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SCHOOLS
TELEPRACTICE

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Employees
Employers
Contact
Blog

HEALTHCARE
- Nursing
- Therapy
SCHOOLS
TELEPRACTICE

SLP/CFY/SLPA Skills Checklist

Please rate your experience / frequency within the last year
0 = No Experience / Observed Only
1 = Limited Experience / Rarely Done (<6 times/year)
2 = May Need Some Review / Occasionally Done (1-2 times/month)
3 = Experienced / Frequently Done (daily or weekly)

Please rate your experience / frequency within the last year

0 = No Experience / Observed Only

1 = Limited Experience / Rarely Done (<6 times/year)

2 = May Need Some Review / Occasionally Done (1-2 times/month)

3 = Experienced / Frequently Done (daily or weekly)

"*" indicates required fields

Please rate your experience / frequency within the last year
0 = No Experience / Observed Only
1 = Limited Experience / Rarely Done (<6 times/year)
2 = May Need Some Review / Occasionally Done (1-2 times/month)
3 = Experienced / Frequently Done (daily or weekly)

Full Name*

Email*

Todays Date*

MM slash DD slash YYYY

Age Of Patients Cared For

Newborn/Neonate (birth to 30 days)

0

1

2

3

Infant (31 days to 12 months)

0

1

2

3

Toddler/Preschool (13 months to 5 years)

0

1

2

3

School Age Child/adolescent (6 years to 18 years)

0

1

2

3

Young Adults Middle Adult (19 years to 64 years)

0

1

2

3

Older Adults/Elderly (65+ years)

0

1

2

3

General Skills

Electronic Documentation

Allscripts

Care360

Cerner

eCLinicalWorks

EPIC

MACLAB

McKesson

Meditech

PACS

Soarian

N/A

Other Electronic Documentation:

Universal Precautions

0

1

2

3

Working with patients in isolation

0

1

2

3

Working with patients in restraints

0

1

2

3

Patient/Family teaching

0

1

2

3

Patient Identification

0

1

2

3

Specialty beds

0

1

2

3

End of life care/palliative care

0

1

2

3

Knowledge of "Do Not Use Abbreviations"

0

1

2

3

Do you have charge/supervisor experience?

Yes

No

Knowledge of current Joint Commission National Patient Safety Goals

0

1

2

3

Knowledge/familiarity with HCAHPS scores

0

1

2

3

Settings

Acute Care/ Hospital

0

1

2

3

Rehabilitation - Acute

0

1

2

3

Rehabilitation - Long Term

0

1

2

3

Home Health

0

1

2

3

Outpatient

0

1

2

3

Day Treatment Centers

0

1

2

3

Skilled Nursing Facility

0

1

2

3

Physician's Office

0

1

2

3

Early Intervention

0

1

2

3

Patient Populations/disorders

Alzheimer's

0

1

2

3

Amyotrophic Lateral Sclerosis ( ALS)

0

1

2

3

Anoxia

0

1

2

3

Aphasia

0

1

2

3

Apraxia

0

1

2

3

Autism

0

1

2

3

Adult Mental Retardation ( Mild-Moderate)

0

1

2

3

Adult Mental Retardation ( Severe-Profound)

0

1

2

3

Pediatric Mental retardation ( Mild-Moderate)

0

1

2

3

Pediatric Mental Retardation ( Severe-Profound)

0

1

2

3

Brain Injury

0

1

2

3

Cleft Palate

0

1

2

3

Coma Stimulation

0

1

2

3

Cognitive Impairment

0

1

2

3

CVA

0

1

2

3

Dysarthria

0

1

2

3

Feeding Disorders

0

1

2

3

Fluency

0

1

2

3

Hearing Impairment

0

1

2

3

Head Trauma

0

1

2

3

Learning disabilities/Early Intervention

0

1

2

3

Laryngectomy

0

1

2

3

Muscular Dystrophy

0

1

2

3

Multiple Sclerosis

0

1

2

3

Parkinson's Disease

0

1

2

3

Progressive Neurological Disease

0

1

2

3

TIA

0

1

2

3

Trachs

0

1

2

3

Ventilator Dependent patients

0

1

2

3

Assessment

Aphasia Language Performance Scale

0

1

2

3

Augmentative Devices

0

1

2

3

Bedside Swallow Testing

0

1

2

3

Boston

0

1

2

3

Blue Dye Test

0

1

2

3

Cervical Auscultation

0

1

2

3

CADL ( Communication Ability for Daily Living)

0

1

2

3

Detroit

0

1

2

3

FEES ( Flexible Endoscopic Evaluation of Swallowing)

0

1

2

3

Fiber optic Voice Evaluation

0

1

2

3

Modified Barium Swallow Study

0

1

2

3

Minnesota (Schuell)

0

1

2

3

PICA ( Porch Index of Communication Ability)

0

1

2

3

Pure Tone Screening

0

1

2

3

Reading comprehension battery for aphasia

0

1

2

3

Ross information processing assessment - geriatric

0

1

2

3

Rossetti Infant-Toddler Language Scale

0

1

2

3

Rehabilitation Institute of Chicago evaluation of communication

0

1

2

3

Western Aphasia Battery

0

1

2

3

Treatment

Individual

0

1

2

3

Co-Treatment

0

1

2

3

Cognitive Training

0

1

2

3

Community Re-Entry

0

1

2

3

Computer

0

1

2

3

Group

0

1

2

3

Dysphagia management

0

1

2

3

Feeding Equipment

0

1

2

3

Memory Aids

0

1

2

3

Safety Awareness

0

1

2

3

Total Communication

0

1

2

3

Vital Stimulation

0

1

2

3

Regulations/documentation

FIMS

0

1

2

3

Home Health Documentation

0

1

2

3

Medi-Cal

0

1

2

3

Medicare

0

1

2

3

Omnibus budget reconciliation

0

1

2

3

RUG levels

0

1

2

3

awards updated 2022

SIA_CM_Member_2018

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