COMMUNICATION SKILLS TEACHER CHECKLIST Student DOB Grade Teacher School Date Please check yes or no to each of the following statements: Articulation (Speech Production) Language Yes No The speech contains speech Yes No The student has difficulty understanding/ student’s sound errors that are not typical for following age-appropriate directions. his/her age and social/cultural background. Sounds in words may be Yes No The student has difficulty answering or omitted, distorted, or substituted. responding to age-appropriate questions and other verbal information. Yes No The speech is consistently student’s difficult to understand, especially when Yes No The student has difficulty answering the topic is not known. comprehension questions about age- appropriate Voice stories. Yes No The voice sounds abnormal Yes No The oral language skills appear to student’s student’s (i.e., hoarseness, harshness, breathiness, be at risk nasal, pitch deviations, or distracting (i.e., grammatical errors, difficulty sequencing loudness level) lasting 3 weeks or information, frequent inappropriate more. responses, difficulty selecting and using vocabulary).This may not apply to English language learners or those known to speak a dialect of English. Speech Fluency Yes No The speech contains Yes No The conversational skills student’s student’s dysfluencies (repetitions of words or appear to be at risk (i.e., turn-taking, staying hesitations) or an abnormal rate that on topic, initiating conversation). interferes with communication. Yes No The student appears to be frustrated when speaking. Please check one: The communication skills appear to be acceptable and do not affect his/her educational progress student’s at this time. The communication skills appear to be at risk and may adversely affect his/her educational student’s progress in a significant way. Refer to School Speech-Language Pathologist. –
COMMUNICATION SKILLS TEACHER CHECKLIST Student DOB Grade Teacher School Date Please check yes or no to each of the following statements: Articulation (Speech Production) Language Yes No The student’s speech contains speech Yes No The student has difficulty understanding/ sound errors that are not typical for following age-appropriate directions. his/her age and social/cultural background. Sounds in words may be Yes No The student has difficulty answering or omitted, distorted, or substituted. responding to age-appropriate questions and other verbal information. Yes No The student’s speech is consistently difficult to understand, especially when Yes No The student has difficulty answering the topic is not known. comprehension questions about age- Voice appropriate stories. Yes No The student’s voice sounds abnormal Yes No The student’s oral language skills appear to (i.e., hoarseness, harshness, breathiness, be at risk nasal, pitch deviations, or distracting (i.e., grammatical errors, difficulty sequencing loudness level) lasting 3 weeks or information, frequent inappropriate more. responses, difficulty selecting and using vocabulary).This may not apply to English language learners or those known to speak a Speech Fluency dialect of English. Yes No The student’s speech contains Yes No The student’s conversational skills dysfluencies (repetitions of words or appear to be at risk (i.e., turn-taking, staying hesitations) or an abnormal rate that on topic, initiating conversation). interferes with communication. Yes No The student appears to be frustrated when speaking. Please check one: The student’s communication skills appear to be acceptable and do not affect his/her educational progress at this time. The student’s communication skills appear to be at risk and may adversely affect his/her educational progress in a significant way. – Refer to School Speech-Language Pathologist.