Hand-Arm Vibration Exposure Log
Record and monitor your exposure to hand-arm vibration from powered tools and machinery. Please complete this form for each exposure event.
Worker Name
*
First Name
Last Name
Employee ID or Number
*
Job Title
*
Date of Exposure
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Start Time of Exposure
*
Hour Minutes
AM
PM
AM/PM Option
End Time of Exposure
*
Hour Minutes
AM
PM
AM/PM Option
Tool or Equipment Used
*
Vibration Magnitude (m/s², if known)
Personal Protective Equipment (PPE) Used
*
Anti-vibration gloves
Hearing protection
Eye protection
Other
Did you experience any symptoms during or after exposure?
*
No symptoms
Tingling/numbness
Blanching/whiteness of fingers
Loss of grip strength
Other
Describe any symptoms or concerns (if any)
Supervisor Name
*
First Name
Last Name
Supervisor Comments or Actions Taken
Submit Exposure Log
Should be Empty: