Jenkins Academy of Applied Technology

Audiometric process — administrative readiness only

Hearing Conservation and Noise · v1.0.0 · October 21, 2026

Blank means pending. This local form does not save entries to an account. Print or save your completed employer copy. Record actual observation, correction and reassessment. Keep audiograms, hearing thresholds, diagnoses and clinical findings in the authorized private process. An LMS pass, appointment or signature does not establish actual exposure, fit or a hearing-test result.

Applicable legal scope or confirmed employer-adopted construction program referenceAuthorized program contact, private provider/record custodian and access routeProvider qualifications/professional responsibility and controlled evidence for appropriate test conditions/calibrationFirst covered exposure date, applicable baseline deadline and actual appointment/completion referenceGI mobile-van exception if applicable: one-year outer deadline and protection during exposure beyond six months until baselineActual baseline preparation instructions and non-work-noise advice; applicable provider/state additionsApplicable annual or adopted program schedule and arrangements for missed appointmentsPrivate comparison, professional review, permitted retest and written notification workflow with responsible ownerGI STS notice process: 21 days from determination; fitting/retraining/control-review/referral routes as applicableControlled actual evidence reference and outstanding administrative actions — no audiogram, thresholds, diagnoses or clinical findings in this form