Nevada's occupational disease exam series for police officers and firefighters includes a hearing examination recorded on the OD-5. The tester enters hearing levels for each ear at 500, 1000, 2000, 3000, 4000, 6000 and 8000 Hz, the average of the 2K, 3K and 4K results, and an otoscopic exam, then recommends a medical referral, a retest or a complete audiogram as needed.
The examining physician, audiologist or hearing technician completes the form and signs with name, title, and test date and time. The officer or firefighter signs too.
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Firefighters and Police Officers Hearing Examination Form
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500, 1000, 2000, 3000, 4000, 6000 and 8000 Hz for the right and left ears, with the average of the 2000, 3000 and 4000 Hz results calculated for each ear. The audiometer's serial number and calibration date are recorded with the results.
The form is signed by the tester, with name and title, so an examining physician, audiologist or hearing technician can complete it. The employee then signs and submits one copy to the employer or organization.
Three options: medical referral, retest recommended, or a complete audiogram. They sit below the otoscopic findings for each ear, and a remarks area allows details on what was seen during the otoscopic examination.