IRC Noise Hazard Identification Checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

GENERAL INFORMATION

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  Address

• Select date

  Date

HARZARD IDENTIFICATION

• Do you need to raise your voice communicate with someone about one metre away?

  Yes

  No

  N/A

• Do the workers notice a reduction in hearing over the course of the day?

  Yes

  No

  N/A

• Are the workers using noisy power tools or machinery?

  Yes

  No

  N/A

• Are there noises due to impacts or explosive sources?

  Yes

  No

  N/A

• Are personal hearing protectors used for some work?

  Yes

  No

  N/A

• Do the workers complain that there is too much noise or that they can’t clearly hear instructions or warning signals?

  Yes

  No

  N/A

• Do any of the workers experience ringing in their ears, blurred hearing or noise sounding different in each ear?

  Yes

  No

  N/A

• Are any long term workers hard of hearing?

  Yes

  No

  N/A

• Have there been any workers compensation claims for noise-induced hearing loss?

  Yes

  No

  N/A

• Does any of the equipment have manufacturer’s information including labels indicating noise levels equal or greater that any of the following?<br>a)80 dB (A) LAeq, T (T-time period over which noise if measured)?<br>b)130 dB(C) peak noise level?<br>c)99 dB (A) sound power level?

  Yes

  No

  N/A

• Does the noise in any part of the workplace sound as loud as or louder than 85 decibels?

  Yes

  No

  N/A

• Are any ototoxins being used in the workplace?<br>(butanol, organic tin, mercury, solvent mixtures, fuels)

  Yes

  No

  N/A

• Are any of the workers exposed to noise and hand vibration?

  Yes

  No

  N/A

• Are there any other issues that cause you to think there may be a noise hazard present?

  Yes

  No

  N/A

ADDITIONAL INFORMATION

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