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SPEECH LANGUAGE PATHOLOGIST SKILLS CHECKLIST
 
The following checklist is used to assess your experience and skills in order to assist us in placing you in a successful assignment. Please provide an accurate self-assessment of your skills using the following guidelines:
Frequency
Experience
  1. Never Done or Observed Only
  2. Rarely Done (less than 6 times/year)
  3. Occasionally Done (1-2 times/month)
  4. Frequently Done (daily or weekly)
  1. No Experience
  2. Limited Experience
  3. Experienced
  4. Highly Skilled
 
Contact Information      
Name:
Home Phone:
Cell Phone:
Email:
                 
 
Frequency
Experience
General Skills
1
2
3
4
1
2
3
4
Electronic Documentation  
Home Health Documentation  
Medicare Documentation  
Patient/Family Education  
Patients in Isolation  
Patients in Restraints  
                   
Assessment Tools & Treatment Techniques
1
2
3
4
1
2
3
4
Bedside Swallow Evaluation  
Boston Assessment of Severe Aphasia  
Boston Diagnostic Aphasia Examination  
CADL (Communication Ability for Daily Living)  
Cognitive Training  
Co-Treatment with OT  
Co-Treatment with PT  
F.E.E.S. (Fiber Endoscopic Evaluation Study)  
Group  
Individual  
Minnesota Test for Differential Diagnosis of Aphasia  
Modified Barium Swallow Study  
PICA (Porch Index of Communicative Abilities)  
Pure Tone Screening  
Rehab Institute of Chicago Evaluation of Communication  
Ross Information Processing Assessment-Geriatric  
Safety Awareness  
Thermal Stimulation  
Thickening Agents  
Vital Stimulation  
Western Aphasia Battery  
                   
Adaptive Equipment                  
Augmentative/Alternative  
Communication Board  
Communication Devices  
Feeding Equipment  
Memory Aide  
                   
Types of Disabilities
1
2
3
4
1
2
3
4
Aphasia  
Apraxia  
Autism  
Cleft Palate  
Obturators
  
Palatal Lifts
  

Prosthetic Devices

  
Dementia/Alzheimers  
Dysarthria  
Dysphagia  

Compensatory Techniques

  

Laryngectomy

  

Tracheotomy

  

Ventilator Dependent/Assisted

  
Fluency/Stuttering  
Head Injury  
Hearing Impaired  
Learning Disabilities  
Progressive Neurological Disease  
Traumatic Brain Injury  
Stroke/CVA/Rehab  
                   
Settings                  
Community Re-Entry  
Day Treatment Center  
Early Intervention  
General Acute Care  
Home Health  
Inpatient Acute Rehab  
School System  
Outpatient Clinic  
Pediatric Rehab  
Private Practice  
Psychiatric  
Skilled Nursing Facility  
                   
Age                  
Newborn (birth – 30 days)  
Infant (30 days – 1 year)  
Toddler (1 – 3 years)  
Preschooler (3 – 5 years)  
School Age (5 – 12 years)  
Adolescents (12 – 18 years)  
Young Adults (18 – 39 years)  
Middle Adults (39 – 64 years)  
Older Adults (64+ years)  
                   
Additional Skills                  
                 
                 
                   
Additional Training                  
                 
                 
                   
Additional Tools & Equipment                  
                 
                 
                   

The information I have given is true and accurate to the best of my knowledge, and I hereby authorize Next Medical Staffing to release this Skills Checklist and any supporting information to staffing clients of Next Medical Staffing.
                 

 

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