Hearing Screening Forms, Tools, and Resources

Training Manuals

• Hearing Screening Manual, Revised 1/2022 (PDF)
• Otoscopy and Tympanometry Manual (PDF)
• Implementing a Successful Otoacoustic Emissions (OAE) Hearing Screening Program

Child and Teen Checkups

• Child and Teen Checkups Schedule of Age-Related Screening Standards
• Hearing Screening Fact Sheet (PDF)

Forms

• Audiometer Mechanical Function Check (PDF)
• Biological Calibration Check Form (PDF)
• Child and Family Hearing History and JCIH Risk Assessment Questionnaire (PDF)
  • Additional languages available on C&TC Translated Documents web page
• Child and Teen Checkups Documentation and Resources for Providers and Clinics
• Early Childhood Screening Worksheet (PDF)
• Hearing Referral Letter (PDF)
  • Additional languages available on C&TC Translated Documents web page
• School Hearing Screening Worksheet (PDF)
• Pure Tone Audiometry Worksheet for children 3 years through 10 years (PDF)
• Pure Tone Audiometry Worksheet for youth 11 years and older (PDF)

Assessment Tools

Clinic Settings

• Child and Family Hearing History and JCIH Risk Assessment Questionnaire Skills Assessment (PDF)
• Environmental Noise Level Check (PDF)
• Pure Tone Audiometry for Clinic Setting (PDF)
• Visual External Inspection of the Ear (PDF)

Community Settings

• Child and Family Hearing History and JCIH Risk Assessment Questionnaire Skills Assessment (PDF)
• Environmental Noise Level Check (PDF)
• Pure Tone Audiometry for Community Setting (PDF)
• Visual External Inspection of the Ear (PDF)

Online Hearing Resources

• American Academy of Audiology
• American Speech-Language-Hearing Association
• CDC, Hearing Loss in Children
• CDC, Preventing Noise-Induced Hearing Loss
• CDC, Teens on Noise-Induced Hearing Loss
• CDC, What Noises Cause Hearing Loss?
• Listen Carefully
• MDE Early Childhood Screening
• Minnesota Early Hearing Detection and Intervention (EHDI)
• MN Early Childhood Screening Statutes
• Minnesota Hearing Screening Guidelines
• National Center for Hearing Assessment and Management
• National Hearing Conservation Association
• National Institute on Deafness and Other Communication Disorders (NIDCD)
• Noisy Planet

To review the Glossary, refer to the Hearing Screening Manual on page 59.