This form can be used by industrial audiometric businesses (IABs) that provide hearing tests to workers. During testing, technicians document workers’ responses to questions about noise exposure, history, hearing conservation, and record hearing test results. The form matches the fields found in the online Hearing Test Submission System. IABs can use it during testing to collect results and enter them into the system.

For help using the system, refer to the Hearing Test Submission System User Guide.