Workplace Noise Risk Assessment Form
Use this form to evaluate noise hazards and control measures in your workplace.
Location or Area Assessed
*
Which of the following noise sources are present?
*
Machinery or equipment
Vehicle traffic
Construction or maintenance
People/voices
Other
How would you rate the overall noise level in this area?
*
1
2
3
4
5
How long is the average exposure to noise per shift?
*
Please Select
Less than 1 hour
1-2 hours
2-4 hours
4-8 hours
More than 8 hours
Is normal conversation possible without raising your voice?
*
Yes
No
Sometimes
Which controls are currently in place to reduce noise exposure?
*
Engineering controls (e.g., barriers, dampening)
Administrative controls (e.g., rotating shifts)
Hearing protection provided
No controls in place
Other
Are existing controls effective?
*
Yes
No
Partially
Not sure
Is further action required to address noise risks?
*
Yes
No
Unsure
If action is required, briefly describe recommended next steps or controls.
Additional comments or observations
Submit Assessment
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