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                                              Hearing Conservation Template 

 Lipin/Dietz Associates, Inc.

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Hearing Conservation Sample Program

29 CFR 1910.95

Noise, or unwanted sound, is one of the most pervasive occupational health problems. It is a by-product of many industrial processes. Sound consists of pressure changes in a medium (usually air), caused by vibration or turbulence. These pressure changes produce waves emanating away from the turbulent or vibrating source. Exposure to high levels of noise causes hearing loss and may cause other harmful health effects as well. The extent of damage depends primarily on the intensity of the noise and the duration of the exposure. Noise-induced hearing loss can be temporary or permanent. Temporary hearing loss results from short term exposures to noise, with normal hearing returning after a period of rest. Generally, prolonged exposure to high noise levels over a period of time gradually causes permanent damage.

OSHA's hearing conservation program is designed to protect workers with significant occupational noise exposures from suffering material hearing impairment even if they are subject to such noise exposures over their entire working lifetimes.

OSHA requires all employer’s who have employees exposed to noise above the action level of 85 dBA averaged over an eight-hour workshift to develop a formal hearing conservation program including the following elements:

  • • Noise Monitoring

  • • Audiometric Testing

  • • Hearing Protectors

  • • Recordkeeping

Although OSHA does not require the program be in writing, the attached program, if properly completed, will not only help you work through the pertinent issues, but will also constitute an adequate hearing conservation program in accordance with 1910.95(c)(1). However, it should not be used without consideration of the unique conditions and requirements at each site and it may be necessary to modify the program for your specific needs.





Hearing conservation is an important aspect of the overall safety and health program. Workplace noise can cause hearing loss, create physical and psychological stress, and contribute to accidents by making it difficult to communicate. An estimated 14 million employees throughout the United States are exposed to hazardous noise.

Fortunately, noise exposure can be controlled. Every effort is made to use quieter processes, machinery, and equipment. When feasible engineering controls do not reduce the noise level to or below the OSHA permissible exposure limit (PEL) of 90 dB, proper hearing protectors are used. Also, all employees exposed to noise levels above 85 dB are included in a hearing conservation program. There are many reasons for providing an effective hearing conservation program, including:

  • • protecting the organization's most important resource - employees,

  • • providing a safe and healthful workplace, and

  • • complying with governmental regulations.

Management, supervisory, and employee commitment to hearing conservation and positive attitude are important aspects of the overall hearing conservation program. The key elements of the organization's hearing conservation program are:

  • 1. Noise exposure measurements

  • 2. High exposure areas or jobs

  • 3. Audiometric testing and follow-up

  • 4. Employee Education

  • 5. Engineering and administrative noise exposure control

  • 6. Personal hearing protection

  • 7. Recordkeeping

<><>ENTER NAME OR JOB TITLE OF RESPONSIBLE EMPLOYEE<><> has been designated as the program administrator for Hearing Conservation.


The success of the company's hearing conservation program depends on an accurate knowledge of the existing noise environment. Accurate surveys define areas within acceptable guidelines for noise exposure and those areas where potentially harmful noise exposure exists. Effective noise exposure measurement prevents possible loss of hearing by detecting work areas where employees must wear hearing protectors and must be tested.

Detailed noise surveys have been performed for the following areas or processes:

Area/Process Date

<><>Describe Areas or Process Where Noise Monitoring Has Been


These surveys were conducted using Type II Noise Dosimeters worn by employees working in the area.

Noise Dosimeters were worn for the duration of the workshift or at least long enough to establish a conservative average noise exposure. All effected employees have been notified regarding these results. Copies of these measurements are included in Appendix A of this program.

Additional monitoring will be conducted whenever changes in work practices or methods may change workplace noise exposures including addition of new equipment or a change in the workplace layout.


Based on the results of the noise exposure measurements, the following areas/jobs have been designated as "High Exposure". "High Exposure" refers to work areas or jobs where employees’ noise exposure may exceed the action level of (85 dBA).

Area/Job Hearing Protection

<><>Describe areas or jobs where noise monitoring has demonstrated exposure above the Action Level or Permissible Exposure Level. Note: These jobs/areas will require implementation of the Hearing Conservation Program including hearing protection and audiometric testing.<><>

<><>Indicate here whether hearing protection will be "Encouraged" or "Required".*

*Monitoring results above the action level (85 db TWA ) indicate areas where hearing protection is "encouraged" and monitoring results above the Permissible Exposure Limit (90 dB TWA) indicate areas where hearing protection is "required".


The objective of this hearing conservation program is the preservation of the hearing of employees. In order to achieve this goal, an effective audiometric testing program has been implemented.

Audiograms and evaluations are conducted by:



(Note: Audiograms and comparisons must be conducted by an audiologist or physician or someone working under a licensed audiologist or physician.)


This program includes:

  • • Audiograms at time of hire for all employees working in "High Exposure" areas or jobs.

  • • Baseline audiograms for existing work force working in "High Exposure" areas or jobs.

  • • Annual audiograms for all employees working in "High Exposure" areas or jobs.

The success of the hearing conservation program with regard to each individual employee is evaluated by comparing annual audiograms to the baseline audiogram. This procedure, among others, helps to determine the effectiveness of the hearing protection program, and, as a result, ensures the protection of employees' hearing.

<><>ENTER NAME OF RESPONSIBLE PERSON OR JOB TITLE<><> is responsible for reviewing the recommendations of the audiologist or physician.


All employees working in "High Exposure" areas or jobs are trained before initial assignment and at least annually on the following topics:

  • • Effects of noise on hearing

  • • Purpose of hearing protectors

  • • Advantages and disadvantages of various types of hearing protectors

  • • Proper use, selection, fit, and care of hearing protectors

  • • Purpose and procedures of audiometric testing

  • • Company requirements for "High Exposure" jobs or areas

  • • Use of specific hearing protectors provided by the company

<><>NAME OR JOB TITLE OF EMPLOYEE <><> is responsible for scheduling this training on a annual basis.

<><>NAME OR JOB TITLE OF EMPLOYEE OR CONTRACTOR<><> is responsible for conducting the training and providing documentation to the program administrator.


<><>ENTER COMPANY NAME<><> recognizes the desirability of controlling the existing noise levels by engineering and/or administrative controls. Therefore, the feasibility of such controls is carefully considered including possible redesign of existing machinery, the building of partial or total enclosures, and other engineering noise control procedures for reducing the existing noise levels. Due to the complexity of some machinery used by the company and in view of economic limitations, some noise levels cannot currently be reduced to below acceptable limits.

Within the limitation of work schedules and employee skills, administrative controls have also been considered. Where feasible, over-exposed employees are rotated to other areas or jobs having noise levels below the required levels. In addition, operational procedures are modified as necessary so that during any one twenty-four hour period the allowed exposure times will not be exceeded.

Engineering and administrative controls are being considered and implemented where feasible on a continuing basis.



Until such time as engineering and/or administrative controls reduce the amount of noise exposure to or below the allowed limits, appropriate personal hearing protective devices are made available and issued to employees working in "High Exposure" jobs or areas. It is recognized that the use of these devices is considered a temporary solution to the problem of overexposure until feasible controls are provided.

The wearing of hearing protection in the following areas or jobs is mandatory:


In addition, hearing protection is mandatory in ALL "High Exposure" areas for any employee who has incurred a standard threshold shift as reported by the program administrator.

All supervisors properly enforce hearing protection requirements. Continuing failure of an employee to properly wear the protection provided could result in the termination of employment with the company.

<><>NAME OR JOB TITLE OF EMPLOYEE <><> is responsible for issuing and fitting hearing protection. This individual has been trained by and is under the supervision of an audiologist or physician.

The following hearing protection devices are provided for employees:

Type of Hearing Protection Noise Reduction Rating


<><>Indicate type, manufacturer, and model number of hearing protection provided.<><>

<><>Indicate here the NRR listed by the manufacturer<><>

Note: Employers are required to make at least two "TYPES" of hearing protectors available to employees. Types include self-molding, pre-molded, custom molded, and ear muffs.


<><>NAME OR JOB TITLE OF EMPLOYEE <><> is responsible for maintaining exposure measurement records. These records will be appended to this written program as Appendix A and maintained for a minimum of two years from the measurement date.

<><>NAME OR JOB TITLE OF EMPLOYEE <><> is responsible for maintaining audiometric test results for all employees working in "High Exposure" jobs or areas. These records will be maintained for the duration of the employment of the affected employee.

All records related to this program will be provided upon request to employees, former employees, or representatives designated by the individual employee.


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Copyright © 2012 Lipin/Dietz Associates, Inc.


All material contained herein, unless otherwise noted or linked to entities other than this one, remain property of Lipin/Dietz Associates, Inc. and reproduction of them in any form, without exclusive permission, is a violation of applicable copyright laws. Copyright © 2008 Lipin/Dietz Associates, Inc.
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Last modified: October 28, 2015