PHYSICAL CAPACITY ASSESSMENT

A physical capacity evaluation typically assesses “isolated” parts of the body (or) functional units.

SMITH PHYSICAL CAPACITY EVALUATION

                                   It has 154 performance items & was found to be very accurate in predicting Reemployment of workers with physical disability.

NUMBER OF HOURS CAPABLE OF WORK

Given the workday, the client can –

PHYSICAL DEMANDS

§  Climbing (stairs / ladders)

§  Balance                       

§  Crouch                        

§  Squat

§  Reach - at shoulder height              

§  Reach – below shoulder height

Client can use feet for repetitive movements:

           Right ----     Left ----          Both ----

Client can use hands for repetitive movements:

           Right ----      Left ----         Both ----

Simple Grasping:                Yes ----                       No ----

Fine Manipulation:            Yes ----                       No ----

Client is restricted by following environmental factors:

            Hot / Cold ----        Dust ----        Height ----    Noise ----

Client will be required to use following:

                              Assistive Devices (or) Braces

Additional comments: -------------------------------------------------------------------------------------------------------------------------------------

Date: ----------------                         Therapist: ---------------------------