• Audit Title

  • Site Name

  • Conducted on

  • Auditor

  • Location
  • Site EHS Manager

Applicable Standards

  • Select those standards that apply.

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?

  • How many people are in the Hearing Conservation Program?

  • Does the site have a noise map?

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

  • Are personal dosimetry results communicated to sampled employees?


  • What is the frequency of training?

  • Does the training program cover the required program elements?

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?

  • 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?

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?

  • Was hearing protection being properly worn?

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

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

  • Was signage posted for high noise areas?

  • Was the posted signage clear?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.