IH - Employee Sampling Template

• Site conducted

  Select

• Division

  Select

• Site or Location

• Sampler

• Conducted on

  Date

Air Sampling Equpment

Add Air Pump

• Pump Equipment Number

• Target Flow Rate

Noise Sampling Equipment

Add Dosimeter

• Dosimeter Equpment Number

Add Sound Level Meter

• Yes

  No

  N/A

• Yes

  No

  N/A

• Yes

  No

  N/A

• Yes

  No

  N/A

• Are Biologic Samples Being Collected?

  Yes

  No

  N/A

• Are Personal Air Samples Being Collected?

  Yes

  No

  N/A

• Are Personal Noise Samples Being Collected?

  Yes

  No

  N/A

• Yes

  No

  N/A

• Yes

  No

  N/A