Forms for Hearing Conservation and Respirator Programs
Respirator Forms
- Online Respirator Questionnaire Answer respirator medical evaluation questions right here!
- Respirator Questionnaire Respirator medical evaluation questionnaire
- Respirator Questionnaire - Spanish Respirator medical evaluation questionnaire in Spanish
Work-relatedness Determinations
- Online Work-Relatedness Questionnaire Complete a work-relatedness determination questionnaire here
- Work-relatedness Questionnaire Request a work-relatedness determination when there is a hearing shift
- Work-relatedness Determination Contract Contract for work-relatedness determinations for those lacking a current customer contract
Audiogram Forms
- Audiogram Form - Single Test Audiogram form for one test for one employee
- Audiogram Form - Multiple Tests Audiogram for up to 6 tests for one employee
- Preprint Form Preprint form for one employee (Spanish/English)
Miscellaneous Hearing Forms
- 10 dB STS Follow-up Checklist verifying completion of STS follow-up
- Baseline Revision Request for Rehire Request to change baseline due to employee rehire
- Test Refusal For documenting employee refusal to take test
- Correction Request Request for corrections to employee name, number or birth date
- Schedule for Hearing Testing To create your hearing testing schedule
- Hearing Testing Employee Notice Breakroom poster alerting employees to upcoming hearing testing
Service Forms
- Pre-service Questionnaire Questionnaire to be completed before on-site service