Mon - Fri 9:00 - 17:30
Test Result
Company Address:
Name:
NRIC/FIN:
DOB:
Sex:
Emp. No.:
Date Joined:
Job Title:
Years of Exposure:
(including previous jobs)
Dept:
IHD:
Previous Result
Does the employees wear hearing protector when exposed to excessive noise ?
Was the employee counselled on the usage of hearing protectors ?
Right
Click the value you want to input
Left
Click the value you want to input
AC: Air ConductionBC:Bone Conduction
Under the above regulations BC should be done when AC is focused Abnormal
Name of Tester
Date Tested
Air Conduction Test
Bone Conduction Test
To be completed DWD:
Autoscopic Examination Finding
Right
Left
Diagnosis:
Action Plans:
Certification of fitness to work in noisy environment
Singapore Occupational Health Services Pte Ltd
16 Ayer Rajah Crescent, Tempco Technominium, #06-06B, Singapore 139955. Tel: 68725020, 67772829.
- Workspace Safety and Health Act 2006
- Workspace Safety and Health (Medical Examinations) Regulations 2011
- Workspace Safety and Health (NOISE) Regulations 2011
Air Conduction Test
Bone Conduction Test
| FREQ/KHz | 0.5 | 1.0 | 2.0 | 3.0 | 4.0 | 6.0 | 8.0 |
|---|---|---|---|---|---|---|---|
| Rt AC/db | |||||||
| Lt AC/db | |||||||
| Rt BC/db | |||||||
| Lt BC/db |
Otoscopy
Action Plan
Certification of fitness to work in noisy environment
This audiogram is vetted by the Designated Workplace Doctor and do not require any signatory.
Dr Teo Tiong Kiat MBBS, GDOM, GDMH, MCR M01507E, DWD 0088
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