Title Page

  • Client / Site

  • Location
  • Conducted on

  • Prepared by

Part A - Survey Paramaters

Survey Parameters

  • Date and time of survey

  • Click + to add persons involved

  • Employee
  • Reason for survey

  • Equipment used

Part B - Noise Survey and Exposure

Noise Survey and Exposure

  • Click + to add equipment producing noise

  • Equipment
  • Item Name

  • Location of equipment

  • Noise level (LAeq)*


  • Exposure duration

Part C - Control Measures

Control Measures

  • Are hearing protective equipment mandatory?

  • Can the noise source be eliminated?

  • Is additional maintenance required to reduce noise levels e.g. by lubrication, tightening, cleaning etc of equipment? (Reassess noise level after maintenance work is complete)

  • Can the equipment be modified to reduce noise at source, e.g. damping, silencers, baffles etc fitted?

  • Can inherently quieter components be selected e.g. slotted circular saw blades on woodworking equipment or quieter fans? (Reassess after replacement)

  • Can the equipment be Isolated i.e. removed to another location away from people at work?

  • Can the equipment be enclosed?

  • Is a noise refuge area needed?

  • Can absorptive material be used to deaden noise in the workspace?

  • Do staff need training or information on the noise risks?

  • Is health surveillance required?



  • Recommendation

  • Full Name and Signature of Assesor

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