We use cookies to improve security, personalize the user experience, enhance our marketing activities (including cooperating with our marketing partners) and for other business use.
Click "here" to read our Cookie Policy. By clicking "Accept" you agree to the use of cookies. Read less
Read more
Accept
Loading
Form preview
  • US Legal Forms
  • Form Library
  • More Forms
  • More Uncategorized Forms
  • Hearing Screening Form

Get Hearing Screening Form

00 Hz 4000 Hz Right Ear (in dB) Left Ear (in dB) Did the student pass the screening? If they failed, were they re-tested on a different day? If yes, record the date of re-testing. Did the student pass or fail the re-screening? OAK HILL ACADEMY PURE TONE HEARING SCREENING FORM Student Name: Date: Examiner: Core/Teacher: Note: Passing threshold is 20db at 1000Hz & 2000Hz, & 25db at 500Hz & 4000Hz. 500 Hz 1000 Hz Right Ear (in dB) Left Ear (in dB) Did the student pass the screening? If the.

How it works

  1. Open form

    Open form follow the instructions

  2. Easily sign form

    Easily sign the form with your finger

  3. Share form

    Send filled & signed form or save

How to fill out the Hearing Screening Form online

Completing the Hearing Screening Form online is a straightforward process that ensures accurate assessment of hearing capabilities. Follow this guide to efficiently navigate through each section of the form, providing the necessary information with ease.

Follow the steps to complete the Hearing Screening Form online.

  1. Press the ‘Get Form’ button to access the Hearing Screening Form and open it for editing.
  2. Begin by entering the student’s name in the designated field to identify the individual undergoing the hearing screening.
  3. Input the date of the screening in the appropriate section to document when the assessment took place.
  4. Specify the name of the examiner responsible for conducting the hearing screening, ensuring proper accountability.
  5. Include the core or teacher's name related to the student to provide context for the screening.
  6. Refer to the note regarding passing thresholds: indicate the decibel levels recorded at 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz for both right and left ears in the corresponding fields.
  7. Evaluate whether the student passed the screening and select 'Yes' or 'No' in the indicated area.
  8. If the student did not pass the initial screening, note whether they were re-tested on a different day; respond with 'Yes' or 'No' accordingly.
  9. If the student was re-tested, document the date of this re-screening in the space provided.
  10. Finally, indicate the outcome of the re-screening, specifying whether the student passed or failed.
  11. After filling out all fields, review the form for accuracy, then save your changes, and choose to download, print, or share the completed document as needed.

Start filling out your Hearing Screening Form online today to ensure your assessment is recorded accurately.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Get form

Related content

Hearing Screening Requirements | Texas Department...
Jul 28, 2020 — To collect screening information for each child, a facility may use its...
Learn more
Hearing Screening - ASHA
Screening Unit/Examiner. ______ _. __ Calibration Date ______. CASE HISTORY—CIRCLE...
Learn more
Ear - Wikipedia
The ear is the organ of hearing and, in mammals, balance. In mammals, the ear is usually...
Learn more

Related links form

Stenerson Sports Foundation MAP Membership Tuition ... Expenditure Request Form Letter Of Undertaking Annexure 1 Ophthalmic Technician Education Program Evaluation Form ... - Eye Keckmedicine

Questions & Answers

Get answers to your most pressing questions about US Legal Forms API.

Contact support

Results of Testing:PASS: child must respond to each test frequency consistently at 20 dB HL in each ear. REFER: child does not respond at 20 dB HL at any one test frequency in either ear *

A hearing test is performed in a sound proof room. You will wear headphones or earplugs connected to a device that sends sounds of different volumes and pitches to one ear at a time. You will be asked to respond by raising your hand or pressing a button each time you hear a sound.

Pure tone audiometry screening should take place in a very quiet room. Perform an Environmental noise level check before performing screenings in any environment. Pause the screening if any distracting noise occurs. Perform thresholds only when there are hearing concerns or a child does not pass pure tone audiometry.

Find a quiet area to complete the hearing test. Choose if you prefer to use your device speakers or headphones. Headphones will provide you with more accurate results, and unlike device speakers, will test your right and left ears individually. Make sure the volume is on and set at a comfortable level.

This frequency range is critical for hearing and understanding speech and other sounds, and is the reason routine hearing screening uses 500, 1000, 2000, 4000 Hz, and 6000 Hz (ages 11 and older). Volume is the range of sound loudness, measured in decibels (dB). The greater the decibel number, the louder the sound.

A hearing screening is a simple pass or fail test. Its purpose is to determine if you have normal hearing or not. It usually consists of a series of beeps or tones at the limit of normal range to see if you are able to hear them.

We have two methods to test newborn hearing. One is called otoacoustic emissions and the other is auditory brainstem response. The OAE or otoacoustic emission, we put a small ear probe in the baby's ear canal and then play a sound and the ear sends back an echo.

If the test doesn't show a clear response from one or both of your baby's ears, your baby will need to have a second test. A 'refer' result requires the hearing screen to be repeated within a few weeks. It doesn't necessarily mean that your baby has a hearing problem.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
Get form
If you believe that this page should be taken down, please follow our DMCA take down processhere.

Industry-leading security and compliance

US Legal Forms protects your data by complying with industry-specific security standards.
  • In businnes since 1997
    25+ years providing professional legal documents.
  • Accredited business
    Guarantees that a business meets BBB accreditation standards in the US and Canada.
  • Secured by Braintree
    Validated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.
Get Hearing Screening Form
Get form
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
altaFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
altaFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232