchair Management and Mob Training (pdf) (doc) – provided by CMS
  • Evacuation Plan for Physical Therapy (pdf) (doc) – provided by CMS
  • Functional Mobility in Education Environment (pdf) (doc) – provided by CMS
  • General Safety Assessment (pdf) (doc)
  • PT Training Form (pdf) (doc) – provided by Durham Public Schools
  • School Safety Drills for Physical Disabilities (pdf) (doc) – provided by CMS
  • PT Continuing Education Record (pdf) (doc) – provided by Durham Public Schools
  • PT Monthly Planner (pdf) (doc) – provided by Durham Public Schools
  • PT Schedule – A (pdf) (doc) – provided by Durham Public Schools
  • PT Schedule – B (pdf) (doc) – provided by Durham Public Schools
  • PT To-Do List (pdf) (doc) – provided by Durham Public Schools
  • PT Weekly Planner (pdf) (doc) – provided by Durham Public Schools
  • Generic Plan of Care (pdf)
  • PT POC Form (pdf)
  • SBPT Plan of Care (pdf)
  • School PT Plan of Care (pdf) (doc)
  • PT Department – Plan of Care (pdf) (doc) – provided by ABSS
  • Plan of Care Template (pdf) (doc) – provided by Cleveland County Schools
  • Sample School-Based Occupational Therapy Plan of Care (pdf) (doc)
  • Sample School-Based Occupational Therapy Intervention Plan (pdf) (doc)
  • Sample School-based Psychological/Counseling Plan of Care (pdf) (doc)
  • Plan for Skilled Intervention/Plan of Care SLP (pdf) (doc)
  • Bench Sitting on Floor (pdf) (doc)
  • Communication Log (pdf) (doc)
  • Long Sitting (pdf) (doc)
  • I.E.P. Team Goals and Objectives (pdf) (doc)
  • Positioning for Education Adaptive Equipment Handout (pdf) (doc)
  • Positioning for Education Desk and Chair Handout (pdf) (doc)
  • Positioning for Education Floor Time Handout (pdf) (doc) – provided by CMS
  • Positioning for Education Wheelchair Handout (pdf) (doc)
  • Procedure Log Sheet and Comments (pdf) (doc)
  • Prone on Wedge PF (pdf) (doc) – provided by Durham Public Schools
  • Sidelyer Positioning Data Form (pdf) (doc) – provided by Durham Public Schools
  • Stander Positioning Data Form (pdf) (doc) – provided by Durham Public Schools
  • Tumbleforms Seat Positioning Data Form (pdf) (doc) – provided by Durham Public Schools
  • PT Support Descripton (pdf) (doc) (Wake)
  • Related Service Support Description Note to Parent (pdf) (doc) (Union)
  • Documentation of Restroom Training (pdf) (doc) – provided by CMS
  • Restroom Data Collection (pdf) (doc) – provided by CMS
  • Restroom FAQ (pdf) (doc) – provided by CMS
  • Restroom Procedure Form (pdf) (doc) – provided by CMS
  • Restroom Strategies and Adaptive Equipment (pdf) (doc) – provided by CMS
  • Exceptional Children’s Program (pdf) (doc) – provided by Durham Public Schools
  • Gross Motor Skill Level (pdf) (doc) – provided by New Hanover County Schools
  • Motor Screen (pdf)provided by Randolph County School System
  • Motor Screen 2.5 to 3 yr (pdf) (doc) – provided by Craven County Schools
  • Motor Screen 3 to 3.5 yr (pdf) (doc) – provided by Craven County Schools
  • Motor Screen 3.5 to 4 yr (pdf) (doc) – provided by Craven County Schools
  • Motor Screen 4 to 5 yr (pdf) (doc) – provided by Craven County Schools
  • Motor Screen for Preschoolers (pdf)provided by Randolph County School System
  • Motor Screening (pdf) (doc) – provided by Durham Public Schools
  • Motor Screening Form (pdf) (doc) – provided by Craven County Schools
  • Motor Screening Tool (pdf)provided by Buncombe County Schools
  • OT and PT in Public Education (pdf) (doc)
  • OT-PT Referral (pdf) (doc) – provided by Durham Public Schools
  • OT-PT Referral Form (pdf) (doc)
  • PT – Gross Motor Pre-Referral Strategies (pdf) (doc)
  • PT Referral Checklist (pdf) (doc) – provided by Durham Public Schools
  • PT Screening (pdf) (doc) – provided by Durham Public Schools
  • PT Teacher Screening (pdf) (doc) – provided by NYC
  • School Function Motor Screen (pdf)provided by Randolph County School System
  • Daily Progress Note Form Filled Sample (NYC) (pdf) (sheet)
  • Student Service Information/Attendance Log (pdf) (doc) – provided by Durham Public Schools
  • Daily Progress Notes (pdf) (doc) – provided by Durham Public Schools
  • Progress Note (pdf) (doc) – provided by Durham Public Schools
  • Sample Goal Data Collection (pdf) (doc)
  • PT Attendance Log (pdf) (doc) – provided by Durham Public Schools
  • PT Record (pdf) (doc) – Winston-Salem/Forsyth County Schools
  • PT Therapeutic Log (pdf) (doc) – provided by Durham Public Schools
  • PT Student Needs School Transition Form (pdf) (doc) – provided by Durham Public Schools
  • Sample Transition Letter CP (pdf) (doc) – provided by CMS
  • Sample Transition Letter Spina Bifida (pdf) (doc) – provided by CMS
  • Student Transition Checklist (pdf) (doc) – provided by CMS
  • Student Transition Info for PT (pdf) (doc) – provided by CMS
  • Telehealth Transition Checklist (CMS) 
  • Procedures for Bus Loading Walker-Crutches (pdf) (doc) – provided by CMS
  • Procedures for Bus Loading Wheelchair (pdf) (doc) – provided by CMS
  • Procedures for Occupant Restraint (pdf) (doc) – provided by CMS
  • Procedures for Using Integrated Child Restraints on the Bus (pdf) (doc) – provided by CMS
  • Procedures for Using Safety Vests on the Bus (pdf) (doc) – provided by CMS
  • Procedures for Using STAR on the Bus (pdf) (doc) – provided by CMS
  • Procedures for Wheelchair Tie down straps (pdf) (doc) – provided by CMS
  • PT Transportation Form (pdf) (doc) – provided by Durham Public Schools
  • PT Transportation Safety List (pdf) (doc) – provided by Durham Public Schools
  • Red Tag Letter to Parents-Spanish (doc) – provided by Durham Public Schools
  • Student Profile Transportation Considerations (pdf) (doc) – provided by CMS
  • Transportation Form – provided by Pitt County Schools