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Course Director Request for Occupational Hearing Conservation Course Approval

Printable form (PDF file)

Effective January 2007.

Complete this form, submit it online or print and mail or fax to the address at the bottom of the page. Any field with an * must be completed or the form application will be negated electronically.

Sponsor:* (Company, Clinic, University,
Course Director, etc.)
Course Location:   City:*
Course Dates (mm/dd/yy):* to

Initial Course
Combination  (Refresher Date) 

Only one course per form.

Course Director:*
Certification # *
CD Mailing Address:*
Course Director E-mail:* 
Course Faculty 1  
Name (Course Director):
Discipline (at least 3): 
Phone Number: 
Course Faculty 2  
Discipline (at least 3): 
Phone Number: 
Course Faculty 3
Discipline (at least 3): 
Phone Number: 
Course Faculty 4  
Discipline (at least 3): 
Phone Number: 
Course Faculty 5  
Discipline (at least 3): 
Phone Number: 
Time Presenter (ref.# above)

Course Material

Initial Refresher
A. Introduction to hearing conservation 30 min. N/A
B. Anatomy, physiology of the ear, and hearing disorders 60 min. N/A
C. Hearing and the physics of sound 45 min. N/A
D. Federal and state regulations related to noise and hearing loss 75 min. 60 min.
E. Audiometer and test environment 90 min. 30 min.
F. Audiometric techniques 60 min. 30 min.
G. Audiometric practicum (supervised) 165 min. 60 min.
H. Review of audiometric evaluation 60 min. N/A
I. The audiogram and employee follow-up 60 min. 60 min.
J. Noise measurement and control 45 min. N/A
K. Personal hearing protection devices (HPDs) 60 min. 60 min.
L. Hearing protector-fitting practicum, including ear inspection (supervised) 60 min. 30 min.
M. Employee training, education and motivation 60 min. 45 min.
N. Recordkeeping 60 min. 45 min.
O. Role of the Occupational Hearing Conservationist 30 min. 30 min.
P. Instruction or practicum, with topic(s) at discretion of CD 90 min. 30 min.


Q. Review of hearing conservation programs 60 min. N/A
R. Examination 90 min. 30 min.
If you are submitting online, you MUST read the following and agree by checking these boxes BEFORE you submit your application.

I verify that this course, if approved by CAOHC, will adhere to the information stipulated in this application, and that I will be physically present and readily accessible throughout the course. If the CD responsible for a course changes, the replacement CD must submit a new approval form prior to the course.

I will provide a student roster [including any changes to faculty, material, etc.] AND certification/recertification application(s) with appropriate fee(s) for all successful students to CAOHC within 60 days of course completion.

I will give a written exam to students in a 20-hour certfication course according to the procedures outlined by CAOHC. [Effective January 1, 2004]

I will give a written exam to students in an 8-hour recertfication course according to the procedures outlined by CAOHC. [Effective January 1, 2005]

Signature (if submitting by mail or fax): ___________________________________________

Date: ____________

[NOTE: Individuals auditing CAOHC-approved courses are not eligible for certification or recertification.]

Until further notice, CDs within the DoD are exempt from administering CAOHC applications and fees for students.

Payment Information*
$15.00 per application - per Course Director - 1 course applied for at one time
$15.00 per application - per Course Director - date or city/state revision only
Payment Type:*
(online orders are payable by credit card only)
Money Order
American Express
Name on Card:*
Credit Card Number:*
Expiration Date (MM/YY):*

* indicates required field

555 E. Wells Street, Suite 1100, Milwaukee, WI 53202-3823
Phone: 414/276-5338    Fax: 414/276-2146

This course application  ___ does  ___ does not meet CAOHC requirements. Comments:



Signature: _______________________________________________ Date: ____________