SLP

SLP Skills Checklist
Answer Key:

1. No Experience

2. Limited Experience

3. Experienced

4. Very Experienced

Settings

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Acute
Rehab
Inpatient
Outpatient
Home Health
SNF
Schools

Adaptive Equipment

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Assessments
Augmentative Communication
Computer-based Treatment/Adaptive Microswitches

Speech / Language / Hearing Disabilities

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Feeding Disorders
Cleft Palate
Cognitive Rehab
Coma Stimulation
CVA / Stroke Rehab
Dysphagia
Fluency / Stuttering
Head Injury
Hearing Impaired
Laryngectomy
Neurological
Voice

Pediatrics

Rows	1	2	3	4
Cerebral Palsy
Early Intervention
Learning Language Disabilities
Intellectual/Developmental Disabilities
NDT for Speech

Other Skills

Rows	1	2	3	4
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

Age

Rows	1	2	3	4
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)

I attest that this checklist represents a true reflection of my experience to the best of my knowledge. By electronically signing this form I give my permission for it to be shared with facilities as a way to assess my skill level and be considered for employment opportunities.
Digital Signature
Phone Number

Area CodePhone Number
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: