Noise Level Survey Form

Noise Level Survey Form


This Noise Level Survey Form is designed to assess and manage noise exposure in the workplace. Please ensure accuracy in measurements and provide detailed observations for effective noise management.

  1. Area and Equipment Details

Surveyed Area

[Area Name, e.g., Factory Floor - Assembly Line.]

Equipment/Machinery Contributing to Noise

[List equipment/machinery name, 

e.g., Hydraulic Presses (5 units)

Conveyor Belts (3 units)

Air Compressors (2 units)]

  1. Noise Measurement Data

Noise Level Readings

Near Hydraulic Presses: 95 dB

Conveyor Belt Area: 90 dB

Near Air Compressors: 92 dB

Time of Measurement

Readings taken during peak operational hours (1:00 PM - 2:00 PM).

  1. Employee Exposure and Duration

Employee Exposure Details

[Employee Name 1]: 8 hours/day near Hydraulic Presses.

[Employee Name 2]: 6 hours/day at Conveyor Belt Area.

Risk Assessment

[Employee Name 1] was identified at higher risk due to prolonged exposure to high noise levels.

  1. Control Measures and Recommendations

Current Control Measures

Existing measures include basic earplugs for all employees and periodic maintenance of machinery.

Recommendations

Implementing noise-canceling earmuffs for employees near Hydraulic Presses.


Installing sound-dampening panels around Air Compressors.


Scheduling regular maintenance checks to ensure machinery operates at optimal noise levels.

Submitted by:

[Your Name]

[Your Job Title]

[Your Company]


Thank you for your detailed input on this Noise Level Survey Form. 

Your efforts are essential in protecting our employees' auditory health and ensuring a safe working environment.

Health & Safety Templates @ Template.net