Free occupational therapist interview questions for small practices without HR: 6 sets with why to ask, what a strong answer sounds like, and a scorecard.
Six question sets for the employer side of the table: clinical reasoning, setting fit, documentation, patients and families, licensure screening, and a 1-to-5 scorecard. Every question carries why to ask it and what a strong answer sounds like. Download as DOCX.
The first time I watched a clinic owner interview an occupational therapist, the clinical part took about four minutes. She was an OT herself, and she could hear within two answers whether the candidate reasoned like a therapist or recited activities. Then the interview drifted into a friendly conversation about where the candidate grew up and whether she had kids, and by the end there was nothing written down.
That is the pattern at small practices. The clinical half goes fine because the owner is a clinician. The employer half, the same questions for every candidate, the questions that must stay out of the room, the written evidence, the license verified before the start date, is the half that gets skipped.
At FirstHR, we build for the owners and practice managers who make this hire themselves. This page is written for the person deciding what to ask, not for the candidate preparing to answer. Every question below comes with a stated reason it is worth asking and a description of what a strong answer sounds like.
TL;DR
Interview an occupational therapist on five things: clinical reasoning, fit for your setting, documentation and billing discipline, patient and family communication, and verified licensure. Ask the same core questions of every candidate, then score six areas on a 1-to-5 rubric. The federal occupation reports a median wage of $100,330 a year. Download six question sets and the scorecard as DOCX.
What to Assess in an Occupational Therapist
Assess an occupational therapist on five things: clinical reasoning, fit for the setting you actually run, documentation and billing discipline, communication with patients and families, and a license you have verified yourself. A candidate can be strong on the first and weak on the third, and the third is what costs a small practice money.
Start from the role as written. If you have not defined it yet, the occupational therapist job description is the place to fix the essential functions, the setting, and the caseload expectation, because the interview questions should test exactly what the job requires and nothing beyond it.
The most reliable way to run this is a structured interview: the same core questions for every candidate, scored on the same rubric. That is fairer, it is easier to defend, and it produces a comparison instead of an impression. It is also the part most small practices leave out, which is why the scorecard is included here rather than offered as an extra.
Why the Setting Changes the Questions
Occupational therapy is one license practiced in very different places, so setting experience is one of the strongest predictors of how fast a new hire becomes productive. A therapist who is excellent in outpatient hand therapy can need months to run a school caseload across three buildings, and a school-based therapist may struggle with the pace of a busy outpatient schedule.
Federal data puts health care and social assistance first among employers of occupational therapists, with educational services second, which is a useful reminder that the two largest hiring settings ask for almost entirely different daily skills. Pick the block below that matches your practice and ask those questions of every candidate for that role.
Setting
What the interview should probe
Outpatient clinic
Diagnosis mix, throughput, splinting or orthotic fabrication
School-based
Educationally relevant goals, push-in versus pull-out, multi-building caseloads
Home health
Home safety evaluation, escalating an unsafe visit, finishing notes on the road
Skilled nursing and rehab
Treatment minutes and group rationale, refusals, current payment rules
Pediatric clinic
Parent expectations, home carryover, keeping a dysregulated child engaged
If your caseload is stable and you mainly need treatment capacity, an occupational therapy assistant may fit better than a second therapist. That choice changes the interview too, because supervision then becomes a question you ask every therapist candidate.
Which Question Set Should You Use?
Use the clinical reasoning set for every candidate, add the setting block that matches your practice, and add the documentation set. The others are situational. This guide shows what each set covers and when it earns its place in a 45-minute interview.
Clinical Reasoning
Start here, always
Evaluation, assessments, goal writing, and what they do when a patient stalls. Every question carries why to ask it and what a strong answer sounds like.
Setting-Specific
Outpatient to schools
Separate blocks for outpatient, school-based, home health, skilled nursing, and pediatrics, because one license is practiced five very different ways.
Documentation and Billing
Where money is lost
Note timeliness, skilled-care language, denials, caseload capacity, and system fluency. The set clinical owners skip and later regret skipping.
Patients, Families, Team
Behavioral evidence
Refusals, family expectations, cognitive impairment, disagreements with providers, and supervising an assistant. Real examples, not self-description.
Licensure and Screening
Ask, then verify
License status, national certification, discipline history, and consent to checks, with a verification checklist and the questions to keep out.
Scorecard and Red Flags
Score, do not guess
A six-area 1-to-5 rubric with an evidence line per area, plus a red-flag checklist, so two candidates you both liked can actually be compared.
Three Sets Is Usually the Right Number
For a single 45 to 60 minute interview, use Clinical Reasoning plus one Setting block plus Documentation and Billing. Save Patients, Families, and Team for a second round or a finalist site visit. Ask Licensure and Screening in the screening call so a licensing gap surfaces before anyone spends an hour. The Scorecard is used with every set, every time. Browse the rest of the hiring templates if you need the job description or an offer letter to go with it.
6 Free Question Sets to Download
Download all six as a single Word document or copy individual sets. Each question lists why it is worth asking and what a strong answer sounds like, followed by what to listen for and space for notes. The last file is the scorecard with a red-flag checklist.
Download All 6 Question Sets and the Scorecard
Clinical reasoning, setting-specific, documentation and billing, patients and families, licensure screening, and a 1-to-5 scorecard. All in one DOCX.
Set 1: Clinical Reasoning and Evaluation Questions
The core set for every occupational therapist hire: evaluation, standardized assessments, goal writing, what happens when a patient stalls, and discharge. Start here regardless of setting.
Clinical Reasoning and Evaluation Questions
OCCUPATIONAL THERAPIST INTERVIEW: CLINICAL REASONING AND EVALUATION
Candidate: __
Practice / Setting: __
Interviewer: __
Date: _
HOW TO USE THIS SET
This is the core set for every occupational therapist hire, whatever the
setting. Ask 5 to 7 of these. Each question lists why it is worth asking and
what a strong answer sounds like, so a practice owner or office manager can
judge the response consistently. Score on the rubric in Set 6.
QUESTIONS
1. Walk me through how you evaluate a new patient, from referral to the first
treatment plan.
Why ask: evaluation is where occupational therapy skill is most visible, and
every setting starts here. A weak evaluator produces weak plans all year.
Strong answer: starts with an occupational profile and what the patient
actually wants to do, names the standardized assessments used, and ends with
measurable functional goals rather than a generic exercise list.
2. Which standardized assessments do you use most often, and why those?
Why ask: it separates a therapist with a real toolkit from one who
improvises, and it tells you whether their tools match your population.
Strong answer: names specific instruments suited to the population and
explains when each one fits and when it does not.
3. Write me a functional goal for a recent patient, out loud.
Why ask: goal writing drives both patient outcomes and whether the claim
holds up on review. It is the single fastest read on clinical rigor.
Strong answer: specific, functional, measurable, time-bound, and tied to an
activity that matters to the patient, not to a range-of-motion number alone.
4. A patient has made no measurable progress in four weeks. What do you do?
Why ask: tests clinical reasoning under real conditions instead of ideal
ones, and reveals whether the therapist questions their own plan.
Strong answer: reassesses, changes the approach or the frequency, talks to
the referring provider, and is willing to discharge a patient who is not
benefiting rather than continue treating out of habit.
5. How do you decide a patient is ready for discharge?
Why ask: over-treating and discharging too early are both real risks, and
the answer shows how the therapist balances outcomes with caseload pressure.
Strong answer: ties discharge to goal attainment or a documented functional
plateau, and includes a home program and a plan for follow-up.
6. How do you keep current with evidence in your practice area?
Why ask: practice changes, and a therapist who stopped reading at graduation
will still be treating the way they were taught a decade ago.
Strong answer: names journals, specific continuing education, or a specialty
certification, with an example of something that changed their practice.
7. Tell me about a treatment approach you changed your mind about.
Why ask: intellectual honesty is hard to fake and predicts how the therapist
will respond to feedback from you later.
Strong answer: a concrete example with a reason, usually evidence or their
own outcomes, and no defensiveness about having been wrong.
WHAT TO LISTEN FOR
•Starts from what the patient wants to do, not from a protocol
•Names real assessments and real goals, not categories
•Reassesses and adjusts instead of repeating the same plan
•Comfortable saying what they do not know
NOTES
__
__
Set 2: Setting-Specific Questions
Separate blocks for outpatient, school-based, home health, skilled nursing, and pediatrics. Use the one that matches your practice, because the daily skills barely overlap.
Setting-Specific Questions (Outpatient, School, Home Health, SNF)
Set 3: Documentation, Billing, and Caseload Questions
Note timeliness, skilled-care language, a past denial, caseload capacity, and system fluency. The set clinical owners most often skip and most often regret skipping.
Documentation, Billing, and Caseload Questions
OCCUPATIONAL THERAPIST INTERVIEW: DOCUMENTATION, BILLING, AND CASELOAD
Candidate: __
Practice: __
Interviewer: __
WHY THIS SET MATTERS MOST TO A SMALL PRACTICE
A therapist who treats beautifully and documents late will cost a small
practice real money, because unfinished notes delay claims and thin
documentation invites denials. Ask these questions directly. They are the
questions clinical owners most often skip and most often regret skipping.
QUESTIONS
1. When do your notes get written, and how often are they same-day?
Why ask: it is the most reliable predictor of billing headaches, and the
honest answer is usually the useful one.
Strong answer: same-day or point-of-care as the default, with a specific
routine for the exceptions. Vagueness here is a real warning sign.
2. Walk me through what you include in an evaluation note so it supports the
plan of care.
Why ask: the evaluation is the document that carries the whole episode.
Strong answer: prior level of function, objective measures, skilled reasoning
for why therapy is needed, and goals that connect to the findings.
3. Tell me about a claim or authorization denial you dealt with. What happened?
Why ask: everyone has had one; how they talk about it shows ownership.
Strong answer: identifies what the documentation was missing and what they
changed afterward, rather than blaming the payer alone.
4. How do you document skilled care so it is clear why a therapist was needed?
Why ask: this is the single most common documentation weakness.
Strong answer: describes the clinical decision-making in the note, not just
the activity performed.
5. What caseload have you carried, and what is realistic for you here?
Why ask: it sets expectations honestly before the first week, and it tells
you whether their number and your number are in the same range.
Strong answer: a specific number tied to a setting, with a reason.
6. What electronic documentation systems have you used, and how quickly do you
pick up a new one?
Why ask: system fluency is days versus weeks of ramp time.
Strong answer: names systems and describes actual tasks done in them.
7. How do you handle a week where the caseload is heavier than you can cover?
Why ask: it surfaces whether they escalate early or quietly fall behind.
Strong answer: flags it early, triages by patient need, asks for help.
WHAT TO LISTEN FOR
•A real, repeatable documentation routine, not good intentions
•Understands why a note is written the way it is
•Honest about caseload capacity instead of agreeing to anything
•Raises problems early rather than absorbing them silently
NOTES
__
Set 4: Patient, Family, and Team Questions
Behavioral and situational prompts on refusals, family expectations, cognitive impairment, disagreements with other clinicians, and supervising an assistant.
Patient, Family, and Team Questions
OCCUPATIONAL THERAPIST INTERVIEW: PATIENTS, FAMILIES, AND THE TEAM
Candidate: __
Practice: __
Interviewer: __
WHEN TO USE THIS SET
Occupational therapy happens through relationships: with a patient who may not
want to be there, with a family that has its own expectations, and with the
other clinicians on the case. Use these behavioral and situational questions to
see how the candidate actually operates, not how they describe themselves.
Ask for a real example, then ask what happened next.
QUESTIONS
1. Tell me about a patient who did not want to participate. What did you do?
Why ask: refusal and low motivation are daily realities in every setting.
Strong answer: looks for the reason (pain, fatigue, depression, fear), adapts
the session, and does not treat refusal as the patient being difficult.
2. Describe a time a family expected an outcome the patient was not going to
reach. How did you handle it?
Why ask: expectation management protects both the patient and your practice.
Strong answer: honest and compassionate, sets realistic goals, documents the
conversation, and keeps the family engaged rather than pushing back.
3. How do you adapt when a patient has significant cognitive or communication
impairment?
Why ask: it separates a therapist who treats the diagnosis from one who
treats the person in front of them.
Strong answer: concrete strategies, involves caregivers, adjusts the plan.
4. Tell me about a disagreement with a physician, nurse, or another therapist
about a patient. What happened?
Why ask: a therapist who cannot advocate, or who cannot back down, creates
friction that a small practice cannot absorb.
Strong answer: advocates with clinical reasoning, stays professional, and can
describe a time they changed their own position.
5. How do you supervise and delegate to an occupational therapy assistant?
Why ask: supervision rules are legally specific and vary by state and payer.
Strong answer: knows their state requirements, delegates appropriately, and
stays involved in the plan of care rather than handing it off.
6. How do you explain occupational therapy to a patient who thinks it is the
same as physical therapy?
Why ask: it tests both clinical clarity and patient communication in one
question, and every therapist has faced it.
Strong answer: plain language, focused on daily activities and independence,
with a specific example.
7. Tell me about a mistake you made with a patient.
Why ask: how someone describes their own error predicts whether they will
tell you about the next one.
Strong answer: a real mistake, disclosed and corrected, with what changed.
WHAT TO LISTEN FOR
•Real examples with a beginning, an action, and an outcome
•Curiosity about why a patient is not engaging
•Advocacy without rigidity, and willingness to be wrong
•Knows the supervision rules for assistants in your state
NOTES
__
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Set 5: Licensure, Credentials, and Screening Questions
License status, national certification, discipline history, and consent to checks, plus a verification checklist and a short list of the questions to keep out of the interview.
Licensure, Credentials, and Screening Questions
OCCUPATIONAL THERAPIST INTERVIEW: LICENSURE, CREDENTIALS, AND SCREENING
Candidate: __
Practice: __
Interviewer: __
WHEN TO USE THIS SET
Occupational therapists are licensed by the state, and an unlicensed or lapsed
therapist treating patients is a problem for the practice, not only for the
therapist. Ask these questions in the interview, then verify every answer
independently. Verification is the step small practices skip, and the one that
matters most. This is general information, not legal advice.
QUESTIONS TO ASK
1. What is your license status in this state, and when does it renew?
Why ask: licensure is state by state, and a therapist moving from another
state may need weeks or months before they can treat here.
Strong answer: a current license number they are happy to have verified, or a
clear, dated account of where an application stands.
2. Are you certified through the national certifying board, and is it current?
Why ask: national certification is tied to licensure in most states and is a
simple, checkable credential.
Strong answer: current certification with no gaps they cannot explain.
3. Have you ever had a license disciplined, restricted, denied, or surrendered
in any state?
Why ask: a direct question is fair, job-related, and lets the candidate
explain before you find it on a board lookup.
Strong answer: a straight answer either way, with context if there is any.
4. How do you track your continuing education requirements?
Why ask: lapsed continuing education is a common cause of a lapsed license,
and it becomes your scheduling problem.
Strong answer: a system and a current count, not a shrug.
5. Are you willing to complete a background check and reference checks as a
condition of the offer?
Why ask: it sets the expectation before the offer instead of after.
Strong answer: yes, without hesitation.
6. May we contact a clinical supervisor as a reference?
Why ask: a clinical reference tells you far more than a peer reference.
Strong answer: offers a real supervisor, not only colleagues and friends.
VERIFY THESE YOURSELF (DO NOT TAKE THE ANSWER ON TRUST)
[ ] State license verified directly on the state board lookup, in every state
the candidate has practiced
[ ] National board certification confirmed as current
[ ] Any disciplinary action reviewed and discussed
[ ] Federal exclusion list checked if you bill any federal health program
[ ] References checked, including at least one clinical supervisor
[ ] Background check completed under your written policy, after the offer
KEEP THESE OUT OF THE INTERVIEW
Do not ask about health conditions, disability, medications, past workers
compensation claims, age, family plans, or religious observance. For a
physically demanding clinical job it is tempting to ask whether someone can
lift a patient. Ask instead whether they can perform the essential functions of
the job, with or without reasonable accommodation, and list those functions in
the job description. Medical questions and exams belong after a conditional
offer and must apply to everyone in the same role.
NOTES
__
Set 6: Scorecard and Red Flags
A six-area 1-to-5 rubric with an evidence line for each area, a red-flag checklist, and a decision block. Use it with any set above, for every candidate.
Occupational Therapist Scorecard and Red Flags
OCCUPATIONAL THERAPIST INTERVIEW SCORECARD AND RED-FLAG CHECKLIST
Candidate: __
Practice / Setting: __
Interviewer: __
Date: _
HOW TO SCORE
Score each area from 1 to 5 immediately after the interview, while it is fresh.
Anchor every score to something the candidate actually said. If more than one
person interviews, each scores independently first, then compare written
evidence before discussing. Use the same rubric for every candidate for the
same role.
Rating scale:
5 = Strong, specific evidence 4 = Solid evidence 3 = Some evidence
2 = Weak or mixed evidence 1 = No evidence or red flags
SCORING AREAS
Clinical reasoning: evaluation, goal writing, adjusting a plan that stalls
Score [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ]
Evidence: ______
Setting fit: real experience in the setting you are hiring for
Score [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ]
Evidence: ______
Documentation and billing discipline: timeliness, skilled-care language
Score [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ]
Evidence: ______
Patient and family communication: engagement, expectations, plain language
Score [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ]
Evidence: ______
Team and supervision: collaboration, advocacy, assistant supervision
Score [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ]
Evidence: ______
Credentials and reliability: license, certification, references, follow-through
Score [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ]
Evidence: ______
RED FLAGS (WEIGH CAREFULLY)
[ ] Cannot describe an evaluation or write a goal out loud
[ ] Vague or defensive about when documentation gets done
[ ] Blames payers, patients, or families for every past problem
[ ] Hesitates about license verification or reference checks
[ ] No example of ever changing a plan that was not working
[ ] Agrees to any caseload number without asking a single question
[ ] Cannot name a mistake or anything they would do differently
The fastest read on clinical reasoning is to ask for a real case: have the candidate walk through an evaluation and write one functional goal out loud. Reasoning is hard to fake in that format, because a therapist either connects findings to a goal the patient cares about or does not.
The three questions below carry the most information per minute. Each one is shown with why it is worth asking, what a strong answer contains, and what a weak answer sounds like, so the interviewer can score it the same way for every candidate.
Walk me through how you evaluate a new patient.
Why ask it: Evaluation is where occupational therapy skill is most visible, and a weak evaluator produces weak plans for every patient on the caseload.
Strong answer: Opens with an occupational profile and what the patient wants to be able to do again, names the standardized assessments they chose and why, and finishes with measurable functional goals that follow from the findings.
Weak answer: Describes a routine set of measurements with no link to the patient’s own goals, or lists activities rather than reasoning.
A patient has made no measurable progress in four weeks. What do you do?
Why ask it: It tests clinical reasoning under real conditions and shows whether the therapist is willing to question their own plan instead of repeating it.
Strong answer: Reassesses, looks for what was missed, changes the approach or the frequency, contacts the referring provider, and is willing to discharge a patient who is not benefiting.
Weak answer: Continues the same plan and attributes the lack of progress entirely to the patient’s motivation or diagnosis.
When do your notes get written, and how often are they same-day?
Why ask it: Documentation timeliness is the most reliable predictor of billing problems at a small practice, and the honest answer is the useful one.
Strong answer: Same-day or point-of-care as the default, with a specific routine for the exceptions and a candid estimate of how often they slip.
Weak answer: Says documentation is never a problem without describing any routine, or gets vague and uncomfortable on the follow-up.
Follow-ups matter more than the question list. The most useful one is some version of what happened next, because it forces a specific outcome instead of a description of good intentions. A second useful probe is asking the candidate what they would do differently, which separates reflection from rehearsal.
Clinical reasoning signals
Starts from what the patient wants to do
Names real assessments and measurable goals
Changes a plan that is not working
Documentation signals
Same-day notes as the default routine
Explains why skilled therapy was needed
Owns a past denial instead of blaming the payer
Communication signals
Looks for the reason behind a refusal
Resets family expectations honestly
Explains the work in plain language
Red flags
Vague about when documentation gets done
Hesitates about license or reference checks
No example of a mistake or a changed plan
The Documentation Questions Owners Skip
A therapist who treats well and documents late costs a small practice real money, because unfinished notes delay claims and thin documentation invites denials. Ask about documentation directly and early, not as an afterthought at the end of the interview.
These questions need no clinical background to score. You are listening for a routine, an understanding of why a note is written the way it is, and ownership of a past problem rather than a story where the payer was always at fault.
Ask
What a strong answer includes
When do your notes get written?
Same-day or point-of-care as the default, with a real routine
Names what the documentation was missing and what changed after
What caseload have you carried?
A specific number tied to a setting, with a reason behind it
What systems have you documented in?
Named systems and actual tasks, not just familiarity
Treat an easy, specific answer here as a strong positive signal. Treat discomfort as a reason to probe rather than to move on, and ask the follow-up: in a normal week, how many notes are still open on Friday afternoon?
Licensure and Credential Verification
Occupational therapists are licensed by the state, so ask about license status in the screening call and then verify every answer yourself before the start date. A license number on a resume is a claim. A board lookup you performed and dated is a verification, and it takes a few minutes.
Ask directly whether a license has ever been disciplined, restricted, denied, or surrendered in any state. It is a fair, job-related question, and it gives the candidate the chance to explain before you find something on a lookup. If your practice bills a federal health program, also search the list of excluded individuals and entities maintained by the HHS Office of Inspector General and keep a dated record of the search.
Verify the license on the state board site
Look the license up yourself on the state board, in every state the candidate says they have practiced. A license number on a resume is a claim, not a verification.
Confirm national board certification
National certification is tied to licensure in most states and is quick to confirm. Ask about any gap in the record and listen to how it is explained.
Check the federal exclusion list
If your practice bills any federal health program, check the excluded-individuals list before the start date and keep a dated record of the search.
Call a clinical supervisor
A former clinical supervisor tells you about documentation habits and caseload reliability. Peer references almost never do. Ask for one by name.
Pair verification with real reference work. A former clinical supervisor will tell you about documentation habits and caseload reliability in a way a peer reference never does, so ask for one by name during the reference check and run any background check under a written policy applied to everyone in the role.
Fair, Legal, and Structured Interviewing
Keep every question tied to the job, ask the same core questions of every candidate, and write down evidence rather than impressions. Those three habits are simultaneously the fair approach, the defensible approach, and the one that produces better hires, which is why they are worth the small amount of extra structure.
The specific trap in a clinical interview is physical ability. Because the work involves transfers, lifting, and long days on your feet, it feels natural to ask whether a candidate has back problems or can lift a given weight. Under the ADA you generally may not ask disability-related questions or require a medical examination before a conditional offer. Ask instead whether the candidate can perform the essential functions of the job, with or without reasonable accommodation, and list those functions in the posting.
Same Questions, Scored on a Rubric, Predict Better Hires
A structured interview, where every candidate answers the same questions scored against a consistent rubric, predicts on-the-job performance more reliably than a free-flowing conversation, and asking the same job-related questions of everyone also keeps you within the EEOC rules against basing decisions on protected characteristics. Structure is both the fairer and the more effective approach.
The rest is discipline about what stays out of the room. Age, family plans, national origin, religion, health conditions, and past workers compensation claims are all off the table, even as small talk, and a review of the usual illegal interview questions before your first interview is time well spent. Consistency also happens to be the simplest way to reduce bias. This is general information, not legal advice.
Occupational Therapist Pay
Occupational therapist pay is set mostly by setting and geography, so use federal data as a floor and adjust to your local market. Skilled nursing and home health typically pay above school-based work, and metropolitan markets pay above rural ones.
Median $100,330 a Year (BLS, May 2025)
According to the Bureau of Labor Statistics Occupational Employment and Wage Statistics survey (May 2025), occupational therapists had a median annual wage of $100,330, about $48.24 an hour. The lowest 10 percent earned around $71,690 and the highest 10 percent around $131,950, with the middle half between $82,510 and $116,670 (U.S. Bureau of Labor Statistics). The occupation held about 160,000 jobs in 2024, with roughly 10,200 openings projected each year through 2034 and growth well above the average for all occupations.
Budget the salary plus payroll taxes, benefits, continuing education, professional liability coverage, and licensure renewal. A tight hiring market at this growth rate also means a slow offer loses candidates, so decide quickly once the scorecards are in. For a mixed rehab team, compare against the physical therapist role you may be hiring alongside it.
Interviewing an OT Without an HR Department
A hospital system interviews occupational therapists through a recruiter, a panel, and a credentialing office. A small clinic interviews through the owner, between patients, usually without anything written down afterward. That difference is where the avoidable mistakes live, and it is fixable with about twenty minutes of preparation.
You can judge the clinical answers, but nobody is checking the rest
Most small practices hiring an occupational therapist are owned by a clinician, so the clinical half of the interview goes fine. The half that gets skipped is everything around it: asking every candidate the same questions, keeping medical and family questions out of the conversation, writing down evidence instead of an impression, and verifying the license before the start date. That is the gap these six sets are built to close. You already know what a good clinical answer sounds like. This gives you a consistent way to record it and a checklist for the parts that are easy to forget when you are between patients.
Two candidates both interviewed well and you cannot separate them
This is the most common outcome of a friendly, unstructured interview at a small practice, and it is why the scorecard is part of the kit rather than an optional extra. Six scored areas with an evidence line each turn a tie into a comparison: one candidate had a real documentation routine, the other did not; one could describe changing a plan that stalled, the other could not. Score independently, right after each interview, before the impressions blur together. If your practice manager also sits in, have them score before either of you talks.
The offer and the first week are where a good hire gets lost
Once you choose a therapist, the work shifts from evaluating to hiring well: a written offer, the new hire paperwork, license and certification records on file, policy acknowledgments, and system access ready before the first patient. Losing a strong candidate to a slow, disorganized offer week happens more often than losing one on pay. FirstHR fits this side of the process for a small practice: send the offer for e-signature, run the onboarding workflow and task checklist, and store the signed documents and credential records on the employee profile. FirstHR is an onboarding and HR platform, not a clinical documentation or billing system, and it does not run payroll, so pair it with those. Applicant tracking is coming soon to FirstHR.
The practical version is short. Print the sets you will use, run the interview the same way for every candidate, score within ten minutes of the candidate leaving, and verify the license before you send anything in writing. Applicant tracking is coming soon to FirstHR, so for now track candidates however you already do and keep the scorecards with them.
Question type
Screening call
Main interview
Licensure and certification status
Setting experience and caseload history
Clinical reasoning and goal writing
Documentation and billing routine
Behavioral questions on patients and families
Front-loading licensure into the screening call is the single highest-value change most practices can make, because a licensing gap that surfaces after two rounds of interviews has already cost you weeks.
From Interview to Onboarding
The interview is step one. Once you choose a therapist, the work shifts to hiring well: a written offer letter, the new hire paperwork, verified credentials on file, and system access ready before the first patient walks in.
Send the offer in writing
Confirm the role, setting, caseload expectation, pay, and start date, with e-signature so there is a clean record on both sides.
File the credentials
Store the verified license, national certification, continuing education record, and renewal dates where you can find them at renewal time.
Set up access before day one
Documentation system, scheduling, and any payer portals ready before the first patient, so the first week is treatment and not setup.
Ramp the caseload deliberately
Start below full caseload, review the first evaluations and notes together, and raise the load once the documentation is clean.
An onboarding template covers the standard first-week items alongside the I-9 and W-4, and a clinical hire adds a few of its own: license and certification copies, continuing education records, professional liability confirmation, and documentation-system training.
FirstHR connects the offer, e-signatures, the paperwork, and the onboarding checklist in one place, and stores the signed documents and credential records on the employee profile, so a small practice can run hiring-to-onboarding from one system instead of a folder and a spreadsheet. FirstHR is an onboarding and HR platform, not a clinical documentation or billing system, and it does not run payroll, so connect those separately. Applicant tracking is coming soon to FirstHR.
Key Takeaways
Assess an occupational therapist on clinical reasoning, setting fit, documentation discipline, communication, and verified licensure.
Every question should carry a reason it is worth asking and a description of what a strong answer sounds like, so scoring stays consistent.
Setting experience predicts ramp speed: outpatient, school-based, home health, skilled nursing, and pediatric practice barely overlap day to day.
Documentation questions need no clinical background and catch the problem that costs a small practice the most money.
Ask about licensure in the screening call, then verify the license, certification, and any discipline yourself before the start date.
Keep medical and disability questions out until after a conditional offer, and ask about essential functions instead.
Score six areas from 1 to 5 with written evidence, independently, right after each interview.
Frequently Asked Questions
What questions should I ask when interviewing an occupational therapist?
Ask across five areas: clinical reasoning, fit for your setting, documentation and billing, communication with patients and families, and licensure. Strong openers include walk me through how you evaluate a new patient from referral to first plan, write me a functional goal out loud for a recent patient, what do you do when a patient has made no measurable progress in four weeks, when do your notes get written and how often are they same-day, and tell me about a family that expected an outcome the patient was not going to reach. Add setting-specific questions, because outpatient, school-based, home health, skilled nursing, and pediatric practice look very different. Every question on this page comes with a stated reason it is worth asking and a description of what a strong answer sounds like, so the interviewer can score consistently.
How do I evaluate an occupational therapist if I am not a clinician?
You can evaluate more than you think, because the reliable signals are structural rather than technical. A strong therapist starts from what the patient wants to be able to do again, names specific assessments rather than categories, gives goals that are measurable and time-bound, and can describe a plan they changed when it was not working. A weaker candidate stays abstract, recites activities instead of reasoning, and blames patients or payers for every past problem. Documentation questions need no clinical background at all: ask when notes get written and how often they are same-day, and listen for a real routine instead of reassurance. If you want an extra check, have a trusted clinician sit in for twenty minutes on the clinical set only, and use the scorecard for the rest.
Does an occupational therapist need a license, and how do I verify it?
Yes. Occupational therapists are licensed at the state level, and requirements are set by each state board rather than nationally, so a therapist moving from another state may need weeks or months before they can treat patients where you practice. National board certification is tied to licensure in most states and is a separate credential worth confirming. Verify both yourself rather than accepting a license number on a resume: look the license up on the state board site for every state the candidate says they have practiced in, confirm certification is current, and ask directly about any disciplinary action before you find it on a lookup. If your practice bills a federal health program, also check the excluded-individuals list before the start date and keep a dated record. This is general information, not legal advice.
What questions are illegal to ask an occupational therapist candidate?
Avoid anything that probes a characteristic protected under federal law, which the EEOC enforces: age, race, color, religion, national origin, sex, pregnancy or family plans, disability, or genetic information. The specific trap in a clinical interview is physical ability. Because the work involves transfers, lifting, and long days on your feet, it feels natural to ask whether someone has back problems or can lift a certain weight. Under the ADA you generally may not ask disability-related questions or require a medical exam before a conditional offer. Ask instead whether the candidate can perform the essential functions of the job, with or without reasonable accommodation, and list those functions in the job description. Medical questions and exams belong after a conditional offer and must apply to everyone in the same role. This is general information, not legal advice.
How much does an occupational therapist cost to hire?
According to the Bureau of Labor Statistics Occupational Employment and Wage Statistics survey (May 2025), occupational therapists had a median annual wage of $100,330, about $48.24 an hour. The lowest 10 percent earned about $71,690 and the highest 10 percent about $131,950, with the middle half between roughly $82,510 and $116,670. Setting and geography move the number substantially: skilled nursing and home health typically pay above school-based work, and metropolitan markets pay above rural ones. Budget the salary plus payroll taxes, benefits, continuing education, professional liability coverage, and licensure renewal. Many small practices also use contract or per-visit therapists to cover peaks, which costs more per hour but carries no benefits load. Benchmark to your local market and setting rather than to the national median alone.
Should I hire an occupational therapist or an occupational therapy assistant?
It depends on what the caseload needs and what your state allows. An occupational therapist evaluates patients, writes and modifies the plan of care, and is responsible for clinical decisions. An occupational therapy assistant delivers treatment under that plan and under the therapist supervision your state and payers require, at a lower pay rate. A practice that needs evaluations, plan changes, and discharge decisions needs a therapist. A practice with a stable caseload and a therapist already in place can often add treatment capacity more affordably with an assistant. Supervision rules are specific, vary by state and payer, and are the therapist responsibility, so ask any therapist candidate how they supervise and delegate before you build a team around that model. This is general information, not legal advice.
How long should an occupational therapist interview be?
Plan 45 to 60 minutes for the main interview, plus a short screening call first and a site visit for finalists. That is enough time for the clinical reasoning set, the block of setting-specific questions that matches your practice, the documentation questions, and two or three behavioral questions about patients and families, with room for the candidate to ask their own. Do not try to ask every question in the kit. Depth beats breadth, and the follow-up on a strong question tells you more than three more questions would. Bringing finalists in to see the clinic and meet the team is worth the extra hour, because setting fit is a large part of whether the hire works. Score immediately afterward while the answers are fresh.
What are red flags in an occupational therapist interview?
The clearest red flags are vagueness about documentation, an inability to describe a plan they changed, and reluctance about verification. A candidate who cannot walk through an evaluation or write a goal out loud is showing you a real gap, not nerves. A candidate who says documentation is never a problem but cannot describe any routine usually has late notes. Blaming payers, patients, or families for every past difficulty predicts how they will talk about your practice. Hesitation about license verification, background checks, or a clinical supervisor as a reference is worth pausing on. Agreeing instantly to any caseload number without asking a single question about scheduling or support is a quieter warning sign, because it usually means the number will not hold.
