Construction Hearing Protection and Noise Exposure Monitoring Log Form
Use this form to log hearing protection measures and monitor noise exposure on construction sites.
Date of Monitoring
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Construction Site Location
*
Person Monitored (Full Name)
*
First Name
Last Name
Job Title or Role
*
Noise Level Measured (dBA)
*
Duration of Exposure (minutes)
*
Type of Hearing Protection Used
*
Please Select
Earplugs
Earmuffs
Custom Molded Plugs
None
Other
Hearing Protection Fit/Effectiveness Check
*
Properly Fitted and Worn
Adjustment Needed
Not Worn
Supervisor/Observer Name
*
First Name
Last Name
Additional Notes or Observations
Submit Log
Should be Empty: