OH Intake Form Audiometric

How many employees need testing?

How many shifts are being tested?

Do they rotate over multiple days?

What are the shift times?

How many employees per shift?

What are the preferred testing times?

Are there any days during the week that you cannot test? (select all that apply)

If you are a new client, is your historical data in an electronic format, such as a spreadsheet? (We would need baselines, baseline shifts and the most recent audiograms at a minimum, preferably all audiograms).

Who will be the main contact? (Need email and cell#)

OH Intake Form Audiometric

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