"Following is an outline of the responsibilities of the audiometric testing program's professional supervisor, who must be an audiologist, otolaryngologist, or other physician. This person's role is to supervise the audiometric testing conducted by the OHC, recommend follow-up procedures, manage the audiometric database, and determine the work-relatedness of an employee's hearing loss…A clear understanding of each person's role will enhance the effectiveness of the hearing conservation program."

1910.95(g)(3) Audiometric Testing Program
"Audiometric tests shall be performed by a licensed or certified audiologist, otolaryngologist, or other physician, or by a technician who is certified by the Council for Accreditation of Occupational Hearing Conservation…A technician who performs audiometric tests must be responsible to an audiologist, otolaryngologist, or physician."

1910.95(g)(7) (iii) Evaluation of audiogram
"The audiologist, otolaryngologist, or physician shall review problem audiograms and shall determine whether there is need for further evaluation. The employer shall provide to the person performing this evaluation the following information:
1910.95(g)(7)(iii)(A)
A copy of the requirements for hearing conservation as set forth in paragraphs (c) through (n) of this section;
1910.95(g)(7)(iii)(B)
The baseline audiogram and most recent audiogram of the employee to be evaluated;
1910.95(g)(7)(iii)(C)
Measurements of background sound pressure levels in the audiometric test room as required in Appendix D: Audiometric Test Rooms;
1910.95(g)(7)(iii)(D)
Records of audiometric calibrations required by paragraph (h)(5) of this section."

1910.95(g)(8) Follow-up Procedures
"1910.95(g)(8)(i)
If a comparison of the annual audiogram to the baseline audiogram indicates a standard threshold shift as defined in paragraph (g)(10) of this section has occurred, the employee shall be informed of this fact in writing, within 21 days of the determination.
1910.95(g)(8)(ii)
Unless a physician determines that the standard threshold shift is not work related or aggravated by occupational noise exposure, the employer shall ensure that the following steps are taken when a standard threshold shift occurs:
1910.95(g)(8)(ii)(A)
Employees not using hearing protectors shall be fitted with hearing protectors, trained in their use and care, and required to use them.
1910.95(g)(8)(ii)(B)
Employees already using hearing protectors shall be refitted and retrained in the use of hearing protectors and provided with hearing protectors offering greater attenuation if necessary.
1910.95(g)(8)(ii)(C)
The employee shall be referred for a clinical audiological evaluation or an otological examination, as appropriate, if additional testing is necessary or if the employer suspects that a medical pathology of the ear is caused or aggravated by the use of hearing protectors.
1910.95(g)(9)
"Revised baseline" An annual audiogram may be substituted for the baseline audiogram when, in the judgment of the audiologist, otolaryngologist, or physician who is evaluating the audiogram:
1910.95(g)(9)( i)
The standard threshold shift revealed by the audiogram is persistent; or
1910.95(g)(9)( ii)
The hearing threshold shown in the annual audiogram indicates significant improvement over the baseline audiogram."

1. Establish policies for adequate testing and appropriate use of audiometric and hearing-related questionnaire information.
2. Establish policies for adequate training and CAOHC certification of all individuals performing testing.
3. Ensure adequacy of test equipment and environment with reference to ANSI and OSHA standards.
4. Ensure proper protocols for testing, including noise-free intervals.
5. Ensure that OHCs are correctly following testing protocols, performing functional checks of equipment, and communicating with their Professional Supervisor regarding nonstandard situations.
6. Ensure proper protocols for review of audiograms by OHC to detect and refer Standard Threshold Shifts (STS) and other problem audiograms, including retesting if indicated.

1. Review problem audiograms, including a comparison of the baseline and subsequent audiograms.
2. Review test booth sound levels and audiometric calibration, and determine whether the testing environment was adequate.
3. Ensure that age correction is being correctly applied, if indicated.
4. Based on the above, determine whether there is a need for further evaluation.
5. Determine whether baseline revision is indicated.

1. Review the audiometric history and information regarding the adequacy of the testing environment and performance.
2. Review the medical history and determine whether additional medical evaluation is indicated. If such an evaluation is required, either performs the evaluation or makes appropriate referral for such testing, and then reviews the test results.
3. Review the history of exposures to occupational and non-occupational noise, as well as hearing protector use and exposures to ototoxic chemicals.
4. Based on the above evaluation, either make a determination of work-relatedness or make appropriate referral for final determination whether the hearing loss is work-related or due to other factors.
5. If the hearing loss is work-related, ensure that appropriate notification and follow-up take place.
6. Determine whether hearing loss is recordable on OSHA log.
7. If the hearing loss is not work-related, ensure that appropriate referral and follow-up take place.

1. Plan preventive strategy for individuals who have experienced a hearing shift from baseline. Strategies can include reduction of noise exposures, improved use of hearing protection, and/or work restriction.
2. Determine other appropriate follow-up actions for individuals with work-related hearing loss and communicate, as appropriate with supervisors, health and safety personnel and co-workers.

1. Oversee the management and integrity of the audiometric database, including record keeping and electronic record management, in order to ensure that audiograms are being correctly tracked and maintained in accordance with relevant federal regulations.
2. Ensure policies are in place to adequately safeguard the privacy and confidentiality of records in the audiometric database.
3. Periodically evaluate the audiometric database using techniques such as audiometric data base analysis (ADBA), to determine whether test-test variability is acceptable, and whether an unacceptable level of hearing loss is occurring.
4. Determine whether the results of this analysis indicate that further preventive action is warranted.

1. Suter, A., Hearing Conservation Manual. 4th ed, ed. E.H. Berger. 2002, Milwaukee: Council for Accreditation in Occupational Hearing Conservation. P. 5.
2. CAOHC: Scope of Practice Document for OHCs 2003
3. OSHA, 1910.95 CFR Occupational Noise Exposure: Hearing Conservation Amendment (Final Rule), in 48 Federal Register. 1983. P. 9738-9785.
4. MSHA Noise Regulation 30 CFR Part 62, in Federal Register Vol. 64 No. 176. 1999.