Observation Form
Physical Therapist Assistant Program
Signature: Last 4 digits Social Security:
In an attempt to assure that persons applying for acceptance into the IHCC Physical Therapist Assistant Program
possess greater awareness and understanding of the responsibilities and duties of Physical Therapist Assistants,
each prospective student is required to have a minimum of forty (40) hours of exposure to the Physical Therapy
Profession. These exposure hours may include hours spent: 1.) observing a licensed physical therapist or physical
therapist assistant while working, 2.) volunteering in a physical therapy department or 3.) being employed in a
physical therapy facility.
COMPLETED FORM DUE AUGUST 10, 2020
Please have this form completed by the P.T. or P.T.A. whom you observed.
Facility Date Hours
O = Observed
V = Volunteered
E = Employed
P.T./P.T.A
Signature
License #
Please return completed form to:
Caroline Peyrone, Program Director
IHCC, 525 Grandview Avenue, Ottumwa, IA 52501
OR
Caroline.peyrone@indianhills.edu
click to sign
signature
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Observation Hours Guidelines
It is the responsibility of each student to arrange their own schedule of observation hours, by contacting
the facility, identifying themselves as an incoming Indian Hills PTA student, and requesting available
opportunities to observe a licensed PT or PTA.
During the time when a student is observing in a clinical setting, it is understood that they will be dressed
professionally, in the manner that paid sta members are dressed. Unless otherwise noted by the facility
representative, the dress code will be, for example, khaki pants, a nice shirt, such as a polo, and nice shoes
(not tennis shoes or high heels, etc.). No t-shirts or jeans should be worn. No open-toed shoes are allowed,
and socks are required. Excessive jewelry should be removed. Acceptable jewelry would include one set of
non-dangling earrings. Any visible tattoos should be covered.
Some facilities may require an observation student to participate in some form of orientation before
seeing patient care. This may include signing a confidentiality form, indicating that a student agrees not
to divulge any personally identifying information about patients that may encounter while observing
patient care. Whether or not a student signs a confidentiality agreement, it is understood that no private
information will be shared with others who are not involved in the patient’s care.
It is the expectation that students participating in observation of Physical Therapy practice will act
professionally, using appropriate language, body posture and demeanor at all times. It is appropriate
to ask questions of the PT or PTA that you are observing, and to assist when asked with equipment or
supplies. A student will not be permitted to participate in hands-on patient care at this time.
Physical Therapy settings that are appropriate for observation include hospital-based Physical Therapy,
out-patient clinics, nursing home/rehab center physical therapy, home health care, Area Education
Association therapy. All recorded observation time must be signed by a licensed Physical Therapist or PTA.