Noise risk assessment template checklist
What does this form include?
This form contains 13 sections:
Date and time of survey Date
Click + to add persons involved
Reason for survey
Equipment used
Click + to add equipment producing noise
Item Name
Location of equipment
Noise level (LAeq)*
EXPOSURE
Exposure duration
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?
Recommendation
Full Name and Signature of Assesor
Use this template