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Noise Risk Assessment Template

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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 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?
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.
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