Get a Form or Publication: hearing impairment
Your search for "hearing impairment" returned 6 documents.
See also
| Title | Type | Number |
|---|---|---|
| Cuestionario Sobre Perdida Del Sentido Auditivo en el Trabajo
Also available in: English Used by injured worker who has filed an occupational hearing loss claim to provide more specific information regarding how the hearing loss occurred. This is requested by the Claim Manager and sent to the Injured Worker. |
Form | F262-016-999 |
| Hearing Impairment Calculation Worksheet
Used by the attending doctor to determine hearing loss. |
Form | F252-007-000 |
| High Noise Area, Wear Hearing Protection
Cartoon of a guy plugging his ears with his fingers while his hearing protection is wrapped around his neck with the words 'High Noise Area' above his head. Get poster printing tips. |
Poster | FSP1-065-000 |
| Occupational Disease Employment History Hearing Loss
Also available in: Spanish Used by injured worker who has filed an occupational hearing loss claim to report their employment history and the nature of the noise exposure at each job. F262-013-111 is the continuation sheet. |
Form | F262-013-000 |
| Occupational Disease Employment History Hearing Loss (Continuation)
Also available in: Spanish Used by injured worker who has filed an occupational hearing loss claim to report their employment history and the nature of the noise exposure at each job. This form is a continuation of form F262-013-000. |
Form | F262-013-111 |
| Occupational Hearing Loss Questionnaire
Also available in: Spanish Used by injured worker who has filed an occupational hearing loss claim to provide more specific information regarding how the hearing loss occurred. This is requested by the Claim Manager and sent to the Injured Worker. |
Form | F262-016-000 |
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