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Click ‘Get Form’ to open the hearing screening form in the editor.
Begin by entering your child’s name in the designated field at the top of the form.
Next, fill in the grade of your child and the screening date to ensure accurate record-keeping.
Assess room noise levels by selecting one of the options: Good, Fair, or Poor.
For each frequency listed (1000 Hz, 2000 Hz, 4000 Hz), indicate whether your child passed or was referred for further testing by checking the appropriate box under both right and left ear columns.
In the comments section, provide any additional notes or observations regarding your child's hearing screening experience.

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What happens during a hearing screening?

Otoacoustic emissions test (OAE) Your audiologist will put a small earphone in your ear. The earphone sends sound into your ear and measures the sounds that come back. Your test results show up on a monitor.

What is a hearing screening?

A hearing screening is a quick test to see how well you hear different sounds. You either pass or fail the screening. If you pass and have no other hearing concerns, then you can continue with regularly scheduled hearing screenings.

What is the 1 3 6 rule for hearing screening?

Employers must make audiometric testing available at no cost to all employees who are exposed to an action level of 85 dB or above, measured as an 8-hour TWA. The audiometric testing program followup should indicate whether the employers hearing conservation program is preventing hearing loss.

What is the difference between a hearing test and a hearing evaluation?

Hearing tests may be done: To check, or screen, babies and young children for hearing problems that might affect their ability to learn, speak, or understand language. Experts recommend that all newborns be screened for hearing loss . Many states require newborn hearing tests for all babies born in hospitals.

What is the difference between a hearing test and a hearing screening?

Have you ever wondered what the difference is between a hearing screening and a hearing evaluation? Screenings are preliminary tests used to determine whether a patient has a hearing loss. Think of it as a pass/fail exam: If the results indicate a hearing loss, a more detailed evaluation is required.