Speech Language Pathologist Skills Checklist

  • LEVELS OF EXPERIENCE:
    Use the following values to rate your level of experience and/or frequency within the last two years.

    1=No Experience
    2=Limited Experience/Supervision or Support
    3=Experience/Needs Minimal Support
    4=Proficient Independently
  • Work Settings
  • 1234
    Acute Care Hospital
    Rehab Hospital/Sub-Acute
    Extended Care Facility
    Assisted Living
    Skilled Nursing Facility
  • 1234
    Hospital Outpatient
    Outpatient Clinic
    Home Helathcare
    School Setting
    Pediatrics
  • Evaluation
  • 1234
    ALPS
    CADL
    PICA
    Oral Peripheral Exam
    CELF
    FEES
  • 1234
    Minnesota (Schuell)
    Western Aphasia Battery (WAB)
    Hearing Screen
    Preschool Language Scale (PLS-4)
    Modified Barium Swallow
  • Interventional Approaches
  • 1234
    Dysphagia Management
    Phonological Process Treatment
    Cognitive Impairment Management
    Augmentative Communication
  • 1234
    Voice/Resonance Therapy
    Langauge Disorder Management
    Aural Rehibilitation
  • Neurologic Disorders
  • 1234
    Amyotrophoc Lateral Sclerosis (ALS)
    Brain Injury
    CVA
    Dysphagia-General
    Dyshapgia-Ventilator Dependent
    Hearing Impairment
    Voice Disorder
  • 1234
    Alzheimer's Disease
    Cognitive Impariment
    Dysarthria
    Dysphagia-Trach
    Fluency
    Parkinson's Disease
  • Pediatric Disorder
  • 1234
    Articulation
    Brain Injury
    Cleft Palate
    Fluency
    Language Disorders
  • 1234
    Autism
    Cognitive Impairment
    Feeding Disorder
    Hearing Impaired
  • Billing/Documentation
  • 1234
    RUG Levels
    Medicare Part B
    OASIS
  • 1234
    Medicare Part A
    Medicaid/Medical
  • Professional Knowledge and Skills
  • 1234
    Management Experience
    national Patient Safety Goals
    Infection Prevention
  • 1234
    Screening/Adding Caseload
    Age Specific Care
  • Certifications
  • Date Taken
  • Date Taken
  • Date Taken
  • Exp. Date
  • Exp. Date
  • Exp. Date