Plant & Equipment Noise and Vibration Assessment Record

• Weekly H&S Audit

• Document No

• Client/Site

• Conducted on

  Date

• Prepared by

• Equipment Photo

  Media

• Equipment type

  Select Whacker Plate Stilth saw Floor saw Fuel supply generator Agetur Dumper truck

  • Whacker Plate
  • Stilth saw
  • Floor saw
  • Fuel supply generator
  • Agetur Dumper truck

Equipment Identification

• Equipment picture

  Media

• Serial No

• Fleet/Plant No

Vibration Reading

• Vibration Action Value

  2.5 m/s2

  2.5 - 5 m/s2

  5 m/s2

• Actual Vibration Value

Noise Reading

• Noise Action value

  <80 DbA

  80-85 DbA

  85< DbA

• Actual Noise reading ?

Sign Off

• Assessor Name

• Assessor Signature

  Sign