Noise Log Record Form

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Noise Log
(Should be kept by a person experiencing Noise Nuisance)
Name: ____________________________
Address:_____________________________________________________________________
Address of Suspected noise Source: ______________________________________________
Date
Start
Finish
Description of Noise
Other Comments
(e.g.
Intensity)
Start
Time
Time
(Tonal or Impulsive)
e.g. Noise woke me up.
e.g. Noise all day but worse
after 8.00pm
Do not forget to complete the declaration of record details.
Declaration of True Record
I (Name) ______________________ confirm that the above list is a true record of events
recorded from (Date) ___________ to (Date) ___________.
Signature:_________________________________ Date:___________________
I am/am not* prepared to appear in court to give evidence if required (*please
delete as appropriate).

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