CAOHC Medical Referral Criteria and Follow-up 1 — Questions and Answers
Question 1: Under OSHA's Hearing Conservation Amendment (29 CFR 1910.95), which finding most clearly requires referral to a physician or audiologist?
- A 5 dB shift at any single frequency from baseline
- A confirmed Standard Threshold Shift (STS) of 10 dB average at 2000, 3000, and 4000 Hz (Correct answer)
- Any audiogram showing thresholds above 15 dB HL
- A worker complaint of ringing in the ears after a single shift
Correct answer: A confirmed Standard Threshold Shift (STS) of 10 dB average at 2000, 3000, and 4000 Hz
OSHA defines STS as a 10 dB or greater average shift at 2000, 3000, and 4000 Hz, and a confirmed STS triggers the mandatory referral requirement.
Question 2: Within what timeframe must an employer notify a worker of a confirmed Standard Threshold Shift under OSHA's hearing conservation standard?
- Within 5 working days of the audiometric test
- Within 21 calendar days of the determination (Correct answer)
- Within 30 working days of the end of the testing cycle
- Within 60 calendar days of the annual test
Correct answer: Within 21 calendar days of the determination
OSHA requires workers to be notified of a confirmed STS within 21 calendar days of the determination.
Question 3: After a worker is found to have a confirmed STS, the employer must take which of the following steps if the worker is not already under physician care for hearing loss?
- Immediately reassign the worker to a quieter department
- File an OSHA 300 recordable entry within 24 hours
- Refer the worker to a physician or audiologist at no cost to the worker (Correct answer)
- Retest the worker every week for 90 days before referral
Correct answer: Refer the worker to a physician or audiologist at no cost to the worker
OSHA mandates that workers with a confirmed STS who are not under a physician's care be referred to a physician or audiologist at employer expense.
Question 4: An OHC observes that a worker's audiogram shows an unusual audiometric configuration — a sudden deep notch at 250 Hz only. What is the most appropriate action?
- Document it as normal noise-induced hearing loss pattern
- Retest in a different booth and average the two results
- Refer the worker to a physician or audiologist for further evaluation (Correct answer)
- Apply age correction and retest at the next annual cycle
Correct answer: Refer the worker to a physician or audiologist for further evaluation
Unusual or atypical audiometric configurations that do not fit expected noise-induced patterns require physician or audiologist referral.
Question 5: Which of the following is a valid reason for an OHC to make an immediate physician referral, independent of audiometric threshold findings?
- Worker reports that hearing protection feels uncomfortable
- Worker's thresholds show a minor improvement at 4000 Hz
- Worker presents with visible ear drainage, ear pain, or signs of infection (Correct answer)
- Worker has worked in noise-exposed areas for fewer than 6 months
Correct answer: Worker presents with visible ear drainage, ear pain, or signs of infection
Physical symptoms such as ear drainage, pain, or signs of infection indicate a medical condition requiring physician evaluation regardless of audiometric results.
Question 6: What is the OHC's primary responsibility after a worker has been evaluated by a physician following a referral?
- Determine whether the physician's findings are work-related and file accordingly
- Assume responsibility for the medical treatment plan going forward
- Document the referral outcome and update the worker's audiometric record accordingly (Correct answer)
- Re-administer the audiometric test to verify the physician's conclusions
Correct answer: Document the referral outcome and update the worker's audiometric record accordingly
The OHC's role after physician evaluation is to document the referral and findings and maintain accurate audiometric records — not to interpret or dispute medical conclusions.
Question 7: An employer instructs an OHC not to refer a worker to a physician after an STS is confirmed, fearing it will create an OSHA recordable entry. What should the OHC do?
- Follow the employer's instructions since liability rests with the employer
- Delay the referral until the worker's next scheduled annual audiogram
- Follow OSHA's requirements and make the referral as mandated (Correct answer)
- Request written confirmation from the employer before proceeding
Correct answer: Follow OSHA's requirements and make the referral as mandated
OSHA standards require STS follow-up referrals; an OHC must comply with regulatory requirements regardless of employer pressure to avoid recordables.
CAOHC Medical Referral Criteria and Follow-up 1
Under OSHA's Hearing Conservation Amendment (29 CFR 1910.95), which finding most clearly requires referral to a physician or audiologist?