Ears/hearing Accomodation Field Exam Form - New Mexico Department Of Public Safety Training Center
Download a blank fillable Ears/hearing Accomodation Field Exam Form - New Mexico Department Of Public Safety Training Center in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Ears/hearing Accomodation Field Exam Form - New Mexico Department Of Public Safety Training Center with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1New Mexico Department of Public Safety Training Center
4491 Cerrillos Road, Santa Fe, New Mexico 87507
(505) 827-9251―(877) 237-7532 (NM Only) ―Fax: (505) 827-3449―
EARS/HEARING ACCOMODATION FIELD EXAM
1. Applicant Name (Last, First, Middle)
2. Birth Date (Mo./ Day/Year)
3. Department
Ears and Hearing Accommodation Field Exam
This applicant failed to meet the one or more of the parameters for hearing in Section2.1. This field test simulation must first be administered to an
individual with acceptable hearing and then to the applicant that is hearing impaired. The purpose of the field test is to determine if the applicant can hear
words or sounds that are safety sensitive to him or another. If the applicant has hearing loss at a significant level in both ears, it does not matter which
direction the projected sound comes from. If the applicant has hearing loss at a significant level in one ear, or one ear worse than the other, then the
projected sound must come from the direction of the affected ear. The field test consists of the following. Both field tests must be passed at 100%.
FIRST TEST
: The first test consists of three parts and simulates an officer contact with an individual on a busy street, highway, or interstate located
within the agency jurisdiction.
Part 1
: Officer approaches an accident scene with a victim trapped inside the vehicle. The victim tells the officer that their leg is trapped under the steering
column. Victim will speak in a normal voice.
Officer correctly hears victim’s words.
Officer failed to correctly hear victim’s words.
Officer approaches a traffic violator and is speaking with the driver when his partner back at the patrol car calls out, from 30 feet away, that the
Part 2:
man in the back seat has a gun. Partner officer will speak in an excited voice and louder than normal volume.
Officer correctly hears partner’s words.
Officer failed to correctly hear partner’s words.
Part 3:
Officer is conducting a field interview of an individual when a second individual approaches from behind and says in a normal voice, from 10 feet
away, "I am going to kill you."
Officer correctly hears individual’s words.
Officer failed to correctly hear individual’s words.
SECOND TEST
: consists of three parts and simulates an officer in a building conducting a search in a dark and silent room, aside from normal HVAC
operations.
Part 1:
Officer will listen to directions whispered by partner officer in same area, 15 feet away.
Officer correctly hears partner’s directions
Officer failed to correctly partner’s directions.
Officer will hear a suspect breathing normally from 10 feet away around a corner.
Part 2:
Officer correctly hears suspect breathing.
Officer failed to hear suspects breathing.
Part 3:
Officer will hear a trigger being cocked/or slide being manipulated, from 15 feet away in the same room.
Officer correctly hears weapon.
Officer failed to correctly hear weapon.
Applicant passed all six tests.
Applicant failed one or more tests.
I, ____________________________________certify that the listed field exam for hearing was
Please type or print Department Head
conducted on___________________________________ by _____________________________ on
Officer/Department representative
Applicant
(date)_____________________ and the results listed are correct.
Department Head Signature________________________________________________
}
State of New Mexico
County of _______________}SS
On this ____________day of _____________, ________, before me personally appeared
____________________________________ known to me to be the person whose name is subscribed
Department Head
to the above instrument and acknowledged the same to be his/her own free act and deed.
Notary Public________________________________My commission expires:_________________
(SEAL)
MEDICAL FORMS (Hearing)
Revised 01-17-12
LEA-EH
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Lea-pst - Safety Telecommunicator Training Paperwork Checklist Form - New Mexico Department Of Public Safety Training Center
Legal
Continuation Of Certification Annual Firearms Training Report Form - New Mexico Department Of Public Safety Training Center
Legal
Annual School Influenza (flu) Immunization Consent Form - New Mexico Department Of Health 2015-16
Legal
Form Pi-1 - Application For Licensure - Oregon Department Of Public Safety Standards And Training
Legal
Related Categories
Parent category: Legal