Clinical Supervisor Therapist Skills Checklist Form
Use this form to review therapist skill areas, supervision context, and development priorities during clinical supervision.
Supervisor and Therapist Information
Supervising Clinician Name
*
First Name
Middle Name
Last Name
Supervising Clinician Title
*
Therapist Name
*
First Name
Middle Name
Last Name
Therapist Credential or Role Title
Department / Program or Practice Name
Supervision Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Clinical Skills Checklist
Therapeutic skill domains observed
*
Rapport building
Active listening
Treatment planning
Documentation quality
Ethics and professional boundaries
Session structure
Risk awareness and escalation
Cultural responsiveness
Time management
Other
Clinical competencies demonstrated consistently
Builds rapport with clients
Uses reflective listening
Develops clear treatment goals
Documents sessions accurately
Maintains ethical boundaries
Structures sessions effectively
Recognizes and escalates risk concerns
Demonstrates cultural responsiveness
Manages time efficiently
Other
Overall competency rating
*
1
2
3
4
5
Notes on observed skill strengths or gaps
Supervisor Notes and Development Focus
Supervisor Notes on Strengths and Observations
Primary Development Goals / Follow-up Focus Areas
Overall Recommendation
*
Ready for Independent Practice
Continue Supervision
Targeted Skill Development
Submit
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