We use this checklist especially with new service users where there is a query about their hearing status. I find this useful to open up a discussion with family or carers about situations where a service user may be having difficulty hearing. If we have a lot of YES responses, then we will talk about making a referral to Audiology from there. Some questions may be explained by a persons learning difficulty but also possibly a hearing loss. The changes in behaviour section could potentially explain a new ear infection.