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Cuestionario sobre la pérdida del sentido auditivo en el trabajo

Usada por el trabajador lesionado que ha presentado un reclamo por pérdida de audición para proporcionar información más específica referente a cómo ocurrió la pérdida de audición.  Esto es solicitado por el gerente de reclamo y enviado al trabajador lesionado.



Form
F262-016-999



Alt Language(s):
Inglés
 
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
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



Alt Language(s):
Español
 
Occupational Disease Employment History Hearing Loss (Continuation)
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



Alt Language(s):
Español
 
Occupational Hearing Loss Questionnaire
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



Alt Language(s):
Español
 





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