How to Fill Out Official Audiogram Data Sheet

Official Audiogram Data Sheet at a glance

What it is: The OFFICIAL AUDIOGRAM DATA SHEET of the International Committee of Sports for the Deaf: athletes need to complete this form fully to receive an Identification number to participate in upcoming Championship or Deaflympics events.

Where and when to file: Please print or use typewriter and send the form to your National Deaf Sports Federation for review. This form must be completed three (3) months before the event.

What to bring and attach to Official Audiogram Data Sheet

Official ICSD Audiogram form must be used.

A filled-in Official Audiogram Data Sheet example: an athlete's audiogram data sheet

Official Audiogram Data Sheet example filled out, example: an athlete's audiogram data sheet
An audiologist completes the audiogram form for Jane Sample, a deaf volleyball player. The examination was on March 3, 2026, with an ANSI 1969 audiometer. The picture shows page 1 and every value in it is made up. Air conduction and bone conduction, tympanometry and reflexometry, pure tone average and type of hearing loss, and comments stay empty because the audiologist has not yet entered the test results.

How to fill out Official Audiogram Data Sheet, box by box

Name, nation, sport and date of birth

Official Audiogram Data Sheet example filled out, name, nation, sport and date of birth

Under Name, enter the Family Name (Last Name), the Given Name (First Name) and the Other Names (Middle Name).

Enter the Nation, the Sport and the Date of Birth as (day / month / year).

Audiometer, examiner and date of examination

Official Audiogram Data Sheet example filled out, audiometer, examiner and date of examination

The yellow box with numbers indicates required fields for you to enter: Audiometer, the name of the audiometer; Examiner Name, the name of the audiologist who performs the test.

Calibration: indicate the name of the calibration used, ANSI 1969, ISO 1964 or Other. Date of Examination: enter the examination date as (day / month / year).

Air conduction and bone conduction

Official Audiogram Data Sheet example filled out, air conduction and bone conduction

All four (4) types of audiogram testing must be filled out entirely for EACH ear. Air Conduction: test on 500, 1000, and 2000Hz. Bone Conduction: test on 500, 1000, and 2000Hz.

If there are no responses in Air Conduction or in Bone Conduction, write NR as noted in “Key to Symbols”.

Tympanometry and reflexometry

Official Audiogram Data Sheet example filled out, tympanometry and reflexometry

For Tympanograms (Tympanometry), write numbers. For Acoustic Reflexes (Reflexometry), write numbers or NR if there are no responses. Do not use dash mark (-) or zero (0).

Pure tone average and type of hearing loss

Official Audiogram Data Sheet example filled out, pure tone average and type of hearing loss

Pure Tone Average: add 500, 1000, 2000Hz and divide by three (3) for both air and bone testing results.

Type of Hearing Loss: identify the type of hearing loss by placing ‘X' accordingly as shown on the form for respective ear.

Comments

Official Audiogram Data Sheet example filled out, comments

Comments: write comments as needed about this athlete. If there are no Tympanogram or reflex equipments to test, write comments in English.

More rules for Official Audiogram Data Sheet

Failure to observe the requirements will result in delayed approval.

Common questions about Official Audiogram Data Sheet

Is there a deadline?

This form must be completed three (3) months before the event.

Where do I file it?

Please print or use typewriter and send the form to your National Deaf Sports Federation for review.

Sources

[1] Official Audiogram Data Sheet, International Committee of Sports for the Deaf (the served file; no issuer file found) (the Official source link on this page).

Audiogram Form PDF Details

The Audiogram Form is a pivotal document officially recognized by both the International Committee of Sports for the Deaf (founded in 1924) and the International Olympic Committee, serving as a comprehensive tool for evaluating athletes' hearing capabilities. Housed at 528 Trail Avenue, Frederick, Maryland, and accessible through controls@ciss.org, this form meticulously records various hearing metrics including air and bone conduction frequencies, impedance tympanometry, and reflexometry, among others. It's mandatory for athletes aiming to participate in prestigious events like the Deaflympics, regional, and world championships to submit this form post completion by a qualified audiologist. The form mandates detailed inputs such as the type of audiometer used, calibration details, exhaustive hearing threshold levels across a wide range of frequencies, and identification of hearing loss type, which are essential for the accurate assessment of an athlete's hearing levels. Furthermore, it introduces a structured guideline for audiologists, emphasizing the importance of using the designated form downloadable from the Deaflympics website, and encompasses a stringent compliance to the testing protocols outlined, ensuring that each ear is evaluated across specified parameters. This not only aids in maintaining uniformity across evaluations but also helps in the identification and categorization of hearing loss, facilitating a fair and equal playing field for participants. The audiogram form stands as not merely a procedural necessity but a significant medium ensuring inclusivity and fairness in sports for the deaf, marking an essential step towards their participation in international sports events.

QuestionAnswer
Form NameAudiogram Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesaudiogram template word, audiogram forms, blank audiogram pdf, audiogram template