Crisis Intervention Therapist Skills Checklist Form
Evaluate crisis-intervention therapist skills, observe core competencies, and document readiness for safe response and follow-up.
Therapist Identification and Evaluation Context
Therapist Name
*
First Name
Last Name
Role / Title
*
Department / Team
Evaluator Name
*
First Name
Last Name
Evaluation Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Evaluation Setting / Context
*
Please Select
Intake Review
Training Observation
Simulation
Live Session
Other
Competency Ratings and Overall Readiness
Overall crisis-response readiness
*
Needs significant development
1
2
3
4
Fully ready
5
1 is Needs significant development, 5 is Fully ready
Communication under pressure
*
Needs significant development
1
2
3
4
Excellent under pressure
5
1 is Needs significant development, 5 is Excellent under pressure
Judgment and escalation decisions
*
Needs significant development
1
2
3
4
Consistently sound
5
1 is Needs significant development, 5 is Consistently sound
Overall performance summary
Strengths and Improvement Notes
Observed strengths
*
Improvement areas or coaching notes
*
Immediate next steps or follow-up recommendations
*
Submit
Should be Empty: