1. Is a raised voice needed to communicate with someone about one meter away?

Yes No

2. Do people working in the area notice a reduction in hearing over the course of the day? (This reduction might not be noticed until after work.)

Yes No

3. Do workers experience any of the following:

(a) ringing in the ears (tinnitus),

(b) the same sound having a different tone in each ear,

(c) blurred hearing?

Yes No

Yes No

Yes No

4. Are any long-term workers hard of hearing?

Yes No

5. Are personal hearing protectors provided?

Yes No

6. Are signs, indicating that personal hearing protectors should be worn, posted at the entrance or in the work area?

Yes No

7. Have there been any workers’ compensation claims for noise-induced hearing loss?

Yes No

8. Does any equipment have manufacturer’s noise information (including labels) that indicates noise levels equal or greater than any of the following:

(a) 80 dB(A) LAeq,T

(b) 130 dB peak noise level,

(c) 88 dB(A) sound power level?

Yes No

Yes No

Yes No

9. Do the results of audiometry indicate that past or present workers have hearing loss?

Yes No

10. Does the noise in any part of the workplace sound as loud or louder than 85 decibels using the scale Decibel Levels of Common Sounds?

Yes No

11 Are any of the workplace ototoxins listed in Appendix 6 being used in the workplace?

Yes No