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MS Gulfport School District Hearing/Vision Screening Report 2015-2025 free printable template

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100115Gulfport School District Child's Name:HEARING/VISION SCREENING REPORT PERSONAL DATA Race/Ethnicity:District/School:ISIS #:Gender:DOB:Grade:Age:PART I INSTRUMENTAL ASSESSMENT A. HEARING SCREENING
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How to fill out gulfport school district hearingvision

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How to fill out MS Gulfport School District Hearing/Vision Screening Report

01
Begin by writing down the date of the screening at the top of the report.
02
Fill in the student’s full name and identification number.
03
Enter the student's date of birth.
04
Note the name of the school and the grade of the student.
05
Indicate the name of the person conducting the screening.
06
For hearing screening, check the appropriate boxes for 'Pass' or 'Fail' for each ear.
07
Record the results of the hearing screening, including any referrals if needed.
08
For vision screening, check the appropriate boxes for 'Pass' or 'Fail' based on the student's vision results.
09
Document the results of the vision acuity tests and any referrals for vision care.
10
Finally, have the report signed by the screener and provide a date of completion.

Who needs MS Gulfport School District Hearing/Vision Screening Report?

01
Students in the MS Gulfport School District
02
Parents or guardians of students
03
School health officials and administrators
04
Healthcare providers for follow-up care
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The MS Gulfport School District Hearing/Vision Screening Report is a document used to track and document the results of hearing and vision screenings conducted within the school district to ensure that students' sensory health needs are met.
The report is typically required to be filed by school health professionals, such as nurses or designated staff members, who conduct the hearing and vision screenings on students.
To fill out the report, school health professionals should enter student identification details, document the screening results, including pass/fail indications, notes on referrals, and any follow-up actions, ensuring clarity and accuracy.
The purpose of the report is to monitor and promote students' hearing and vision health, identify potential issues early, facilitate timely intervention, and comply with educational and health regulations.
The information that must be reported includes student name, date of birth, grade level, dates of screening, results for hearing and vision tests, any referrals for further evaluation, and signatures of personnel conducting the screenings.
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