Practical Forms for Speech-Language Pathology Assistants
Direct Observation Skills Brief Checklist
Educational Setting
Speech-Language Pathology Assistant: ___________________________________________
Supervising SLP: ____________________________________________________________
Student Observed: ___________________________________________________________
Date/Time of Observation: ____________________________________________________
Rate the following on a scale of 1 (disagree) to 5 (agree).
Interpersonal Skills
1. Maintains appropriate relationship with student. 1 2 3 4 5
2. Demonstrates appropriate level of self-confidence. 1 2 3 4 5
3. Considers the student's cultural/linguistic needs. 1 2 3 4 5
4. Uses language appropriate for student's age and education. 1 2 3 4 5
5. Is courteous and respectful at all times. 1 2 3 4 5
Personal Qualities
1. Arrives punctually for the intervention session. 1 2 3 4 5
2. Arrives prepared for the intervention session. 1 2 3 4 5
3. Appearance is appropriate for the intervention session. 1 2 3 4 5
4. Recognizes professional boundaries during the intervention session. 1 2 3 4 5
Stays within professional boundaries during the intervention session. 1 2 3 4 5
Technical and Intervention Skills
1. Completes assigned tasks within the designated session. 1 2 3 4 5
2. Uses appropriate materials based on treatment plan. 1 2 3 4 5
3. Uses materials that are age and culturally appropriate. 1 2 3 4 5
4. Uses materials that are motivating. 1 2 3 4 5
5. Prepares the intervention setting to meet the needs of the student. 1 2 3 4 5
6. Accurately determines correct vs. incorrect responses. 1 2 3 4 5
7. Provides appropriate feedback as to the response accuracy. 1 2 3 4 5
8. Verbally reports the session. 1 2 3 4 5
9. Provides appropriate documentation of the session. 1 2 3 4 5
Comments:
Copy freely American Speech-Language-Hearing Association
