Hearing Conservation

Recordkeeping

Medical / Legal
• Most HCP forms are considered medical-legal documents. • All must be filled out completely & accurately. • Invalid data entry or misinformation may result in the unjust awarding of compensation claims.

Noise Survey Data (DD Form 2214)
• Noise exposure measurements must be entered on DD 2214 (Noise Survey Data) and a copy placed in the employee’s medical record. In most cases, measurements are made by an IH or IH technician. • Noise survey data are retained locally for 5 years. • Each service must keep survey records for the duration of an individual’s employment, plus 30 yrs. • Other service-specific requirements may vary.

Biological Calibration Check (DD Form 2217)
• Must be performed each test day and documented on a DD Form 2217 and printed out monthly. • An individual DD Form 2217 must be established for each designated listener, whether human or artificial ear. • A new DD Form 2217 baseline test must be established for each listener every time the audiometer is electroacoustically calibrated (annually). • Biological calibration records must be kept locally for 5 years.

DD Form 2215 Reference Audiogram A baseline test
         For all military personnel and  noise­exposed civilian employees 

Requirements for taking test:
• No ear, nose or throat problems

• At least 14 noise­free hours (NFH

The DD 2215 is used for the following test purposes:
• Reference established prior to noise exposure (purpose = 1) • Reference established following exposure in noise duties (purpose = 2) • Reference re-established after follow-up testing (purpose = 3)

DD 2215 Referral Criteria
High Frequency Hearing Loss: 55 dB HL or more at 3000, 4000 or 6000 Hz (either ear) Low Frequency Hearing Loss: Greater than 25 dB average at 500,1000 and 2000 Hz (either ear)

DD 2215 Referral Criteria (cont.)
When Masking Is Required: 40 dB or > difference between ears at the same frequency Asymmetric Hearing Loss: 25 dB HL or more between ears at any two consecutive frequencies

DD Form 2216 Hearing Conservation Data
Completed annually/periodically A valid DD 2215 must be in the employee’s health record Completed as a comparison to the reference (baseline) hearing test

The DD 2216 is used for the following test purposes:
• 90-day (purpose = 1) • Annual (purpose = 2) • Follow-up #1 (purpose = 5) • Follow-up #2 (purpose = 6) • Termination (purpose = 3) • Other (purpose = 4)

DD 2216 Referral Criteria
When Masking Is Required: 40 dB or > difference between ears at the same frequency Asymmetric Hearing Loss: 25 dB HL or more between ears at any two consecutive frequencies Significant Threshold Shift (STS)

Definition of STS
Positive STS:
+ 10 dB average at 2000, 3000 and 4000 Hz or + 15 dB at 1000, 2000, 3000 or 4000 Hz

Negative STS:
- 10 dB average at 2000, 3000 and 4000 Hz or - 15 dB at 1000, 2000, 3000 or 4000 Hz Employee’s supervisor (civilian)/unit commander (military) must be notified promptly

Negative STS DD Form 2216 Follow-up Procedures
• Counsel; patient signs form to document
the need for a follow-up test. • Complete Follow-up #1 the same day (patient must be noise free for 14 hours ). • If STS, re-establish DD2215 audiogram. • Follow-up #1 must be completed within 30 days of the annual test.

Positive STS
DD Form 2216 Follow-up Procedures
Follow-up #1 • Complete Follow-up #1 (14 hours noise free)** • Counsel; patient signs DD 2216 (an OSHA notification requirement) • If STS resolved, no further testing required Follow-up #2 • Complete FU #2 (can be same day as F/u #1)** • When STS noted, counsel; patient signs form • If STS resolved, no further testing required ** Follow-ups #1 and #2 must be completed within 30 days of annual test

Positive STS
DD 2216 Follow-up Procedures (Cont.)
Audiological Referral • When STS is confirmed after Follow-up #2 • Refer for complete audiological evaluation • Re-establish the DD 2215, Reference Audiogram

STS
"Red Flags" when STS confirmed:
• Notify employee and their supervisor/commander within 21 days of F/u #2. • Re-fit employee with hearing protection. • Identify any new noise hazards in workplace. • Enforce the use of hearing protection and increase supervision. • Provide additional health education.

OSHA REPORTABLE HEARING LOSS (ORHL)
• OSHA Reportable Hearing Loss:
- Occurs when a + 25 dB or greater average change occurs at 2K, 3K, AND 4K Hz, in either ear, when compared to the original baseline (reference or re-established reference). - Only reported the first time per ear and again when an additional 25 dB or greater average decrease in hearing thresholds occurs in either or both ears. - DOEHRS-HC automatically identifies individuals with an OSHA RHL and prints an OSHA RHL log. A list of all individuals with OSHA Reportable Hearing Loss can be obtained from DOEHRS-HC Reports.

New Record Keeping Rule for Hearing Loss
Title 29 CFR Part 1904.10

If an employee’s hearing test (audiogram) reveals. . . a work-related Standard Threshold Shift (STS) in one or both ears, and the employee’s. . .[average] hearing level is 25 decibels (dB) or more above audiometric zero ([the] average at 2000, 3000, and 4000 Hz) in the same ear(s) as the STS, you must record the case on the OSHA 300 Log.

New Record Keeping Rule for Hearing Loss
• Hearing loss is reportable when:
– A STS occurs (an average 10 dB or greater change for thresholds averaged at 2,3, and 4 k Hz in either ear from the current baseline audiogram) and. . . – Hearing thresholds for the current audiogram show an average of 25 dB or greater at 2, 3, and 4 k Hz from audiometric zero for the shifted ear

Department of Defense Policy (future changes)

The 15 dB shift at 1, 2, 3 or 4 k Hz will be dropped from the DOD STS definition, but will be retained as an early warning flag. No follow-up will be required when a 15dB shift occurs

Management of OSHA Reportable Hearing Loss
• Keep a copy for your records • Use the OSHA RHL log to notify Safety and/or Occupational Health that an OSHA Reportable Hearing Loss has occurred • Must notify the supervisor/unit commander in writing within 21 days. • Supervisor/unit commander must complete the appropriate form (CA-1, CA2), within 7 calendar days (DA 285) within 6 days and submit to the Safety and/or Occupational Health Office • The CA-1, CA2, and DA Form 285 will be used to complete the OSHA 300 Log • Only done once and each time another OSHA Reportable Hearing Loss occurs

New Record Keeping Rule for Hearing Loss (Forms)
• Three recordkeeping forms
– OSHA Form 300 – Log of Work-Related Injuries and Illnesses – OSHA Form 300A – Summary of Work-Related Injuries and Illnesses (required annually.) – OSHA Form 301 – Injury and Illness Incident Report (individual report) – Tutorial
OSHA Forms for Recording Work-Related Injuries http://www.osha. gov/recordkeeping/OSHArecordkeepingforms.pdf

New Record Keeping Rule for Hearing Loss
• The ruling is not retroactive and only applies to periodic (DD2216) audiograms performed after December 31, 2002. • Authority to implement the new reporting rule has not yet been finalized by DOD.

Records Maintenance DD 2215 and DD 2216 Audiograms

• Copy for individual’s medical record • Other copies may be required by service regulation or local policy • Audiologist or physician reviews audiograms with high reference thresholds and STS (must be confirmed and determined to be noise-induced) • HC technician reviews all other audiograms

Record Maintenance (cont.)
• Maintain audiometric and noise exposure data for duration of individual’s enlistment or employment, plus 30 years. • Provide copies of an employee’s audiometric test and noise exposure data to the employee, former employee, or people designated in writing by the employee to receive the records. • Forward data from all DD 2215s & 2216s to the DOEHRS Data Repository monthly. • Maintain annual electro-acoustic calibration records for 5 years.

Hearing Test Booth Certification
• Must be certified annually (by audiologist or industrial hygiene). • Post in plain view on booth. • Retain these certification data locally for 5 years.

Rosters of Noise-exposed Personnel
• Personnel enrolled in a HCP must be identified by name and IDN/SSN. • Rosters will be maintained by the medical surveillance personnel and updated at least semi-annually. • Records of health education training for noise-exposed personnel should be kept for a minimum of 5 years.

DoD Guidelines vs. OSHA Guidelines
• TWA (varies by service/organization): OSHA 85 dBA and 5 dB exchange rate Army/Air Force 85 dBA and 3 dB exchange rate Navy 85 dBA and 4 dB exchange rate • STS Criteria All permanent STS after F/u #2 must be reported to Occupational Health & Safety Offices. STS that meets OSHA Reportable Hearing Loss (RHL) must be submitted in writing (added to the Log of Federal Occupational Injuries and Illness). Civilians (CA-1 or CA-2 Form submitted) Military (DA Form 285 – Accident Report)

Audiology Workload Reporting
• Requirements for reporting workload may vary between commands. • Utilize the Composite Health Care System (CHCS) and the Ambulatory Data System (ADS) for capturing workload information. • Utilize the MEPRS code (FBN_*) to capture hearing conservation program workload accurately. *Add any alpha or numeric character to
distinguish the type of provider (audiologist/ technician) or level of service offered.
32

Recordkeeping
I. The objective of this lesson is to learn about the recordkeeping requirements of a Hearing Conservation Program by identifying the forms and how they are used and by understanding and implementing the guidelines for STS follow-up procedures.
II. REFERENCES: Workbook

The DD Form 2217

1a-d Audiometer Information 2a-c Listener Information 3. Dates and Data Review - Dates of calibration and the examiner. Indication of daily calibration pass or failure. 4. Threshold Levels - Daily calibrations must be within +/-5dB of the baseline test for all frequencies except at 6000Hz (a +/- 10 dB difference is allowed). 5. Remarks - When calibration fails, the form should be printed and an explanation given for the failure and corrective action taken.

The DD Form 2215

Patient Demographic Information
1. 2. 3. 4. 5. 6. 7. 8. 9. Must be Installation’s Zip Code DoD Component Service Component SSN Name Date of Birth (YYYY/MM/DD) Sex Pay Grade Uniformed Pay Grade Civilian 10. Service Duty Occupation Code 11. Mailing address of assignment (the UIC information appears in this block) 12. Location – Place of Work 13. Major Command 14. Duty Phone

The DD 2215 (cont.)

1.

The most common purpose is #2 (reference established following noise exposure). #3 is used to re-establish reference thresholds of individuals with permanent STS. 2. Audiometric Data (“M” indicates data manually entered) 3. Date of Audiogram 18. Meets Referral Criteria 19. Military Time of Day 20. Must be at least 14 hours noise free 21. Patient must not have ENT problems at time of testing. 22. Examiner Information 22a. Must be CAOHC certified 22b. Has changed from a 6 digit numeric to a 7 digit alpha/ numeric. The first 6 numeric characters denote “year”, “course no.” and “student number”; the last character (alpha) indicates who did the training (A-Army, F-Air Force, N-Navy, CContractor). The system will accept certification numbers in both formats. 22c. Job title code of the examiner (MOS-Army, AFSC-Air Force, NEC/NOBCNavy) 22d. Office Symbol of Examiner

The DD 2215 (cont.)

1. 23a. 23b. 23c. 23d. 23e. 7. 24a. 24b. 24c. 24d. 24e. 25.

Audiometer Information Microprocessor CCA-200 Benson Medical Serial Number Test must be performed within 12 months of the last acoustic calibration date Personal Hearing Protection Indicates type of hearing protection Individuals can have different sizes for each ear Indicates whether double protection is used Glasses Worn (refers to eye glasses) Frequency of glasses used Remarks (remarks cannot be entered at the time of testing, but can be through the audiogram edit process)

The DD Form 2216

Information in fields 1-14 are the same as those in the DD 2215 3. Audiometry 15a. Most 2216s will be purpose #2 (annual). Upon leaving government employment, all civilians and military personnel should receive a termination audiogram (#3). 15b. Current audiogram date – the current audiogram is compared to the reference audiogram (15c) to determine whether a significant threshold shift has occurred. A positive shift indicates worse hearing thresholds and a negative shift indicates improved hearing thresholds (+/- 10 dB average shift at the frequencies of 2000, 3000 or 4000 Hz or +/- 15 dB shift at any one frequency between 1000-4000 Hz).

The DD 2216 (cont.)

15d. Indicates whether a shift has occurred. Persons who have an STS must return for follow-up testing. 15e. Positive and negative shifts require follow-up within 30 days; negative shifts may be performed on the same day as the test identifying the negative STS; however, positive STS must be retested after 14 noise-free hours 15f. The individual must sign the 2216 acknowledging that the STS has occurred and the need for a follow-up test. 15g. Hearing protection information 15h. Examiner name 15i. Examiner certification number (see DD 2215 22b for further explanation) 15j. Examiner’s job title code (MOS - Army, AFSC - Air Force and NEC/NOBC - Navy) 15k. Examiner’s office symbol

The DD 2216 (cont.)

The same audiometric data is required for both the DD 2215 and the DD 2216

1.

Follow-up #1 - Individuals who show an STS on their annual test must return for a Follow-up #1. (a) The Follow-up #1 for a negative STS may be conducted on the same day as the annual, if performed after 14 noise-free hours. (b) When STS on Follow-up #1 is negative, the patient’s reference thresholds must be re-established to reflect the improved results. (c) If the STS on Follow-up #1 is positive, the patient must complete a Follow-up #2 within 30 days.

The DD 2216 (Cont.)

A positive STS on a Follow-up #2 requires medical review for proper patient disposition. The reference audiogram is re-established after proper medical review to determine the cause of the hearing loss. The patient is counseled and fitted with new hearing protection. The medical review may require referral to an audiologist or a physician.