HEALTH & SAFETY

NOISE HAZARD IDENTIFICATION FORM

Use this in conjunction with the Health & Safety: Noise requirements.
For further information contact your Health and Safety Business Partner.

1. NOISE IDENTIFICATION RECORD

Location name       Building no      

Area assessed/room      
Assessed by       Date      
Management representative      
HSR/Employee representative      

2. HAZARD INDICATORS CHECKLIST

2.1Is there a difficulty communicating between two employees at one metre from the noise source? Yes ☐
2.2Do employees have to raise their voices to be heard at their workstations? Yes ☐
2.3Do employees experience any of the following:

 Ringing in the ears? Yes ☐

 The same sound having a different tone in each ear? Yes ☐
 Blurred hearing? Yes ☐
2.4Are any long-term employees hard of hearing? Yes ☐
2.5Are signs present indicating that hearing protection should be worn in work areas? Yes ☐
2.6Does the noise in the workplace seem to be above 85db? Yes ☐
2.7Do results of past noise surveys indicate noise levels above 85 dB? Yes ☐
2.8Do results of audiometric tests indicate any employee having a hearing loss? Yes ☐
2.9Have there been any industrial deafness claims? Yes ☐
2.10Does equipment have noise emission information that indicates noise above 85 dB? Yes ☐

If you tick Yes to any question, a noise hazard may be present, and a further risk assessment may be required.

safety.unimelb.edu.au HEALTH & SAFETY: NOISE HAZARD IDENTIFICATION FORM 1

Date: February 2019 Version: 1.1 Authorised by: Manager, Health & Safety, Operations Next Review: February 2024
© The University of Melbourne – Uncontrolled when printed.