SLP-Assistant Competency Checklist

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Supervisor Information

THIS MAY ONLY BE COMPLETED BY THE BOARD APPROVED SUPERVISING SLP, THIS FORM MAY NOT BE COMPLETED BY ANOTHER SLP, THE SLP-ASSISTANT, OR OFFICE STAFF.

Primary Supervisor*

Prefix First Middle Last

NC License Number*

Assistant Information

Name*

Prefix First Middle Last

NC Registration Number*

Instructions

The primary supervising speech-language pathologist will complete this competency and orientation document during the first sixty (60) days of employment. A new competency assessment and orientation must be completed whenever the licensee who registers the assistant changes.

Qualifications and Employment Overview

The speech-language pathology assistant has completed an approved course of study acceptable to the Board, is currently registered with the Board, and is in good standing as a speech-language pathology assistant.*

Meets standard

Does not meet standard

The speech-language pathology assistant has completed an employment orientation at all sites where speech-language services will be delivered by the assistant.*

Meets standard

Does not meet standard

The speech-language pathology assistant knows and understands the approved rules for SLP-assistants, specifically Attachment 1 (Summary of Authorized Tasks and Supervision Requirements for SLP-Assistants).*

Meets standard

Does not meet standard

The supervising speech-language pathologist has informed the SLP-Assistant of the overall scope of his/her duties and responsibilities in the specific employment context.*

Meets standard

Does not meet standard

Direct Services to Patients/Clients

The speech-language pathology assistant conducts self 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 speech-language pathology assistant identifies self as a speech-language pathology assistant when greeting client and/or family.*

Meets standard

Does not meet standard

The speech-language pathology assistant wears a name tag at all times which identifies him/her as an assistant.*

Meets standard

Does not meet standard

The speech-language pathology 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 speech-language pathology 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 speech-language pathologist.*

Meets standard

Does not meet standard

The speech-language pathology assistant accurately scores and reports the results of screening tests to the supervising speech-language pathologist.*

Meets standard

Does not meet standard

The speech-language pathology assistant prepares treatment/screening materials before the beginning of each treatment/screening session, as directed by the supervising speech-language pathologist, 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 speech-language pathology assistant starts and ends treatment sessions on time and follows the written treatment protocol developed and prescribed by the supervising speech-language pathologist.*

Meets standard

Does not meet standard

Health and Safety Standard

The speech-language pathology assistant utilizes universal precautions and adheres to the infection control procedures and guidelines of the employer(s).*

Meets standard

Does not meet standard

The speech-language pathology 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

Action plans for unmet standards

Signature of Speech Language Pathology Assistant*

Registration Number*

Date*

MM slash DD slash YYYY

Signature of Primary Supervising Licensee*

License Number*

Date*

MM slash DD slash YYYY

Email print version of completed form

Would you like a PDF version of this completed form emailed to you?*

Yes

Email (for PDF delivery)*

Please enter an email address to receive a copy of this completed form.

Proposed Rule Change (NCBOESLPA) – Supervision of SLP-Assistants view announcement

Supervisor Information

Assistant Information

Instructions

Qualifications and Employment Overview

Direct Services to Patients/Clients

Health and Safety Standard

Summary

Email print version of completed form

Assistants