This document contains a checklist with various statements about potential signs of hearing difficulties. Many of the statements indicate that the individual has trouble hearing in noisy environments or when multiple people are speaking at once. They may ask people to repeat themselves often and watch speakers' faces closely when listening.

2. YES NO
 Has trouble hearing when two or
more people are talking.
 Appears to have trouble hearing
when there is a lot of background
noise.
 Frequently misunderstands you
when you speak.
 Asks you to repeat what you have
said.
 Watches your face intently when
you are speaking.
 Responds inappropriately to what
are others are saying.

3. YES NO
Seems in a world of his/her own at
times.
Speech is unclear or immature.
May have trouble with sounds at a
specific frequency.
Grammar is incorrect or immature.
Has the television sound turned up
high.
Sits very close to the teacher or
the television.
Tilts head to listen.
Mouths the words as other speak

4. YES NO
Has had recurrent ear infection.
Seem to switch off when listening
in a group.
Speaks more loudly that is
necessary.
Watches others and copies them
when instructions are given.
Does not respond to speech
when not able to the speaker.
Sits close to the front when given
the choice.