Speech Therapist Initial Competency

Name(Required)

Date of Hire(Required)

Date Completed(Required)

Demonstrates ability to process paperwork and associated tasks related to:

1) Self-Assessment

1. Initial Evaluation

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

2) Self-Assessment

2. OASIS Documentation

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

3) Self-Assessment

3.Care coordination/discharge planning

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

4) Self-Assessment

4. Transfer of patient

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

5) Self-Assessment

5. Documentation

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

6) Self-Assessment

6. Other

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

Assessment/Evaluation:

1) Self-Assessment

1. Mental Status/Cognition/Communication

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

2) Self-Assessment

2. Verbal/non-verbal expression

Eval Method

Competent

Preceptor Initials(Required)

3) Self-Assessment

3.Graphic expression

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

4) Self-Assessment

4. Auditory comprehension

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

5) Self-Assessment

5. Reading comprehension

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

6) Self-Assessment

6.Visual comprehension

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

7) Self-Assessment

7. Speech intelligibility

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

8) Self-Assessment

8. Voice

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

9) Self-Assessment

9. Prosody

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

10) Self-Assessment

10.Oral/motor functions

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

11) Self-Assessment

11. Functional skills

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

12) Self-Assessment

12. Environment evaluation / barriers

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

13) Self-Assessment

13. Equipment/assistive device needs

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

14) Self-Assessment

14. Other

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

Skilled Treatments/Interventions:

1) Self-Assessment

1.Therapeutic activities

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

2) Self-Assessment

2.Speech articulation disorders

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

3) Self-Assessment

3. Language disorders

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

4) Self-Assessment

4. Non-verbal communication

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

5) Self-Assessment

5. Language processing

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

6) Self-Assessment

6. Therapy to increase articulation, proficiency, verbal expression

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

7) Self-Assessment

7. Dysphagia instruction/treatments

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

8) Self-Assessment

8. Develop/teach communication system

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

9) Self-Assessment

9. Voice disorders

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

10) Self-Assessment

10. Aural rehabilitation

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

11) Self-Assessment

11. Alaryngeal speech skills

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

12) Self-Assessment

12. Food texture recommendations

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

13) Self-Assessment

13.Swallow/vocal skills exercises

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

14) Self-Assessment

14. Care of voice prosthesis

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

15) Self-Assessment

15.Tracheostomy care/management education

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

16) Self-Assessment

16. Pain assessment/management

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

17) Self-Assessment

17. Safety/fall prevention

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

18) Self-Assessment

18.Miscellaneous Skills

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

19) Self-Assessment

19. Other

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

Use of Equipment/Modalities:

1) Self-Assessment

1. NMES

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

2) Self-Assessment

2. Other

Eval Method

Infection Control

1) Self-Assessment

1. Hand hygiene technique

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

2) Self-Assessment

2. Proper bag technique

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

3) Self-Assessment

3. Personal protective equipment

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

4) Self-Assessment

4. Exposure control plan

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

5) Self-Assessment

5. TB exposure control plan

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

6) Self-Assessment

6. Reporting of infections for patient and personnel

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

7) Self-Assessment

7. Standard precautions

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

Safety

1) Self-Assessment

1. Assessment of patient safety risks and home safety

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

2) Self-Assessment

2. Emergency preparedness

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

3) Self-Assessment

3. Fire extinguishers

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

4) Self-Assessment

4. Hazardous materials

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

Patient Education

1) Self-Assessment

1. Determines patient / family learning needs

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

2) Self-Assessment

2. Sets measurable objectives

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

3) Self-Assessment

3. Develops/implements teaching plan

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

4) Self-Assessment

4. Evaluates effectiveness of teaching

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

5) Self-Assessment

5. Revises teaching plan based on patient needs

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)

6) Self-Assessment

6. Documents response to teaching

Eval Method

Competent

Preceptor Initials(Required)

Date(Required)