Attachment J_Audiometric exam results notification letter

Attachment J- Audiometric Exam Results Notification Letter

NIOSH Study “Noise Exposures and Hearing Loss in the Oil and Gas Extraction Industry”: Report of Findings from Audiometry (Hearing) Exam

Name: Date:

Address:

Date of Exam:

Location of Exam:

Thank you for taking part in the “Noise Exposures and Hearing Loss in the Oil and Gas Extraction Industry” study. As part of this research study in which you voluntarily participated, the National Institute for Occupational Safety and Health (NIOSH) performed audiometric (hearing) exam on you at an oil and gas industry worksite between [DATE RANGE]. We are writing because you asked for your individual exam results.

The softest sounds you are able to hear are called hearing thresholds. Your thresholds at different frequencies (pitches) are reported in the table below. The lower pitched sounds are towards the left of the table and the higher pitched sounds are toward the right. Smaller numbers mean quieter sounds, and therefore indicate better hearing. Values of 25 dB or less are considered normal hearing.

Hearing Levels by Ear and Frequency (Air Conduction)

	Frequency (Hz)
	500	1000	2000	3000	4000	6000	8000
Right Ear (dB HL)	999	999	999	999	999	999	999
Left Ear (dB HL)	999	999	999	999	999	999	999

Print legend only if “***” or “NRS” appears in table:

 = threshold could not be determined

NRS = no response at limits of equipment

Your hearing was tested by a trained examiner. Results <insert normal hearing text or text from audiometry table> in your right ear. In your left ear, results <insert normal hearing text or audiometry table text>. <Insert functional impact text here, if required> <Insert healthcare provider referral text, if required>

What happens next?

Once all testing has been completed, we will summarize all the results, including these tests, and will make a summary report available to you and your employer. This report will not mention you or your individual results by name. We encourage you to discuss your work and possible exposures with your company management. If you have any questions, please call me at (303) 236-5933.

Sincerely,

Bradley King, PhD, MPH, CIH

Senior Industrial Hygienist

NIOSH Western States Division

Bradley.King@cdc.hhs.gov