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California Hearing Conservation Program Forms - DHCS 2026
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- Click ‘Get Form’ to open the California Hearing Conservation Program Forms - DHCS in the editor.
- Begin by filling out the identifying information, including the reporting school year, CDS Code Number, and district details such as name, email address, and address.
- In Column (1), list all grades within your district that require screening. Remember that grades marked with an asterisk must have all students screened.
- For Column (2), enter the total number of students enrolled in each grade as of October's CALPADS report.
- Proceed to Column (3) and input the number of students screened according to Section 2951(c), CCR, Title 17.
- In Column (4), record how many students failed both threshold tests as per Section 2951(d).
- Complete Columns (5) and (6) by detailing the number of students referred for medical evaluation and those examined or under treatment.
- Once completed, utilize our platform’s ‘E-mail’ button to send your form directly or select ‘Print’ to mail or fax it.
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