9. Sound level data.
a. Location--specific equipment and/or worker location relative to the sound
source, you may reference the map.
b. Meter action--"S" slow, "F" fast.
d. dB(A)--required except for impulse noise.
e. Risk assessment code--as appropriate.
10. Protection required--place a check mark in column that corresponds to appropriate
a. Type(s) of ear protection in use.
Other deficiencies noted at time of survey.
12. More detailed evaluation requires yes or no. If yes, identify type required.
13. Persons identified for audiometric monitoring.
a. List by name all those persons exposed to sound levels above the standards.
b. Identify those persons not previously given audiometric testing.
14. Name, phone, and organization of supervisor of noise hazardous area--first line
15. Survey performed by--name and signature.
16. Hearing conservation monitor--usually Pvnt Med officer of audiologist, name and