Hearing Conservation Program Template printable pdf download

SURVEY

04/04/17

OOL

YPE

AST

EVIEWED

EOGRAPHY

OURCE

ASHINGTON

EMPLOYEE SURVEY ON HEARING CONSERVATION

BENEFITS

Exposure to excessive noise is a serious safety hazard in many workplaces. Regular exposure to high levels of

noise can cause permanent hearing loss and other health issues. To protect workers’ hearing, you should

implement a hearing conservation programs if your workplace has noise above specified levels. And you

should regularly review these programs to ensure that they’re effective.

HOW TO USE THE TOOL

Use this survey, which was developed by researchers at the University of Washington, to get feedback from

employees on your hearing conservation program. A week before, announce to employees that you’ll be

conducting the anonymous survey and explain why. When you distribute the survey, give employees a week

to complete it. Use the results to develop a plan to improve the weaknesses in your program and build on

your strengths. The

University website

has a spreadsheet you can download and use to tabulate the survey

responses.

OTHER RESOURCES:

University of Washington’s Assessing and Improving Occupational Hearing Loss Prevention Programs

Annual Hearing Conservation Program Review Form

Noise Control: How to Implement a Compliant Hearing Conservation Program

Hearing Conservation Plan Checklist

O H S T

Templates and tools from OHS

H I S T O O L A N D H U N D R E D S M O R E A V A I L A B L E I N T H E

O O L B O X A T

Insider are provided for members of our service. Members may use this document as is or as a starting point to customize their

own documents. OHS Insider assumes no responsibility for the effectiveness or legality of any of its online templates or tools.

Always consult your legal counsel and management before implementing any new policies or procedures.

Hearing Conservation Program Template