Leichhardt Municipal Council Noise/Hearing Conservation Safety Checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

A. Sources of Noise

• 1. Equipment capable of producing more than 85 dB have been identified and monitored for noise levels

  Yes

  No

  N/A

• 2. High noise areas posted with warning signs

  Yes

  No

  N/A

• 3. Warning sticker on mobile high noise producing equipment

  Yes

  No

  N/A

Duration of exposure

• Yes

  No

  N/A

B. Noise Reduction

• 1. Engineering controls in place or considered to reduce noise

  Yes

  No

  N/A

• 2. Variety of hearing protectors available to employees

  Yes

  No

  N/A

• 3. Reusable hearing protectors are clean and in good condition

  Yes

  No

  N/A

• 4. Hearing protectors worn where needed

  Yes

  No

  N/A

C. Audiometric Testing

• 1. Individuals working in high noise areas receive audiometric (hearing) testing biannually ?

  Yes

  No

  N/A

• 2. New workers receive baseline audiogram within 6 months of employment

  Yes

  No

  N/A

• 3. Individuals leaving Princeton receive end-of-employment audiogram

  Yes

  No

  N/A

D. Training and Information

• 1. Training attended annually

  Yes

  No

  N/A

• 2. Training is documented

  Yes

  No

  N/A

• 3. A copy of the OSHA Occupational Noise Exposure Standard is posted or available

  Yes

  No

  N/A

• Summary of Findings

• Please sign upon audit completion.

  Sign