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Noise Risk Assessment Template

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Noise Risk Assessment Template

Part A - Survey Paramaters

Survey Parameters

Date and time of survey

Click + to add persons involved

Reason for survey

Equipment used

Part B - Noise Survey and Exposure

Noise Survey and Exposure

Click + to add equipment producing noise

Item Name

Location of equipment

Noise level (LAeq)*

EXPOSURE

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?

Completion

Recommendation

Full Name and Signature of Assesor

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Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.