Employee Medical History Questionnaire

A questionnaire can be printed and used for collecting information that is supplemental to the annual hearing test. This will facilitate collection of the data. The form includes codes that are keyed to a "Fast Entry" mode in all HearTrak versions, minimizing the time required for entry of this data.


The above setup window is used to choose the options you wish to appear on the form. Once chosen and saved, you will not have to access this setup. To test the setup you have chosen, click on the "Create Sample Report" tab, select an employee and print a form.

These forms can be printed when working with the individual, or batch printed in the HearTrak Professional version. A sample printout is shown below. A small "o" in the lower right corner of some of the check boxes indicates that the condition was checked on the previous history.