Speech Language Pathologist Assistant Skills Checklist

Requested by:

Requested by email:

Today's Date: * +

First Name: *

Last Name: *

Mobile Phone Number: *

Email Address: *

Confirm email: *

GENERAL SKILLS EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Supervisor experience	123
National Patient Safety Goals/Core Measures	123
Awareness of HCAHPS	123
Accurate patient identification	123
Demonstrates knowledge of anatomy	123
Use proper body mechanics	123
Use of transfer/lifting devices	123
Infection control	123
Universal precautions	123
Isolation precautions	123
Minimize fall risks	123
Crash cart	123
Defibrillator	123
Care of patient in restraints	123
Obtain vital signs	123
Patient/Family education	123
Ensures HIPAA compliance	123

SCREENING & ASSESSMENT SKILLS:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Implementing screening procedures as directed by SLP	123
Assist with collecting comprehensive case history information and assessment	123
Assist with administration and scoring of assessments according to state and employer regulations	123

PEDIATRICS:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Cerebral Palsy	123
Early Intervention	123
Learning Language Disabilities	123
Intellectual and Developmental Disabilities	123
NDT for Speech	123

SPPECH, LANGUAGE, & HEARING DISABILITIES:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Feeding Disorders	123
Cleft Palate	123
Cognitive Rehab	123
Coma Stimulation	123
CVA / Stroke Rehab	123
Dysphagia	123
Fluency / Stuttering	123
Head Injury	123
Hearing Impaired	123
Laryngectomy	123
Neurological	123
Voice	123

DATA MANAGEMENT, RECORD KEEPING, & EMR EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Epic Computerized charting	123
Cerner	123
Meditech	123
McKesson	123
Other computerized charting platforms	123

COMMUNICATION & INTERPERSONAL SKILLS:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Effective communication with other healthcare professionals	123
Effective communication with patients	123

OTHER SKILLS:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Assist with Accent Reduction	123
Assist with Aural Rehabilitation / Speech Reading	123
Assist with Biofeedback-EMG	123
Assist with Cognitive Assessment	123
Co-Treatment with OT	123
Co-Treatment with PT	123
Assist with Group Activities	123
Prosthetics- Cleft Palate	123
Rehab Feeding Group	123
Sign Language	123
Tracheostomy	123
Ventilator	123
Video Fluoroscopy	123
FEEST	123
Electronic Documentation	123

BASIC MEDICAL KNOWLEDGE:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Medical terminology and abbreviations	123
Patient Safety	123

PROBLEM-SOLVING, CRITICAL THINKING, ETHICAL & PROFESSIONAL CONDUCT:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Ability to identify and troubleshoot common issues that may arise	123
Decision-making ability based on protocols and guidelines	123
Maintain patient confidentiality and adhere to ethical standards	123
Follow professional codes of conduct	123

WORK SETTING:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Inpatient Hospital	123
Outpatient	123
Small Facility	123
Large/Regional Teaching Facility	123
Clinic setting	123
Skilled Nursing Facility	123
Acute Care	123
Rehab Care	123
Home Health	123
Schools	123

AGE-SPECIFIC EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *

Newborn / neonate (birth-30 days)	123
Infant (31 days-1 year)	123
Toddler (ages 2-3 years)	123
Preschool (ages 4-5 years)	123
School age (ages 6-12 years)	123
Adolescent (ages 13-21 years)	123
Young adult (ages 22-39 years)	123
Adult (ages 40-64 years)	123
Older adult (ages 65-79 years)	123
Elderly (ages 80+ years)	123

Attestation

ATTESTATION: *

I certify that the information provide above accurately reflects my experience in each of the clinical areas identified within the past three years.

If you agree with the Attestation above, please electronically sign your name. *