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Audiology Assistant Competency Checklist
Audiology Assistant Competency Checklist
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Supervisor Information
This may only be completed by the Board approved supervising Audiologist, this form may not be completed by another Audiologist, the Audiology Assistant, or Office Staff.
Primary Supervisor
*
Mr.
Mrs.
Miss
Ms.
Dr.
Mx.
Prefix
First
Middle
Last
NC License Number
*
Assistant Information
Name
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Middle
Last
NC Registration Number
*
Instructions
The primary supervising audiologist will complete this competency and orientation document during the first sixty (60) days of employment and forward the signed, original copy to the Board of Examiner’s (the Board) office within 30 days of completion. A new competency assessment and orientation must be completed whenever the licensee who registers the assistant changes.
Qualifications and Employment Overview
The audiology assistant has completed an approved course of study acceptable to the Board, is currently registered with the Board, and is in good standing as an audiology assistant.
*
Meets standard
Does not meet standard
The audiology assistant has completed an employment orientation at all sites where audiology services will be delivered by the assistant.
*
Meets standard
Does not meet standard
The audiology assistant knows and understands the approved rules for audiology assistants, specifically Administrative Code 21 NCAC 64 .1101 – Administrative Code 21 NCAC 64 .1105.
*
Meets standard
Does not meet standard
The supervising audiologist has informed the Audiology Assistant of the overall scope of their duties and responsibilities in the specific employment context.
*
Meets standard
Does not meet standard
Direct Services to Patients/Clients
The audiology assistant conducts themself in a courteous and appropriate manner in all communication and interaction with clients/patients, families, caregivers, and other staff
*
Meets standard
Does not meet standard
The audiology assistant identifies themself as a audiology assistant when greeting client and/or family.
*
Meets standard
Does not meet standard
The audiology assistant wears a name tag at all times which identifies themself as an assistant.
*
Meets standard
Does not meet standard
The audiology assistant provides instructions and/or explanations of treatment to the patient/client which are clear and complete, and are appropriate for the patient/client’s developmental level, language use, communication disorder, and level of understanding.
*
Meets standard
Does not meet standard
The audiology assistant has been instructed in the proper administration of the screening instruments/tests which will be used in the employment setting(s) and accurately administers these screening instruments, as prescribed by the supervising audiologist.
*
Meets standard
Does not meet standard
The audiology assistant prepares treatment/screening materials before the beginning of each treatment/screening session, as directed by the supervising audiologist, assuring that such materials are appropriate to the patient/ client’s age, developmental level, culture, and communication disorder.
*
Meets standard
Does not meet standard
The audiology assistant starts and ends treatment sessions on time and follows the written treatment protocol developed and prescribed by the supervising audiologist.
*
Meets standard
Does not meet standard
Health and Safety Standard
The audiology assistant utilizes universal precautions and adheres to the infection control procedures and guidelines of the employer(s).
*
Meets standard
Does not meet standard
The audiology assistant will use appropriate procedures for the physical management of patients/clients and any necessary injury prevention strategies consistent with the employer’s policies and with state regulation.
*
Meets standard
Does not meet standard
Summary
Were there any unmet standards?
*
Yes
No
Action plans for unmet standards
Signature of Audiology Assistant
*
Registration Number
*
Date
*
Month
Day
Year
Signature of Primary Supervising Licensee
*
License Number
*
Date
*
Month
Day
Year
Email print version of completed form
Would you like a PDF version of this completed form emailed to you?
*
Yes
No
Email (for PDF delivery)
*
Please enter an email address to receive a copy of this completed form.
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Audiology Assistant Competency Checklist
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