SAMPLE  SCREENING LOG

	OAE 1	OAE 2	OAE 3		
Name	Location	Date
 initial screen	Right/Left Ear
   Pass
   Refer 
   Couldn’t Test	Right/Left Ear
   Pass
   Refer 
   Couldn’t Test	Right/Left Ear
   Pass 
   Refer 
   Couldn’t Test	Next Step	

			R:
L:	R:
L:	R:
L:		

			R:
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L:	R:
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			R:
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			R:
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L:	R:
L:		

			R:
L:	R:
L:	R:
L:		

			R:
L:	R:
L:	R:
L:		

			R:
L:	R:
L:	R:
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			R:
L:	R:
L:	R:
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			R:
L:	R:
L:	R:
L:		

			R:
L:	R:
L:	R:
L: