Sample Workplace Accommodation Letter for Hearing Loss

Use this professionally formatted example to document hearing-related work needs for an employee. Print on clinic letterhead, include the date, summarize the hearing profile, and (optionally) suggest accommodations.

What the Letter Should Include

• Official Letterhead: Print on the hospital, ENT practice, or audiology clinic’s letterhead to establish authenticity.
• Date: Include the issue date near the top (for example, December 3, 2015).
• Patient Identification: Use the employee’s full name. Avoid unnecessary medical details unrelated to work function.
• Description of Hearing Loss: Note whether loss is unilateral or bilateral, relevant degree/configuration, and core functional impact (e.g., speech understanding in noise, localization challenges). Learn more about unilateral hearing loss.
• Workplace Impact: Briefly explain how typical job settings (meetings, open offices, shop floors) may affect communication and safety. See our guide on hearing loss in the workplace for detailed strategies.
• Optional Accommodations: You may suggest examples (quieter workstation, written summaries, assistive listening devices, captioned calls/meetings, visual alerts). This section is helpful but not required.
• Contact Information: Provide a professional point of contact for verification or questions.
• Signature & Credentials: Sign and include professional credentials. (For public-facing examples, redact sensitive details.)

Formatting Tips

• Keep it concise (one page) and written in clear, professional language.
• Use plain-language descriptions of functional impact rather than extensive audiometric data.
• Maintain privacy: share only information necessary to support reasonable accommodations. See ADA hearing rights for more details.

Sample Letter (Template)

Copy/paste onto clinic letterhead and replace bracketed text. Patient name, license number, and clinic phone are intentionally blanked.

[Clinic/Hospital Letterhead]

Date: [Month Day, Year]

To Whom It May Concern:

[Patient Name: ____________] is a patient under my care. Their most recent hearing evaluation indicates a unilateral hearing loss (left/right) with normal hearing sensitivity in the opposite ear (or replace with the appropriate bilateral description as applicable).

Individuals with this type and degree of hearing loss typically experience difficulty understanding speech in the presence of background noise and may have challenges localizing where sounds originate. In practical workplace terms, this can mean reduced clarity when multiple people speak at once, difficulty following conversation in open or noisy areas, and the need for additional visual or written cues during verbal communications.

Reasonable accommodations can improve communication access and safety. Examples may include locating the employee’s workstation in a quieter area, minimizing nearby loud equipment, providing written agendas and post-meeting notes, enabling live captions for calls/meetings, and considering an assistive listening device or remote microphone when appropriate.

Please feel free to contact our office should further clarification or confirmation be required.

Respectfully,

Jonathan Javid, Au.D., CCC-A
Doctor of Audiology
License # __________
Phone: __________