Get Au Worksafe Victoria Hearing Assessment And Device Exception Request Form 2011-2025
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How to fill out the AU WorkSafe Victoria Hearing Assessment and Device Exception Request Form online
This guide will assist you in accurately completing the AU WorkSafe Victoria Hearing Assessment and Device Exception Request Form online. This form is essential for workers seeking devices not listed on the WorkSafe Approved Hearing Device List, ensuring their particular needs are met.
Follow the steps to complete the form correctly.
- Click 'Get Form' button to access the document and open it in your online editor.
- Begin by filling out the 'Worker Details' section. Include the worker’s name, claim number, date of birth, date of injury, and the employer's name.
- In the 'Work Status' section, indicate whether the worker is currently working or planning to return to work. Provide any relevant details regarding their current job or educational status.
- Next, address the 'Exceptions Criteria' section by selecting the applicable criterion that justifies the request for a device not on the approved list.
- Fill out the 'Hearing Device and Clinical History' section detailing whether the request is for a new or replacement device, including reasons for replacement and pertinent clinical history.
- In the 'Hearing Assessment' section, provide the date of assessment and ensure to attach the required test results, including audiograms and speech discrimination results.
- Complete the 'Recommended Hearing Device' section by specifying the requested device's details, ensuring to attach the manufacturer’s quotation.
- Proceed to the 'Communication Assessment and Clinical Rationale' to describe communication difficulties in specific environments. Outline the communication goals and the rationale for the requested device.
- Fill in the details of the treating audiologist or audiometrist, including their name, address, contact information, and signature.
- In the 'Consent' section, the worker must sign and date the form to authorize the collection and use of their personal information.
- Finally, review the form for completeness, ensuring all sections are filled out as required. Save your changes, download, print, or share the completed form.
Complete your documents online to ensure a smooth submission process.
Real ear verification is a method used to measure how sound from a hearing aid interacts with your ear. This process checks that the hearing aid delivers the right amplification at different frequencies. By documenting this information, you can ensure that your hearing aid is truly enhancing your hearing experience, which can be vital in the AU WorkSafe Victoria Hearing Assessment and Device Exception Request Form process.
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