Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Employee/Area

  • Name of Employee/Area

  • Employee Monitoring Photo

  • Employee Working Photo

  • Job Title

  • Dosimeter Model

  • Serial Number

  • Did you calibrate the dosimeter?

  • CEL Instruments Ltd. Acoustical Calibrator-CEL 110/2-Class 2C IEC 60492:2003-ANSI S1.40 1984-1000 Hz 114dB

  • Serial Number

  • Did you calibrate the dosimeter?

  • CEL Instruments Ltd. Acoustical Calibrator-CEL 110/2-Class 2C IEC 60492:2003-ANSI S1.40 1984-1000 Hz 114dB

  • Serial Number

  • Did you calibrate the dosimeter?

  • CEL Instruments Ltd. Acoustical Calibrator-CEL 282-Class 2L IEC 942:1988-ANSI S1.40 1984-1000 Hz 114dB

  • Serial Number

  • Did you calibrate the dosimeter?

  • SV-34 Acoustic Calibrator-Class 2 IEC 60942:2003-1000 Hz/114dB

  • Start Time

  • End Time

  • Elapsed Time Including Breaks

  • Employee wearing hearing protection?

  • Type of Hearing Protection

  • Hearing Protection

  • Employee wearing additional PPE?

  • Eye Protection

  • Gloves

  • Steel-Toe Shoes

  • Face Protection

  • Respiratory Protection

  • Head Protection

  • Pre-Calibration Date

  • Post-Calibration Date

  • Calibration By

  • Tasks Worked/Completed in Area

  • Break Times

  • OSHA TWA (dBA)

  • ACGIH TWA (dBA)

  • Additional Comments

  • Additional Photos

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