Title Page
-
Site conducted
-
Conducted on
-
Prepared by
Untitled Page
1.0 Training Program (Safety / Training Department)
-
Does the site have a training program which covers the effects of noise on hearing, the purposes of protectors (advantages and disadvantages), the purposes of testing and the explanation of procedures? 1910.95(k)
-
Does the site have a new hire training for hearing conservation?
-
The site training includes the use and care or all hearing protectors provided to employees? 1910.95(i)(4)
-
During initial fitting, the employees are supervised to ensure correct use of all hearing protectors? 1910.95(i)(5)
2.0 Hearing conservation program (General / Medical)
-
The site has a hearing conservation program if exposures for employees are over 85 decibels?
-
The hearing conservation program includes procedures for monitoring? 1910.95(d)
-
The program identifies when monitoring should be completed? This includes a change in production, process, equipment or controls to the extent that additional employees may be exposures above the action limit or attenuation may be inadequate for the expsoures.
-
The program identifies that employees will be notified if their exposures are at or above the 8 hour TWA of 85 decibles?
-
The site has an adiometric testing program which includes: no cost to the employees, audiometric tests performed by a licensed or certified physician, audiologist or technician certified by CAOHC? 1910.95 g3
-
The site has an established baseline program that must be completed within an employees first 6 months of being exposed at or above the action limit? 1910.95g5
-
Conservation program has a procedure for annual audiograms to be completed at least annually after the baseline? 1910.96 g6
-
Program identifies annual audiogram retesting procedure for employees who suffer from standard threshold shifts? This includes a retest within 30 days, shall be informed in writing within 21 days, retraining and fitting for hearing protectors and referred for a clinical evaluation. 1910 g8
-
The program identifies procedures for audiometer calibration? 1910.95h5 Equipment checked before each day's use, shall be checked acoustically anually and deviations greater than 15 db require exhaustive claibration at least every 2 years. Testing frequencies below 500Hz and above 6000Hz are omitted.
-
Program identifies when hearing protectors must be worn? 1910.95 (i)
3.0 Condition Observation (Visual Inspection)
-
Has the site posted a copy of the hearing conservation standard in the workplace? 1910.95 (I)(1)
-
Instruments to are used to measure noise exposure are calibrated to ensure measurement accuracy? 1910.95d2ii
-
Is there hearing protection obtainable in locations under the hearing conservation program?
-
has the audiometric measurement machine been calibrated?
-
Are their signs identifying hearing conservation locations?
-
Employees in hearing protection locations are wearing their hearing protection?
-
Employees can demonstrate how to properly don an ear plug?
4.0 Employee Knowledge (Employee Questions)
-
Do employees know if they are located in the hearing conservation program?
-
Do employees know when they must where hearing protection?
-
Do employes know where to obtain hearing protection?
-
Can employees tell you controls in there areas to protect them from noise exposure?
-
Can employes describe how to take care of their hearing protection?
5.0 Documentation and Retention (Engineering / Maintenance / Safety)
-
The site maintains an accurate record of all employee exposure assessments? 1910.95 (m)(1)
-
Audio metrics testing includes : Name, job classification, date of audiogram, examiner, date of last acoustic or exhaustive calibration of audiometer and the employees mose recent noise exposure assessment. 1910.95(M)(2)
-
The employees retains measurement records for two years. 1910.95m3i
-
Audiometric test records are retained for the duration of the affected employees employment. 1910.95m3ii
-
The site has performed audiometric monitoring in locations where it is likely that employees would be oer 85 decibles?