Noise Risk Assessment Template

• Client / Site

• Location
  Address

• Conducted on

  Date

• Prepared by

Survey Parameters

• Date and time of survey

  Date

• Click + to add persons involved

Employee

• Reason for survey

• Equipment used

Noise Survey and Exposure

• Click + to add equipment producing noise

Equipment

• Item Name

• Location of equipment

  Media

• Noise level (LAeq)*

• EXPOSURE

• Exposure duration

Control Measures

• Are hearing protective equipment mandatory?

  Yes

  No

  N/A

• Can the noise source be eliminated?

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Can the equipment be enclosed?

  Yes

  No

  N/A

• Is a noise refuge area needed?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Is health surveillance required?

  Yes

  No

  N/A

Completion

• Recommendation

• Full Name and Signature of Assesor

  Sign