Hearing Screening Capacity Survey

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* 3. Who performs hearing screenings? (check all that apply)

On-staff SLP(s)

On-staff audiologist(s)

Other staff members

State or regional health department audiologists or SLPs

Contract SLPs

Contract audiologists

Other

If "Other," who?

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* 4. How serious are your issues with hearing screenings related to the following?

	0 - Not an Issue	1 - Mildly serious	2 - Moderately serious	3 - Serious	4 - Very serious
Scheduling & logistics for the volume of students	Scheduling & logistics for the volume of students 0 - Not an Issue	Scheduling & logistics for the volume of students 1 - Mildly serious	Scheduling & logistics for the volume of students 2 - Moderately serious	Scheduling & logistics for the volume of students 3 - Serious	Scheduling & logistics for the volume of students 4 - Very serious
Scheduling & logistics for on-staff SLPs/audiologists	Scheduling & logistics for on-staff SLPs/audiologists 0 - Not an Issue	Scheduling & logistics for on-staff SLPs/audiologists 1 - Mildly serious	Scheduling & logistics for on-staff SLPs/audiologists 2 - Moderately serious	Scheduling & logistics for on-staff SLPs/audiologists 3 - Serious	Scheduling & logistics for on-staff SLPs/audiologists 4 - Very serious
Scheduling & logistics for contractors	Scheduling & logistics for contractors 0 - Not an Issue	Scheduling & logistics for contractors 1 - Mildly serious	Scheduling & logistics for contractors 2 - Moderately serious	Scheduling & logistics for contractors 3 - Serious	Scheduling & logistics for contractors 4 - Very serious
Supervision of the testing program	Supervision of the testing program 0 - Not an Issue	Supervision of the testing program 1 - Mildly serious	Supervision of the testing program 2 - Moderately serious	Supervision of the testing program 3 - Serious	Supervision of the testing program 4 - Very serious
Costs of using outside contractors	Costs of using outside contractors 0 - Not an Issue	Costs of using outside contractors 1 - Mildly serious	Costs of using outside contractors 2 - Moderately serious	Costs of using outside contractors 3 - Serious	Costs of using outside contractors 4 - Very serious
Costs of hearing test equipment, training & maintenance	Costs of hearing test equipment, training & maintenance 0 - Not an Issue	Costs of hearing test equipment, training & maintenance 1 - Mildly serious	Costs of hearing test equipment, training & maintenance 2 - Moderately serious	Costs of hearing test equipment, training & maintenance 3 - Serious	Costs of hearing test equipment, training & maintenance 4 - Very serious
Reporting, data & record keeping	Reporting, data & record keeping 0 - Not an Issue	Reporting, data & record keeping 1 - Mildly serious	Reporting, data & record keeping 2 - Moderately serious	Reporting, data & record keeping 3 - Serious	Reporting, data & record keeping 4 - Very serious
Testing for students who are identified during the school year outside the regular testing periods	Testing for students who are identified during the school year outside the regular testing periods 0 - Not an Issue	Testing for students who are identified during the school year outside the regular testing periods 1 - Mildly serious	Testing for students who are identified during the school year outside the regular testing periods 2 - Moderately serious	Testing for students who are identified during the school year outside the regular testing periods 3 - Serious	Testing for students who are identified during the school year outside the regular testing periods 4 - Very serious

Other (please specify)

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* 5. Do you have any other comments regarding your capacity to provide hearing screenings for students? What about vision screenings?

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* 6. PresenceLearning is investigating the feasibility of delivering hearing screenings online. Would you be willing to do a 10-minute phone interview about your district's needs with respect to these screenings?

Yes (if yes, please provide contact info below)

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* 7. Contact information

Name

Organization Name

Phone number

Hearing Screening Capacity Survey

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* 1. What is your job title?

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* 2. How frequently does your school conduct hearing screenings? (choose all that apply)

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* 3. Who performs hearing screenings? (check all that apply)

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* 4. How serious are your issues with hearing screenings related to the following?

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* 5. Do you have any other comments regarding your capacity to provide hearing screenings for students? What about vision screenings?

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* 6. PresenceLearning is investigating the feasibility of delivering hearing screenings online. Would you be willing to do a 10-minute phone interview about your district's needs with respect to these screenings?

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* 7. Contact information