WCB Nova Scotia Audiometric Report (Hearing Loss)

WCB Nova Scotia uses this three-page report to record an audiologist's test results on a noise-induced hearing loss claim, from tympanometry and acoustic reflexes to pure-tone and speech audiometry. It also captures the worker's noise exposure history and the audiologist's view of test reliability. WCB's Hearing Health Services Guide says every field is mandatory and the completed report goes to the worker's WCB case worker.

Who completes it

A certified audiologist completes the whole report, including who did the testing and their credentials, and confirms the results were shared with the worker. WCB's guide allows hearing re-evaluations by hearing instrument specialists, but an evaluation for permanent medical impairment must be done by a certified audiologist.

Submitting and payment

How to submit it
Upload the completed PDF as a secure-message attachment in WCB Online, or fax it to WCB, with the claim number on every page. In most cases the WCB case worker must pre-authorize the assessment first.
Who pays
WCB pays audiometric assessments under fee code 19A in its Hearing Health Services Guide, and hearing re-evaluations every two years under 19C.

Good to know

  • Tympanometry and acoustic reflexes are mandatory for an audiologist diagnostic assessment, and you confirm the worker was free of hazardous noise exposure for 16 hours before testing.
  • Page 2 asks whether the loss began in the first 10 to 15 years of noise exposure, started as a 3000 to 6000 Hz notch and developed symmetrically; submit earlier audiograms if available.
  • Page 3 flags low-frequency thresholds above 40 dBHL, high-frequency thresholds above 75 dBHL, or asymmetry over 15 dB, and each needs an explanation.
  • Workers must claim within 12 months of learning of noise-induced hearing loss, and WCB generally treats the date a specialist such as an audiologist confirms it as that date.

Get the official form

Download the current version from the source each time; forms change without notice.

Audiometric Report

Fill it with Vero

Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

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Frequently asked questions

Who can complete the WCB Nova Scotia Audiometric Report?

A certified audiologist, according to WCB's Hearing Health Services Guide, which also asks that a copy of the audiogram go to the worker's family physician. Hearing re-evaluations every two years may be done by a hearing instrument specialist or practitioner, but a permanent medical impairment evaluation must be done by a certified audiologist.

Does WCB Nova Scotia need to approve the hearing test first?

In most cases, yes. The guide says WCB may require a complete audiometric assessment and that it usually must be pre-authorized by the case worker. WCB only reimburses hearing services for workers approved for benefits, so the guide asks providers to confirm the worker has an accepted hearing loss claim before providing services.

What time limit applies to a noise-induced hearing loss claim in Nova Scotia?

Workers must make a claim within 12 months of learning of the occupational disease, and WCB may extend this but not beyond five years. WCB's current practice is to use the date a medical specialist, such as an audiologist, confirms the hearing loss, so audiologists are encouraged to tell workers to contact WCB.