Occupational Audiometry Assessment

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Occupational Audiometry · AS/NZS 1269.4:2014

Select the assessment type below, then complete worker information. Results and recommended next steps are generated automatically per AS/NZS 1269.4:2014.

Reference Only (Baseline)

Pre-employment or first-time baseline audiogram. No Significant Threshold Shift (STS) comparison performed.

Reference + Monitoring Audiogram

Compare against a reference audiogram and automatically calculate Significant Threshold Shift (STS) per Clauses 4.10 & 9.3.

Worker Name

Date of Birth

Sex

Employer / Site

Job Title / Role

Assessor / Audiometrist

Assessment Date

Equipment & Testing Conditions

Audiometer Model

Audiometer ID / Serial No.

Audiometer Calibration Date

Transducers Used

Date of Ambient Noise Level Check

Background noise levels meet MPANLS (Maximum Permissible Ambient Noise Level Standards) for the frequencies to be tested

Daily Biological Performance Check completed prior to testing (audiometer response verified within ±10 dBHL of expected values)

Informed Consent

Worker Consent to Audiometric Assessment

The worker must provide informed consent prior to testing. Click the button to open the consent form for the worker to read and sign.

Noise History — Reference / Baseline

Noise History — Monitoring

Otoscopic Examination

Examine both ears using an otoscope before audiometric testing. All fields default to normal. Use the dropdowns to record findings — multiple findings can be selected per ear. Items marked * may indicate a clinical referral is required.

Section	● Right Ear	✕ Left Ear
Outer Ear	▾ Clear Redness / Inflammation * Suspicious Moles / Skin Lesions * Swelling / Oedema * Tenderness on Palpation * Foul Odour * Dermatitis / Eczema Ear Deformity Other	▾ Clear Redness / Inflammation * Suspicious Moles / Skin Lesions * Swelling / Oedema * Tenderness on Palpation * Foul Odour * Dermatitis / Eczema Ear Deformity Other
External Auditory Canal	▾ Clear Foreign Body * Discharge (note colour/character) * Erythema (Redness) * Significant Wax Obstruction * Fungal Elements (Otomycosis) * Partial Wax Obstruction Partial Blockage (e.g. stenosis) Complete Blockage Other	▾ Clear Foreign Body * Discharge (note colour/character) * Erythema (Redness) * Significant Wax Obstruction * Fungal Elements (Otomycosis) * Partial Wax Obstruction Partial Blockage (e.g. stenosis) Complete Blockage Other
Tympanic Membrane	▾ Normal Appearance Redness / Discolouration * Bulging or Retraction * Suspected Perforation / Rupture * Blocked / Unable to Observe * No Cone of Light Observed Loss of Translucency Scarring (suspected) Grommet Present Abnormal Landmarks (umbo, manubrium, pars flaccida/tensa) Partially Observed Other	▾ Normal Appearance Redness / Discolouration * Bulging or Retraction * Suspected Perforation / Rupture * Blocked / Unable to Observe * No Cone of Light Observed Loss of Translucency Scarring (suspected) Grommet Present Abnormal Landmarks (umbo, manubrium, pars flaccida/tensa) Partially Observed Other

Reference (Baseline) Audiogram

Input the worker's previous reference (baseline) audiometric assessment results below. The reference audiogram serves as the benchmark against which all future monitoring audiograms will be compared to determine any significant threshold shift.

Threshold Levels (dBHL) ● Right & ✕ Left Ear

Monitoring Audiogram

Enter the worker's monitoring audiogram thresholds below. The tool will automatically compare each frequency against the reference audiogram, calculate the shift in dBHL, and flag any frequencies that meet Significant Threshold Shift (STS) criteria as defined in AS/NZS 1269.4:2014 Clauses 4.10 and 9.3. Results, outcome determination, and recommended next steps are generated instantly on the Results page.

Threshold Levels (dBHL) ● Right & ✕ Left Ear

AMA

Occupational Audiometry

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1. Have you had any loud noise exposure above normal speaking volume in the last 16 hours? (e.g. loud music, engine noise, machinery) *
2. Have you previously worked in noisy environments?	Yes No
3. Have you previously worn ear protection?	Yes No
4. Are you exposed to hand-arm, or whole body vibration?	Yes No
5. Have you previously had an audiogram (hearing test)? a. If yes — year and location:	Yes No
6. Have you ever been exposed to shots or blasts (including from pneumatic tools)?	Yes No
7. Do you wear a headset regularly? a. Which ear(s)? Left Ear Right Ear Both Ears In-Ear Over-Ear b. How often? Constantly Frequently Occasionally Rarely	Yes No
8. Are you regularly exposed to any noisy recreational activities? (e.g. motorbike riding, shooting, live music)	Yes No

1. Have you had a hearing test with this employer before? a. If yes — details:	Yes No
2. Has your job or noise level changed since your last hearing test? a. Does your current role expose you to high levels of noise? — Yes No	Yes No
3. Do you have to shout to make yourself heard at a distance of 3 metres away at work?	Yes No
4. Have you been given hearing protection for work? (e.g. ear plugs, ear muffs) a. If yes, do you wear it: All the time Occasionally Seldom Never b. Type of hearing protection: Ear plugs Ear muffs Safety cap with ear muffs Other	Yes No
5. Are you currently exposed to any hand-arm, or whole body, vibration? *	Yes No
6. Have you had difficulty with your hearing or ears since you were last tested? *	Yes No
7. Have you had your ears cleaned out since your last hearing test?	Yes No
8. Have you experienced tinnitus (ringing in your ears) since your last hearing test? * a. Has your tinnitus worsened since your last hearing test? — Yes * No	Yes No
9. Have you taken any new prescription medication since your last hearing test?	Yes No
10. Have you taken up any noisy hobbies since your last hearing test? (e.g. motorbike riding, shooting)	Yes No