Industrial deafness claim form from Russell Jones & Walker Solicitors
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Industrial Deafness Questionnaire

Equality Express

Thank you for choosing to complete our online questionnaire.

Please complete the questions in as much detail as you can. This information will enable us to provide you with preliminary advice as to whether or not you might have a claim for industrial deafness, and if so, what your options are.

Once you have completed the form please check the details and pres the submit form.

This form will take approximately 10 minutes to complete.


If you would prefer to fill this form out over the phone please call:


0870 143 0970


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  • Step 4
 

Noise exposure details

  • Did the noise prevent you from talking to fellow workers?
  • Did you need to lip read, or shout, to make yourself heard?
  • Was hearing protection made available?
  • Was the wearing of it enforced?
  • Did you wear hearing protection?
  • Did your employer provide you with a hearing test at any time during your employment?
  • Save your form and continue later
 

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