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Section V:

Human Resources


Safety and Benefits


Hearing Conservation Plan

Current Effective Date:


Revision History:


Original Effective Date:




The purpose of this policy is to establish procedures to preserve personnel hearing through identification and control of high noise levels and mandatory use of hearing protection. This policy applies to all DHHS staff working in high noise areas.


It is the policy of DHHS to protect employees, patients, clients, residents, and any other individuals from hazards associated with elevated noise levels. Many facility operations could potentially expose staff to noise levels at or above 85 dBA (decibels, A scale) for an eight hour time-weighted-average (TWA). Any identified increases in noise exposures above this level will require modification of this plan and enrollment of affected staff in a Hearing Conservation Program.


Audiometric Testing – A test used to determine a subject's hearing levels with the help of an audiometer, but may also measure ability to discriminate between different sound intensities, recognize pitch, or distinguish speech from background noise. Acoustic reflex and otoacoustic emissions may also be measured.

dBA- An expression of the relative loudness of sounds in air as perceived by the human ear. In the A-weighted system, the decibel values of sounds at low frequencies are reduced as a correction to approximate human hearing.

Decibels- A logarithmic unit used to express the ratio of two values of a physical quantity, often power or intensity.

Noise Level – The background sound pressure level at a given location, normally specified as a reference level to study a new intrusive sound source.

Permanent Threshold Shift – A permanent threshold shift is a permanent shift in the auditory threshold. It may occur suddenly or develop gradually over time. A permanent threshold shift results in permanent hearing loss.

Temporary Threshold Shift - A temporary shift in the auditory threshold. It may occur suddenly after exposure to a high level of noise, a situation in which most people experience reduced hearing. A temporary threshold shift results in temporary hearing loss.

Time Weighted Average - A time-weighted average (TWA) is used to calculate a workers daily exposure to a hazardous substance (such as chemicals, dusts, or vapors) or agent (such as occupational noise), averaged to an 8-hour workday, taking into account the average levels of the substance or agent and the time spent in the area.

Roles and Responsibilities

Safety Programs Manager
The Safety Programs Manager (SPM) ensures that a written plan is in place to establish a policy for hearing conservation. The SPM reviews the policy periodically.

Safety Officer
The Safety Officer is responsible for identifying high noise level areas, providing training, developing a policy specific to the facility/division/office, and monitoring compliance during routine inspections.

The manager/supervisor ensures that applicable staff are enrolled in the hearing conservation program and that staff are compliant with this policy.

DHHS Staff
Staff are responsible for complying with this policy. Affected staff complete training and testing as required.


Program Scope

Audiometric Testing

Noise Level Survey

High Noise Level Areas/Operations
Each facility/division/office should develop a list of high noise level operations and include that information in this section.


Personal Protective Equipment

Notification and training is provided when there is a change to noise output, engineering controls or protective equipment. The supervisor will be responsible for coordinating mandatory training for new employees. Personnel enrolled in the Hearing Conservation Program will receive training that includes the following:

The employee audiometric test records are maintained within the employees’ medical file. Individual audiometric test results will be retained for the duration of employment. The Safety Office will retain noise survey results for a period of two (2) years. The records will include:

Access to Information, Training Materials, and Records

Policy Update and Program Changes


For questions or clarification on any of the information contained in this policy, please contact Human Resources. For general questions about department-wide policies and procedures, contact the DHHS Policy Coordinator.

Exposure to high noise levels can result in permanent hearing loss. The amount of loss depends on the volume and duration of exposure. Exposure to dangerous noise can occur on the job or during leisure time activities such as loud music or television volume.

The Occupational Safety and Health Administration has established an exposure to sound levels of 85 decibels over an 8 hour time weighted average to be excessive. We have implemented a hearing conservation program to protect and monitor individual's hearing exposed to noise above that level.


There are two primary styles of hearing protection used at this facility; the foam plug and hearing muff. Hearing protectors are rated for the amount of noise they reduce. Hearing protection must also conform to American National Standards Institute S3.19-1974.

Hearing protection should comfortably fit the head and ears. A tight seal must be maintained for the protector to adequately reduce incoming noise. Hearing protection should be cleaned regularly and protected from damage that may reduce its effectiveness.


This institution has a written hearing conservation program. Persons enrolled in the program will be tested for hearing loss every year. Audio grams will be conducted with calibrated equipment and interpreted by a qualified physician or audiologist. Test results will be reviewed to determine if an appreciable loss in hearing has occurred. A plan will be developed to conserve your hearing if a loss occurs.

_____________________________ _________________

Signature Date


Job Title

____________________________________ __________________
Firma de Recluso Fecha


Titulo de Trabajo

Employee Name: ___________________________________________________


Date of Consultation: ________________________________________________


Purpose of Consultation: Circle Below

Type and size of PPE worn: ______________________________

Date of Initial Fitting/Issue: _______________________________

Off-the-Job Noise Exposure: Circle Below

Change in PPE: Yes/NO

Date of Refitting/Issue: _____________________

Medical Referral

To: ____________________________________________________

Purpose of Referral:

Other: ___________________________________________________

Employee Signature: _______________________________________

Supervisor Signature: _______________________________________

Location of audio grams: Audiometer make: _________ Model: _________

Date of last calibration: / / Functional / Exhaustive


Last First Middle

Department: _____Position Title: _______________________

Audio grams Test Date: /  /_____

        Month Day Year

Personal Protective Equipment (PPE): _________________________________

NRR: Exposure dBA:

Age: PPE: ________________________  Exposure TWA:

        Left Ear


        Right Ear


























Hearing History

1. Known hearing loss
2. Head Injury
3. Family member w/hearing loss
4. Flu Measles, Mumps, Diabetes, Scarlet Fever, Viral Pneumonia, Otosclerosis, Meniere’s Ear Infection
5. Hearing Aid
6. Employee Estimate of hearing: Good Fair Poor
7. Medications: Streptomycin Neomycin Excess Aspirin Kanamycin
8. Noise exposure history: Military Service Pre. Occ Noise Exposure
9. Otoscopic Exam (If conducted) Ear Canal Clear? Ear Drum visible? Inflammation? Scarring of eardrum? Drainage from ear?
10. Ear Complications: Pain in ears Active Drainage Tinnitus Sudden hearing loss Perforated ear drum Vertigo Fullness in ears Excess wax Previous ear surgery Foreign objects in ear canal allergies.

Technician Signature: __________________________________

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