Annual Program Review - Hearing Conservation

• Audit Title

• Site Name

• Conducted on

  Date

• Auditor

• Location
  Address

• Site EHS Manager

Applicable Standards

• Select those standards that apply.

  Select 29CFR1910.95, Occupational Noise Exposure EHS&S Standard 14, Noise & Hearing Conservation

  • 29CFR1910.95, Occupational Noise Exposure
  • EHS&S Standard 14, Noise & Hearing Conservation

Documents Reviewed

• Written Program

• IH Risk Assessments / Reports

• Sound Level Surveys

• Dosimetry Reports

• Hearing Conservation Surveillance Records

• Training Program

• Training Records

• List of Personnel in Hearing Conservation Program

Program Execution

• Is there an IOSS program leader on site?

  Yes

  No

  N/A

• How many people are in the Hearing Conservation Program?

  0 to 5

  5 to 10

  10 to 50

  50+

• Does the site have a noise map?

  Yes

  No

  N/A

• Is personal dosimetry conducted when sound levels are greater than 82dBA?

  Yes

  No

  N/A

• Are personal dosimetry results communicated to sampled employees?

  Yes

  No

  N/A

Training

• What is the frequency of training?

  Select Initial Annual Every 3 Years Initial Only

  • Initial
  • Annual
  • Every 3 Years
  • Initial Only

• Does the training program cover the required program elements?

  Yes

  No

  N/A

Medical Evaluation

• Is the list of participants in the GOH hearing conservation medical surveillance program aligned with the list of employees who work in high noise areas?

  Yes

  No

  N/A

• What is the system for notifying those in the hearing conservation program when they are due for medical surveillance?

• Are potential cases of noise induced hearing loss investigated and documented?

  Yes

  No

  N/A

Employee Discussions

• Discussions were held with the following groups or employees on site. List number of people when applicable.

Plant Tour

• Was hearing protection observed being used in posted high noise areas?

  Yes

  No

  N/A

• Was hearing protection being properly worn?

  Yes

  No

  N/A

• Was hearing protection available at the entrances to high noise areas?

  Yes

  No

  N/A

• Were all areas with the potential to be high noise identified in the site noise map?

  Yes

  No

  N/A

• Was signage posted for high noise areas?

  Yes

  No

  N/A

• Was the posted signage clear?

  Yes

  No

  N/A