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Sound Level Survey Form I: Person/Equipment

This sound level survey form documents a facility's noise monitoring. It records the date, equipment used, calibration readings, and person conducting the survey. Sound level thresholds require single hearing protection for levels at or above 85 dBA and double protection for levels at or above 96.5 dBA. The form lists persons/equipment and corresponding sound level measurements in dBA along with any comments.

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115 views

Sound Level Survey Form I: Person/Equipment

This sound level survey form documents a facility's noise monitoring. It records the date, equipment used, calibration readings, and person conducting the survey. Sound level thresholds require single hearing protection for levels at or above 85 dBA and double protection for levels at or above 96.5 dBA. The form lists persons/equipment and corresponding sound level measurements in dBA along with any comments.

Uploaded by

Retselisitsoe
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Sound Level Survey Form I

Facility: Date:
Instrument Used: Serial Number:
Calibrator Used: Serial Number:
Calibration Reading: Beginning Level Ending Level:
Survey Conducted By:
Single Hearing Protection >= 85 dBA Double Hearing Protection >= 96.5 dBA*
*Double hearing protection level is calculated using a single hearing protector with a NRR rating of 30 dBA

Person/Equipment Sound Level (dBA) Comments

SAFETY/INDUSTRIAL HYGIENE/NOISE MONITORING/SOUND LEVEL


ROUTING SCAN
SURVEY/MMDDYY PERSON AND OR EQUIPMENT

Brieser Construction Page Section 21


Safety, Health & Environmental Manual 10 Hearing Conservation- rev. 4

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