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RADIOGRAM AUDIOMETRIC QUESTIONNAIRE 2.LOCATION CODE3.SOCIAL SECURITY NUMBERINITIAL AND UPDATE OTOLOGIC HISTORY DATE25.YE SHAVE YOU EVER HAD:4.NAMELASTFIRSTD A TE MIDDLE INITIALINITIAL OTOLOGIC HISTORY (CONTINUED)The
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Start by gathering all the necessary information such as personal details and medical history.
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Carefully read each question on the audiometric questionnaire.
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Provide accurate and detailed answers to each question.
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If you are unsure about any question, consult a healthcare professional for guidance.
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Double-check all the information filled in before submitting the questionnaire.

Who needs audiometric questionnaire?

01
Anyone who is experiencing hearing problems or suspects they have hearing loss should fill out an audiometric questionnaire.
02
Employers might also require their employees to complete an audiometric questionnaire for occupational health and safety purposes.
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The audiometric questionnaire is a form used to gather information about an individual's hearing health and any previous exposure to noise.
Employers are required to file audiometric questionnaires for their employees who are exposed to occupational noise.
The audiometric questionnaire can be filled out by the employee themselves or with the assistance of a qualified healthcare professional.
The purpose of the audiometric questionnaire is to assess and monitor the hearing health of individuals who may be at risk of noise-induced hearing loss.
The audiometric questionnaire typically includes questions about an individual's medical history, hearing health, and any previous exposure to noise.
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