GIG Noise Assessment

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

Noise Assessment

Operatives are to answer the the sections below prior to noisy operations in excess of 80dB(A)

• Operatives

Operative

• Do you suffer from any of the symptoms listed below ?

• Is if difficult to understand conversation when there is background noise ?

  Yes

  No

  N/A

• Do you have difficulty following group conversations?

  Yes

  No

  N/A

• Do you find it difficult to identify from which directions sounds are coming?

  Yes

  No

  N/A

• Do you turn up the TV or radio louder than others prefer?

  Yes

  No

  N/A

• Have friends of family members told you that you do not hear well?

  Yes

  No

  N/A

• If any of the above are 'yes', no work should be undertaken that exposes the operatives to noise levels above 80dB(A) until advice has been sought from your Doctor or an Occupational Hygienist

• Operatives Signature

  Sign