Work Relatedness Determinations

OSHA Recordable Work Relatedness Determinations

Pursuant to 29 CFR 1904, potentially Recordable hearing loss events may undergo comprehensive case study to determine Work Relatedness. Applicable OSHA 300 log entries may be "lined off" upon a non-occupational determination.

Our convienent Form

Work Relatedness Determinations (WRDs) require submission of a Work Relatedness Determination Questionnaire.
  WRD Questionnaire.pdf

We suggest that the HCP coordinator complete this form via an interview process. Every effort to ensure that all questions are answered satisfactorily is requested. An accurate employee time weighted noise exposure level is required for determinations.

Sending Us Your WRD

Mail forms to:
 T K Group, Inc.
ATTN: Data Processing
1781 S. Bell School Rd.
Cherry Valley, IL 61016

Fax forms to:
(815) 332-5175
ATTN: Data Processing

Email forms to:
 audiology@tkontheweb.com

OSHA Recordable Work Relatedness Determinations

After submitting a Work Relatedness Determination Questionnaire, your reviewing Audiologist will promptly return a determination pursuant to your preference (mail or email). Emailed documents will be encrypted for security at your request.

Please note that before T K Group can perform A Work Relatedness Determination we must have a signed contract with your company. If you just want a Work Relatedness Determination and no other TK Group services please fill out and return the following form.
  Contract for Extended Questionnaire.pdf