McCREARY COUNTY
EC-10a Rev. 7/08
COMMUNICATION SCREENING CHECKLIST
Student’s Name: ____________________
DOB: __________
Age: _______
SS#: _______________
Gender: __________
Teacher: ____________
School: ___________________________
Grade: __________
Date of Screening: __________
Person Conducting Screening: _________________________
Title: _______________
(This screening is to be conducted only after written parental consent is obtained)
Check item that apply to this student:
Articulation
Student avoids speaking in class and/or appears frustrated by his/her difficulty in communicating.
Student is difficult to understand even when the listener knows the content
Student appears uncomfortable when trying to communicate with peers.
Student exhibits speech errors that are noticeably different from peers.
When compared to similar age peers, there are no concerns about this student in this area.
Voice
Student’s voice quality is significantly different than that of similar age peers.
Student’s voice has a low pitch, high pitch, or chronic hoarseness.
Student’s voice is consistently too loud or too soft.
When compared to similar age peers, there are no concerns about this student in this area.
Fluency (Stuttering)
Student exhibits difficulty when speaking (whole word repetitions, part word repetitions, prolongation of a
sound, struggles to release words).
When compared to similar age peers, there are no concerns about this student in this area.
Language:
Student does not speak in complete sentences (omits is, the, a, etc. and other parts of speech).
Student does not have grammar or sentence length that is comparable to similar age peers.
Student has difficulty remembering longer oral directions (take out book, turn to page 3, do problem 6).
Student has difficulty with age appropriate vocabulary.
Student has difficulty understanding concepts (spatial, temporal, sequential).
Student has difficulty when involved in conversation (maintaining topic, turn taking, ending or beginning
conversation, maintaining eye contact).
Other students tease or make fun of the student’s expressive communication.
Student has difficulty understanding/manipulating the sounds he/she hears & in the order that they hear it.
When compared to similar age peers, there are no concerns about this student in this area.
Section to be completed by SLP
Additional Evaluation needed in the following area(s):
Articulation
Voice
Fluency
Language
When compared to similar age peers, there are no concerns about this student in this area. No additional
evaluation needed at this time.
_____________________________________________________ Date Reviewed: _____________________
Speech/Language Pathologist