Skills Checklist:
Speech Language Pathologist

Skills Checklist - Speech Language Pathologist

Cerebral Palsy*

Early Intervention*

Learning Language Disabilities*

Mental Retardation*

NDT for Speech*

This self-evaluation is for assessing your experience in specific clinical areas. This self-evaluation will not be a determining factor in accepting your application to become an employee of Connected Health Care.

0 = Not Applicable
1 = No Experience
2 = Some Experience
3 = Intermittent Experience
4 = Experienced
5 = Very Experienced

SETTING:(Required)

ADAPTIVE EQUIPMENT(Required)

SPEECH / LANGUAGE / HEARING DISABILITIES(Required)

PEDIATRICS(Required)

OTHER SKILLS(Required)

	0	1	2	3	4	5
Accent Reduction*
Aural Rehabilitation / Speech Reading*
Biofeedback-EMG*
Cognitive Assessment*
Co-Treatment with OT*
Co-Treatment with PT*
Family Education*
Group Activities*
In-service Education*
Myofunctional Therapies*
Prosthetics- Cleft Palate*
Rehab Feeding Group*
Sign Language*
Tracheostomy*
Ventilator*
Videofluoroscopy*
FEEST*
Electronic Documentation*
Newborn/ Neonate (birth to days)*
Infant ( month to year)*
Toddler ( year to years)*
Preschooler ( years to years)*
School Age Child ( years to years)*
Adolescents ( years to 8 years)*
Young Adults (8 years to 9 years)*
Middle Adults (9 years to 6 years)*
Older Adults (6 years to 79 years)*
Elderly Adults (over 79+ years)*

Name

First Last

Date

Specialty

By Signing this, I am authorizing that the information I have given is true and accurate to the best of my knowledge. I hereby authorize Connected Health Care to release this Skills Checklist to staffing clients of Connected Health Care. Submit this skills evaluation with your initial application.

Signature(Required)

	0	1	2	3	4	5
Acute*
Rehab*
Inpatient*
Outpatient*
Home Health*
SNF*
Schools*

	0	1	2	3	4	5
Feeding Disorders*
Cleft Palate*
Cognitive Rehab*
Coma Stimulation*
CVA / Stroke Rehab*
Dysphagia*
Fluency / Stuttering*
Head Injury*
Hearing Impaired*
Laryngectomy*
Neurological*
Voice*