Military Claims

Noise Induced Military Hearing Loss

The form below will give us the information that we need to assess your claim. Make sure that all sections are filled out to allow us to accurately progress your claim.

Induced Hearing Loss - Military

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Title

Address:

Tel Work:

Forename:

Postcode:

Tel Mobile:

Surname:

Tel Home:

Email:

Date of Birth:

DD slash MM slash YYYY

National Insurance Number:

Current Occupation:

Preferred Mode of Communication

When did you first start experiencing hearing loss?

What do you believe has caused your hearing loss?

Did the hearing loss come on gradually or all of a sudden?

Please provide details

Have you ever linked your hearing loss to exposure to noise within the Armed Forces?:

If yes when and provide an explanation how:

Name of your GP:

Address of Your GP:

Have you attended your GP or any hospital as a result of your symptoms?

Can you remember any dates of attendance?

If a specific date cannot be provided, an approximate year will be useful.

What did your GP or Hospital diagnose or advise?

Did you discuss your employment/exposure at work with your GP/Hospital? If so, what was discussed?

If you have attended any hospital, please provide the full name/address:

Have you attended anywhere such as boots or Specsavers for any hearing test? If yes, what date did you attend

If a specific date cannot be provided, an approximate year will be useful.

Have you had any other hearings tests in the past?

If yes please provide full details.

Have you made any previous claim for NIHL?

Have you ever Instructed any solicitor to claim for NIHL previously?

Have you ever had any compensation from any previous employer for NIHL?

Have you ever been fitted with a hearing aid or treated for tinnitus?

If yes, please provide full details.

Do you have any symptoms of Hyperacusis? (finding loud noises uncomfortable)

Please provide examples if so.

Have you ever had any noisy hobbies (eg. shooting, motorbike racing, playing the drums/electric guitar etc).

Please provide examples if so.

Have you worked in any other forms of employment, other than the Armed Forces, where you were exposed to noise?

If yes, please provide details

What was the address of the Battalion/Barracks you were situated at?

Start Date of Your Service

DD slash MM slash YYYY

End Date of Your Service

DD slash MM slash YYYY

Please confirm your position within the MOD and what Regiment you were in:

Did your role ever change whilst in service?

If so, please list as many ranks or changes as you can recall:

What hours would you normally work on active duty or when you were on training?

I.e. what were your scheduled working hours within the Armed Forces?

What noise were you exposed to during each day, if applicable?

Rifles

Machine guns

IEDs

Grenades

Rocket launchers

Tanks

Mortars

Aircraft noise

Other

If it was not per day, please provide information as to when they were exposed:

I.e. live exercise, active duties, active tours

Was any exposure to noisy machines/weapons constant or intermittent (i.e. without any break) for the full shift?

If you were using firearms yourself, how many rounds would you fire when using this and what weapon was used?

How often would you use this weapon?

How many others, within your vicinity, would use weapons actively around you?

What breaks were you allowed?

Did you have to shout to be heard when talking to colleagues or was communications impossible? How did you communicate?

Were you provided with any personal protective equipment (PPE) such as ear plugs or ear muffs?

If so please provide as much information as possible.

Was the PPE equipment provided worn by you all of the time?

If so, please provide details how often you would wear this.

Was the PPE equipment enforced by your Commanding Officer or any other Officer?

Was the wearing of PPE monitored and was it replenished/replaced regularly?

Was the PPE equipment adequate?

Do you consider there to have been any issue or fault with the PPE?

Was the PPE always available? If not, when was it first provided?

Was training provided or did your employer explain why PPE was provided and necessary?

Was it a verbal demonstration or guide format?

Were you subject to any disciplinary action for not wearing PPE?

Did you have any hearing tests whilst in service?

If so, please confirm how many and whether you were told of the results?

What were the conditions of these hearing tests?

I.e. did you have to have repeated hearing tests?

This field is for validation purposes and should be left unchanged.

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Noise Induced Military Hearing Loss

Induced Hearing Loss - Military

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