Speech Language Pathologist

Adaptive Equipment

Speech Therapy Experience

Assessments*

1
2
3
4

Augmentative Communication*

1
2
3
4

Computer-based Treatment/Adaptive Microswitches*

1
2
3
4

Speech/Language/Hearing Disabilities

Speech Therapy Experience

Feeding Disorders*

1
2
3
4

Cleft Palate*

1
2
3
4

Cognitive Rehab*

1
2
3
4

Coma Stimulation*

1
2
3
4

CVA/Stroke Rehab*

1
2
3
4

Dysphagia*

1
2
3
4

Fluency/Stuttering*

1
2
3
4

Head Injury*

1
2
3
4

Hearing Impaired*

1
2
3
4

Laryngectomy*

1
2
3
4

Neurological*

1
2
3
4

Voice*

1
2
3
4

Pediatrics

Speech Therapy Experience

Cerebral Palsy*

1
2
3
4

Early Intervention*

1
2
3
4

Mental Retardation*

1
2
3
4

Learning Language Disabilities*

1
2
3
4

NDT for Speech*

1
2
3
4

Other Skills

Speech Therapy Experience

Accent Reduction*

1
2
3
4

Aural Rehabilitation/Speech Reading*

1
2
3
4

Biofeedback-EMG*

1
2
3
4

Cognitive Assessment*

1
2
3
4

Co-Treatment with OT*

1
2
3
4

Co-Treatment with PT*

1
2
3
4

Family Education*

1
2
3
4

Group Activities*

1
2
3
4

In-service Education*

1
2
3
4

Myofunctional Therapies*

1
2
3
4

Prosthetics-Cleft Palate*

1
2
3
4

Rehab Feeding Group*

1
2
3
4

Sign Language*

1
2
3
4

Tracheostomy*

1
2
3
4

Ventilator*

1
2
3
4

Videofluoroscopy*

1
2
3
4

FEEST*

1
2
3
4

Age Groups

Age-Appropriate Care: Ability to adapt care to incorporate normal growth and development, adapt method and terminology of client instructions as it relates to the age and comprehension level of the client, and to ensure a safe environment - reflecting specific needs of the client and various age groups.

Newborn (birth-30 days)*

1
2
3
4

Infant (30 days-1 year)*

1
2
3
4

Toddler (1-3 years)*

1
2
3
4

Preschooler (3-5 years)*

1
2
3
4

School Age (5-12 years)*

1
2
3
4

Adolescents (12-18 years)*

1
2
3
4

Young Adults (18-39 years)*

1
2
3
4

Middle Adults (39-64 years)*

1
2
3
4

Older Adults (64+ years)*

1
2
3
4

I certify that the information provided above accurately reflects education received and my experience in each of the clinical areas identified within the last 2 years.

The information I have given is true and accurate to the best of my knowledge, and I hereby authorize Magnet Medical to release this Skills Checklist to staffing clients of Magnet Medical. Submit this skills evaluation with your initial application. To be updated annually.

Name*

First Last

Email*

Signature

Date*

skills checklist