Skill Checklists
Speech Language Pathologist
Name
Email
LAST 4 OF SSN
This checklist was electronically signed on (Today’s date)
Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.
Proficiency Scale:
1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
Acute care
Children’s hospital
Daily treatment center
Home health care
Inpatient acute rehab
Neonatal intensive care
Outpatient/outpatient community re-entry
Pediatrics
Psychiatric hospital
Private practice
School setting
Early intervention
Skilled nursing facility
Geriatrics
Hearing impaired
Learning disabilities
Pediatrics/school age
Progressive neurologic disease
Trachs/ventilators
Transient Ischemic Attach (TIA)
Traumatic brain injury
Voice/laryngectomy
Boston assessment of severe aphasia
Boston diagnostic aphasia examination
Minnesota test for differential diagnosis of aphasia
Informal testing
Porch index of communicative abilities
Reading comprehension battery for aphasia
Ross information processing assessment-geriatric
Western aphasia battery
Bedside swallow evaluation
Blue dye test
Cervical auscultation
Fiber endoscopic evaluation study
Modified barium swallow study
Rehab Institute of Chicago evaluation of communication
Augmentative devices
Pure tone screening
Aphasia
Apraxia
Autism
Cleft palate
CVA/stroke
Fluency
Dementia/alzheimers
Dysarthria
Dysphagia
Hearing loss
Behavior modification
Cognitive training
Community re-entry
Computer
Co-treatment
Group
Individual
Safety awareness
Total communication
Vital stimulation
Dysphagia across the age-spectrum
FIMS
Medi-Cal
Medicare
Omnibus budget reconciliation
RUG levels
Patient/family teaching
Patients in isolation
Patients in restraints
Initial evaluation
Lift/transfer devices
Specialty beds
End of life care/palliative care
COMPUTERIZED CHARTING:
Cerner
EPIC
McKesson
Meditech
NATIONAL PATIENT SAFETY GOALS:
Accurate patient identification
Effective communication
Pain assessment & management
Infection control
Universal precautions
Care of patients in isolation
Minimize risk of falls
Prevention of pressure ulcers
Infant (birth to 1 year)
Toddler (ages 1-3 years)
Preschooler (ages 3-5 years)
Childhood (ages 6-12 years)
Adolescents (ages 12-21 years)
Young Adults (ages 21-39 years)
Adults (ages 40-64 years)
Older Adults (ages 65-79 years)
Elderly (ages 80+ years)
I hereby certify that ALL information I have provided on this skills checklist and all other documentation is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.
