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�1 C � � � Canter for <br />i HactFtnq FieaNh <br />ME/�RrHG C�MSERrLTlON 5FRY6CE5 <br />SERVICE CONTRACT AGREEMENT <br />Hearing Conservation Program <br />This agreement is between hereinafter known as the "Company" and Center for Hearing <br />Health, Inc., herinafter known as "CHH ". The purpose of this agreement is to bring together the resources and commitment <br />required to achieve the objectives of both parties. <br />a) CHH agrees to perform audiometric hearing tests on a mutually agreeable date, time, and place for employees of the Company. <br />b) The on -site hearing tests will be conducted onboard CHH's mobile van within aself- contained soundroom that has been constructed <br />by the manufacturer to meet the acoustical test environment criteria Each audiometer receives and annual exhaustive calibration and <br />is reassessed at each setup for performance accuracy. <br />c) Hearing tests will be performed by an audiometric technician who is certified by the Council of Accreditation in Occupational Hearing <br />Conservation. In addition to an academic degree, the supervising Audiologist holds a "Certificate of Clinical Competency in <br />Audiology" issued by the American Speech, language and Hearing Association and a current license from the state's Boazd of <br />Medical Quality Assurance. <br />d) Each employee will receive and audiometric pure tone air conduction test at the frequencies of 500, 1000, 2000, 3000, 4000, 6000, <br />and 8000 Hz taken separately for each eaz. Compliance with the permissible noise level of the test environment is measured and <br />monitored throughout the test procedure. CHH policy further directs the technician to record observations of each employee's <br />otoscopic exam and, when applicable, determine and perform retest verification, i.e., spurious or "problem" audiograms. <br />e) Test results will be individually reviewed and classified. A problem audiogram includes the reviewing Audiologist's stated opinion <br />and recommended action. <br />f) CHH manages the Company's hearing test records electronically. Ancillary forms (or master forms) used as a source of information <br />are provided by CHH. Note: CHH is classified "not a covered entity" pertaining to compliance with the privacy of medical records, <br />commonly known as HIPAA. Therefore, CHH is not required to obtain the employee's written consent to gather information, perform <br />a hearing test, or maintain related documents on file. <br />p)� CHH will present a summary Report to Management that documents all audiometric recordkeeping requirements along with <br />individual test results, specific instruction to guide the Program Manager's responsibility in the fulfillment of requirements and <br />recommendations, and a preprinted Audiologist Review Report for each employee whose test results suggest a medical and/or legal <br />follow -up, Generally, this report is delivered within l0 business days following completion of the on -site testing. <br />h) The CHH insurance portfolio includes general liability, auto liability, and workers' compensation coverage consistent with best business <br />practices. <br />Terms: Net 10 Days <br />The foregoing services are provided by CHH to the Company at the current published rate unless arranged otherwise at noted below: <br />Other considerations and/or comments: <br />Company Authorized Signature � <br />Center for Hearing Health <br />� � - - Trent Lubiens - President <br />-4 <br />Date: � ■ - Date: July 13, 2011 <br />r � <br />80_0- 228 -6067 530- 888 -9977 fax 530- 888 -1177 / 2945 Bell Rd., #122, Auburn CA 95603 <br />_ chh .centerforhearinQhealth_com / www.CenterforHearingHealth_com <br />�fi�l�t <br />