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How to use or fill out c 72 1 form with our platform
- Click ‘Get Form’ to open the c 72 1 form in the editor.
- Begin by entering the claimant's name and WCB Case Number at the top of the form. This information is essential for identifying the case.
- In the 'Hearing Levels' section, input the results from audiometric tests for both right and left ears at specified frequencies (500 Hz, 1,000 Hz, etc.). Ensure accuracy as these values are critical for calculating hearing loss.
- If multiple tests were conducted, record the lowest hearing levels at each frequency in section D. This will help in determining the average hearing loss.
- Calculate the Adjusted Hearing Loss by subtracting 25 db from your average hearing levels and then multiplying by 1.5 to find the percentage of binaural hearing loss.
- Complete the certification section by signing and dating it, ensuring that all test conditions meet required standards.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2012 | 4.9 Satisfied (402 Votes) |
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