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Jefferson County Public SchoolsEarly Childhood Hearing Screening Results2016-2017School______________________________ Teacher_____________________________Student’s NameDate of ScreeningResultsNotes1. Jane Doe9/9/14Pass/Fail2.3.4.5.6.7.8.9.10.11.12.13.14.15.16.17.18.19.20.All Students must be screened within 45 calendar days of entryChildren who were absent on their classroom screening day and newly enrolled children should be referred to your site’s speech pathologist for screening.For assistance, please contact your Resource Teacher or Health Coordinator (Laura Boisseau 6847)ECH Centers will receive additional information for screening new children.Speech Pathologists: Please return this form to the classroom teacherTeachers: Please enter results on the ECH Hearing screening tab. ................
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