SPEECH-LANGUAGE PATHOLOGIST SKILLS CHECKLIST

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* - Required Fields

* First Name:      * Last Name:      * Date:   (mm/dd/yyyy)

Job Description: Speech and Language Pathologist Diagnoses and treats speech and language problems, and engages in scientific study of human communication. Evaluates speech and language skills as related to educational, medical, social, and psychological factors. Plans, directs, or conducts rehabilitative treatment programs to restore communicative efficiency of individuals with communication problems of organic and nonorganic etiology. Requires a master's degree in speech-language pathology and may require a certificate of clinical competence in speech-language pathology (CCC). Expected to meet certain state licensing requirements. Familiar with standard concepts, practices, and procedures within a particular field. Typically reports to a manager or director.

Please Check Work Settings:
Acute Care
Community Re-Entry
Home Health
Outpatient Clinic
Pediatric Rehab
Psychiatric
Rehab Hospital
Rehab Unit in Hospital
School System
Skilled Nursing Facility

KEY: For each criteria Score 1: Two plus years Expert Experience Score 2: One-Two Years Current Experience Score 3: Less than one year or Intermittent Experience Score 4: Theory, no experience

CRITERIA	SCORE
	1 2 3 4
Adaptive Equipment
Assessment
Augmentative Communication
Computer-Based Treatment
Adaptive Microswitches
Pediatrics
Cerebral Palsy
Early Intervention
Learning Language Disabilities
Mental Retardation
NDT Speech
Speech/Language/Hearing Disabilities
Cleft Palate
Cognitive Rehab
Coma Stimulation
CVA/Stroke Rehab
Fluency/Stuttering
Head Injury
Hearing Impaired
Laryngectomy
Neurological
Voice
Other Skills
Accent Reduction
Aural Rehabilitation/Speech Reading
Biofeedback - EMG
Cognitive Assessment
Co-Treatment with Occupational Therapy
Co-Treatment with Physical Therapy
Family Education
Group Activities
In Service Education
Myofunctional Therapy
Prosthetics - Cleft Palate
Rehab Feeding Group
Sign Language
Tracheostomy
Ventilator
Videofluoroscopy
FEEST

AGE SPECIFIC CARE
Please indicate the frequency with which you provide care for each age group inthis specialty area.	1	2	3	4
Infant (Birth to 1 year)
Toddler (1-3 years)
Pre-school (3-6 years)
School Age (6-12 years)
Adolescent ( 12-18 years)
Young Adult ( 18-30 years)
Mature Adult (30-60 years)
Elderly (>60 years)

JCAHO: I acknowledge and understand JCAHO's list of "Do Not Use Abbreviations" : Yes No

The information I have given is true and accurate to the best of my knowledge. I have read and fully understand the job description. By signing below or submitting electronically, I attest that the information provided within this skills checklist represents a full and complete disclosure of information, and is true and correct to the best of my knowledge and belief. I hereby authorize Sagent Healthstaff to release this skills checklist to client facilities for employment purposes.

* I agree with the above statements. : Yes

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* Date: (mm/dd/yyyy) :