Physical Checklist

Lab:
 Verify patient and date of birth

 Vitals (Height/Weight, Blood Pressure, Respirations, Pulse)

 Drug Screen

 PPD Placement

 CMP-

 CBC

 Lipid- lavender tube centrifuge for 10 minutes

Audiogram
Step 1: Preparing the subject for a test:

“I am going to place these earphones over your ears. You will hear tones or beeping sounds
which may be loud or soft. Whenever you hear, or think you hear one of these tones, raise your
hand. Lower your hand’s when you no longer hear the sound. Remember, raise your hand when
you hear the tone and lower your hand when you do not”

Step 2: Familiarize your subject with the test and determine the start point:

1. Start with the “better” or RIGHT eat

2. Demonstrate a tone for the subject using: 100Hz at 50dB HL.
3. If the subject responds, repeat at 40 dB
4. If the subject responds again, this is the “start” point,

Determine the threshold

 5. Present the tone at 50 dB
6. Present the tone for 1-2 seconds. The time between the tones should vary, but should
not be shorter than the test tone
7. With each response, decrease the tone 10 dB for the next presentation.
8. After each failure to respond, increase the tone 5dB until the first response occurs.
9. Continue with DOWN 10dB, UP 5 dB until the threshold is reached.
10. Record the threshold on the audiogram

NOTE: Repeat steps 5-10 for each tone setting. The following is suggested order of
frequencies: 1000, 250, repeat 1000, 2000, 3000, 4000, 800- Hz.

Sight:
1. Snellen test

2. Titmus Machine (Depth perception (# 5)

Type of test: Stereopsis

(Only allowed to miss 2)

3. Peripheral vision:

4. Jaeger No. 2

5. Color vision: