HEARING CONSERVATION PROGRAM

TABLE OF CONTENTS

I. PURPOSE ....................................................................................................................................... 1
II. SCOPE ............................................................................................................................................ 1
III. APPLICABILITY .............................................................................................................................. 1
IV. DEFINITIONS .................................................................................................................................. 1
V. ROLES & RESPONSIBILITIES ....................................................................................................... 6
VI. GENERAL REQUIREMENTS ........................................................................................................ 9

TABLES .............................................................................................................................................. 11
TABLE 1: ACGIH THRESHOLD LIMIT VALUES .................................................................................. 11
TABLE 2: 8- HOUR TWA SOUND LEVELS & ALLOWABLE EXPOSURE TIMES ........................................... 12
TABLE 3: PERCENT NOISE EXPOSURE (DOSE) AND EQUIVALENT 8-HOUR TWA .................................... 12

APPENDICES ..................................................................................................................................... 13
APPENDIX A: NOISE DOSIMETRY DATA SHEET ................................................................................... 10
APPENDIX B: AREA NOISE SURVEY DATA FORM ................................................................................ 12
APPENDIX C: STS NOTIFICATION LETTER.......................................................................................... 15
APPENDIX D: AUDIOMETRIC TESTING LETTER OF AGREEMENT……………………………………………………20
APPENDIX E: OSHA , ANSI & ACGIH STANDARDS, APPENDICES & GUIDANCE ................................... 22

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 I. PURPOSE

Exposure to excessive noise in the workplace can cause permanent hearing loss. Certain
operations and workstations may expose faculty, staff, or students to significant noise levels. The
Hearing Conservation Program has been established to help ensure that members of the UVA
community do not suffer health effects from exposure to excessive noise while at work. Elements
of this written program include those designated in OSHA 1910.95: exposure monitoring,
audiometric testing, engineering and administrative controls, hearing protection devices (HPD),
training, recordkeeping, and program evaluation.

II. SCOPE
The provisions of this Hearing Conservation Program apply to all personnel in academic
departments, Athletics, Parking & Transportation and the main hospital. University satellite
research locations and campuses are also included.

III. APPLICABILITY
This program shall apply to all operations where employees are expected to be exposed to
noise levels of 85 dB(A) or above for 8 hours as a time weighted average.

IV. DEFINITIONS
Action Level OSHA
An 8-hour time weighted average (TWA) of decibels measured on the A-weighted scale, slow
response, or equivalently a dose of 50%. This is the level of sound exposure at which
employee participation in the UVA Hearing Conservation Program is mandatory.
ACGIH
American Conference of Governmental Hygienists
ANSI
American National Standards Institute
A-Weighted Sound Level (dB(A))
The weighting of sound levels that is equivalent to sound response of the human ear.
Audiometric Testing Program
The portion of the Hearing Conservation Program that consists of measuring an employee's
hearing threshold to establish a baseline and subsequent comparisons, usually on an annual
basis.
Decibel (dB)
Unit of measurement of sound level.
Dose
A ratio of noise exposure relative to the OSHA noise criterion level of 90 decibels, expressed as
a percentage. Ninety decibels represents a dose of 100% over an 8-hour work shift. Eighty-five
decibels represents a dose of 50% over an 8-hour work shift. Dose is based on the OSHA 5 dB
exchange rate. Dose may be determined from the equation given in Table 2 for non-continuous
noise or estimated from Table 3 based on the TWA.
Hearing Conservation Program (HCP)

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 A written program that establishes procedures to ensure the protection of employees from high
noise areas or operations in compliance with the OSHA Occupational Noise Regulation 29 CFR
1910.95 and in accordance with best practices published in consensus guidelines from ACGIH
and National Institute for Occupational Safety and Health (NIOSH) research.
Hearing Protection Attenuation
The estimated reduction in the noise level at the eardrum as a result of the use of hearing
protection. Estimated using the formula: Attenuated TWA, dB(A) = TWA - (Noise Reduction
Rating, NRR, – 7) for A – scale weighted sound levels. Attenuated TWA, dBC = TWA – NRR for
C-scale weighted sound levels.
Noise Induced Hearing Loss, NIHL
The OSHA recordable occupationally related hearing loss, as defined by 29 CFR 1904.10 and
29 CFR 1904.5, and includes a Standard Threshold Shift (STS) of 10 db, with age correction,
averaged over the 2K, 3K, and 4K frequencies from baseline in either ear and a 25 db shift from
audiometric zero, in the same ear as the 10 dB STS at the same frequencies.
Noise Reduction Rating (NRR)
The theoretical maximum amount of noise reduction that can be achieved using a hearing
protection device. This is a manufacturers’ calculated value and must be displayed with the
hearing protection device.
Monitoring
The sampling of noise levels using a sound level meter, octave band analyzer, or personal noise
dosimeter.
Permissible Noise Exposure
The maximum daily noise exposure which may be experienced by employees not using hearing
protectors from a continuous 8-hour exposure to a sound level of 90 dB(A) or equivalent dose of
100%.
Standard Threshold Shift (STS)
A change in hearing threshold, relative to the most recent audiogram for that employee, of an
average of 10 decibels (dB) or more at 2000, 3000, and 4000 hertz in one or both ears and
substantiated within 30 days with a follow-up audiogram.
Threshold Limit Value (TLV)
Health based exposure limits, established by ACGIH committees from the review of existing
published and peer-reviewed scientific literature, concluded to be safe for workers to experience
without adverse health effects.
Time Weighted Average (TWA)
The [equivalent] noise level, in dB, based on an 8-hour exposure time frame. If the noise is not
constant over an 8-hour exposure, then a calculated 8-hour TWA must be made using the
equation in Table 1. The TWA may also be estimated from the dose or percent noise exposure,
based on noise exposure continuous over 8-hours, as given in Table 2.

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V. ROLES & RESPONSIBILITIES

Three departments participate in administering the hearing conservation program; Environmental

Health and Safety (EHS), UVA WorkMed and UVA Audiology. EHS acts as the overall
administrator of UVA’s Hearing Conservation Program in accordance with the OSHA Noise
Standard 20 CFR 1910.95 The ongoing tasks of this program also include a cooperative effort
between EHS, principal investigators in UVA research departments, UVA Health System,
Athletics and Parking & Transportation. and staff and supervisors in all the aforementioned areas.

A. Environmental Health & Safety Department (EHS)

1. Develop the written Hearing Conservation Program and revise the program as
necessary.
2. Identify an audiometric testing clinic(s) for occupationally exposed employees. See
requirements of the testing clinic below.
3. Obtain and review written opinions and audiograms for all employees in the HCP from
the audiometric testing clinic and/or WorkMed. Track standard threshold shifts (STS) and
hearing related medical evaluations recommended by the healthcare provider per 29 CFR
1910.95. Notify employees of confirmation of a persistent STS. Update baseline
audiograms as needed.
4. Inform the Workers’ Compensation Coordinator in Human Resources (HR) of any STS
so it can be reflected on the OSHA 300 Log. The age correction calculation used in 29
CFR 1910.95 Appendix F will be used and considered prior to reporting an STS on the
300 Logs.
5. Conduct monitoring to identify areas or operations requiring inclusion in a hearing
conservation program (HCP).
6. Assist in noise control measures (i.e. hearing protection devices (HPD), noise control
engineered solutions, administrative controls) to reduce employee exposures to below 85
dB(A).
7. Identify approved hearing protection for use by UVA employees requiring protection.
8. Enroll an employee in the HCP after learning from departmental supervisors that an
employee is assigned to a work area or combination of work areas where the
occupational noise exposure is known to exceed 85 dB(A) for occupational noise.
9. Train personnel enrolled in the HCP including effects of overexposure to noise, and the
use, care and limitations of hearing protection devices.
10. Remove enrolled employees from the HCP upon receipt of one of the following:
• Noise exposure monitoring results that show administrative or engineering controls
have been implemented and have reduced employee exposure to occupational
noise below the OSHA action level.
• Notification that an employee’s job responsibilities change so that the employee is
no longer a member of a similar exposure group included in the HCP.
• Notification that the employee has terminated employment.
11. Oversee calibration and servicing of monitoring equipment (sound level meters, noise
dosimeters, and other such equipment as necessary to protect the health of the
employees) as manufacturers' guides instruct.
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 12. Maintain exposure monitoring records, training records, audiometric test results, and any
medical reports related to 29 CFR 1910.95 for the duration of employment plus 30 years.
13. Review and revise the HCP as needed for compliance with applicable regulations.

B. Healthcare Providers

Healthcare providers perform audiometric tests (hearing tests) and evaluate the results for
employees enrolled in the HCP. They also arrange the scheduling of audiometric tests, referrals
to specialists for hearing loss evaluations and repeat audiograms for persistent STS. They
maintain the records of audiometric test results and outcomes of specialist referrals. They are in
partnership with the UVA Office of Environmental Health & Safety in ensuring that the medical
surveillance aspects of the UVA Hearing Conservation Program are fulfilled.

B.1. WorkMed – UVA WorkMed, in its role as occupational health program provider for UVA
employees, is responsible for ensuring the scheduling, completion and recordkeeping of OSHA
mandated medical surveillance examinations for UVA employees enrolled in the hearing
conservation program. The medical surveillance program shall be under the supervision of an
audiologist or physician.

1. Coordinate baseline audiometric testing within 6 months of an employee’s enrollment in

the HCP through UVA Audiology Dept. Inform the employee to avoid high levels of
occupational and non-occupational noise for at least 12 hours prior to baseline
audiometric testing and reschedule if this has not occurred. Schedule baseline testing for
the first thing in the morning.
2. Coordinate annual audiometric testing for all employees enrolled in the HCP through UVA
Audiology Dept. Inform the employee that annual audiograms are to occur after a
minimum of four hours of noise exposure in the typical work environment and schedule
the employee’s annual audiometric test accordingly.
3. Provide EHS with written results for employees that have experienced a standard
threshold shift (STS) of 10 dB or more following loss correction for age, regardless of a
25 dB shift from audiometric zero within 5 days of the audiometric test.
4. Schedule a repeat audiometric test within 30 days for any employee who has
experienced a STS.
5. Inform the employee that has experienced a STS within 21 days of the initial testing.
6. Notify EHS if any medical condition related to the use of HPD are found during the
audiometric or annual physical examinations.
7. Inform employee of the need for otological examination if a medical condition unrelated to
the use of HPD is suspected.
8. Provide EHS with UVA Audiology’s written opinion with a copy of the audiogram,
including time of day of testing, following each audiometric evaluation.
9. Maintain all audiometric test records for the duration of employment plus 30 years.

B.2. UVA Audiology - The healthcare provider in Charlottesville performing audiometric tests
and evaluating the results for the HCP is the UVA Audiology Department. UVA Audiology staff
performing the tests are audiologists certified by the Council of Accreditation in Occupational
Hearing Conservation (CAOHC). Specific responsibilities of UVA Audiology for this HCP are:

1. Conduct audiometric testing for University employees potentially exposed to noise levels
at or above 85 dB(A) as an 8 hour TWA in accordance with 29 CFR 1910.95.

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 2. For baseline testing, verify that the employee has avoided high levels of occupational and
non-occupational noise for at least 12 hours prior to audiometric testing and reschedule if
this has not occurred.
3. For annual testing, verify that the employee has been working for a minimum of 4 hours
in the routine noise environment prior to audiometric testing.
4. Provide UVA WorkMed with written results and opinion with a copy of the audiogram,
including time of day of testing, within 10 days of each audiometric evaluation.
5. Provide UVA WorkMed with written results for employees that have experienced a
standard threshold shift (STS) of 10 dB or more following loss correction for age,
regardless of a 25 dB shift from audiometric zero.
6. Notify EHS if any medical condition related to the use of HPD are found during the
audiometric examination.
7. Inform employee of the need for otological examination if a medical condition unrelated to
the use of HPD is suspected.
8. Participate with UVA WorkMed to meet the requirement to conduct a re-test audiometric
evaluation for an employee within 30 days if the employee has experienced a STS or for
other reasons as requested by UVA WorkMed or EHS.
9. Retain audiometric testing results for the duration of an employee's employment.
10. Maintain written calibration of audiometers and daily operational pre-testing checks.
Conduct an exhaustive calibration, as specified in 29 CFR 1910.95(h)(5)(iii), of the
audiometric measuring instruments at least every two years.

B.3. Mobile and other Ancillary Audiometric Testing Facilities

Mobile and ancillary audiometric testing facilities include any facility other than UVA Audiology,
Charlottesville, VA. Mobile and ancillary testing facilities are required to: 1) meet all requirements
specified in OSHA 1910.95 including Appendices, 2) be operated under the supervision of a
physician or audiologist, 3) be approved by UVA EHS and complete an Audiometric Testing
Letter of Agreement (see Appendix D) prior to the performance of testing on UVA staff enrolled in
the HCP. Audiometric tests shall be performed by a physician, audiologist or an occupational
hearing conservationist certified by the Council for Accreditation in Occupational Hearing
Conservation (CAPHC) or the equivalent working under a physician or audiologist. These
facilities shall meet all the requirements specified in B.1. and B.2 when servicing UVA employees
enrolled in the UVA Hearing Conservation Program.

C. Departments, Supervisors, Directors, Managers Shall:

1. Identify potentially hazardous noise locations and operations and contact EHS for
evaluations.
2. Coordinate baseline audiometric testing within 6 months of an employee’s hire for those
with job titles enrolled in the HCP. Inform the employee to avoid high levels of workplace
and non-workplace noise for at least 12 hours prior to audiometric testing and ensure this
has occurred. Reschedule the audiometric test if the latter has not occurred.
3. Ensure that employees required to participate in the hearing conservation program
complete their annual audiometric testing, at the clinic with which a written agreement
has been established. Annual tests are to occur after at least 4 hours of routine noise
exposure in the workplace.
4. Require employees exposed to noise in access of 85 dB(A) to attend hearing protection
training.

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 5. Implement EHS recommendations for controlling employee noise exposures to
equipment and work areas above 85 dB(A). The feasibility of controlling noise levels at
the source through administrative and/or engineering controls will be considered as first
options. If such controls are not feasible, hearing protection devices must be used to
reduce exposures to below 85 dB(A).
6. Provide the required hearing protection devices for employees including more than one
style as required to provide a proper fit. Ensure employees wear the assigned HPD.
7. Maintain any noise area postings required by EHS.
8. Notify EHS if an employee enrolled in the HCP transfers to a new position or terminates
employment.
D. Employee Shall:
1. Assist the supervisor in identifying potentially hazardous noise locations or operations to
which they may be exposed.
2. Schedule and complete audiometric testing or exposure assessments as instructed.
3. Use hearing protection as required and in accordance with training received.
4. Attend hearing protection training as instructed.
5. Notify the supervisor or EHS of any concerns related to the use of HPD.

VI. GENERAL REQUIREMENTS

A. Exposure Limits
The OSHA PEL for noise is based upon an eight-hour TWA of 90 dB(A) with a doubling rate
of 5 dB(A). The OSHA Action Level for noise is an eight-hour TWA of 85 dB(A) with a
doubling rate of 5 dB(A). Exposure to impulse or impact noise should not exceed 140 dB
without proper hearing protection.
The ACGIH Threshold Limit Value (TLV) for noise is based upon an eight-hour TWA of 85
dB(A) with a doubling rate of 3 dB(A). Though not a regulatory requirement, the TLV is the
most up-to-date, scientifically sound exposure limit for the assessment of noise exposure.

B. Monitoring
When information indicates that an employee’s exposure may equal or exceed 85 dB(A) for
an 8-hour TWA assessment, monitoring shall be conducted by EHS. Affected employees
shall be notified of the results of the monitoring including an explanation of the significance of
the results. Monitoring activities may consist of:
1. Sound level measurements for locations where the noise level is stationary and expected
to be continuous or
2. Personal noise dosimetry for work operations that are highly mobile or random in noise
level.
3. Re-monitoring, if a change in equipment, process or controls increases the noise level to
the extent that:
• Additional employees may be exposed at or above 85 dB(A) or;
• The attenuation provided by the hearing protectors used by the employee(s) does not
reduce the noise exposure level to 85 dB(A) for an 8 hour TWA or 80 dB(A) as 8 hour
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 TWA for employees that have experienced a standard threshold shift.
• Follow-up monitoring if an STS has occurred.
4. The opportunity for affected employees to observe the noise measurements during
collection.

C. HCP Enrollment

Employees must be enrolled in the HCP if they are assigned to a work area (or work in a
similar exposure group) where occupational exposure to noise exceeds 85 dB(A).

Enrolling Employees in the HCP

Upon receipt of written results that an employee or a group of employees who are exposed
to occupational noise above 85 dB(A), EHS will enroll the employee or group of employees in
the HCP.

Removing Employees from the HCP

EHS will remove employees from the HCP if any of the following criteria are met:
1. Exposure monitoring results indicate that an employee or a group of employees who
work in a similar exposure group are no longer exposed to occupational noise above
85 dB(A) after implementing engineering or administrative controls.
2. Notification from the employee’s supervisor that an employee’s job responsibilities
have changed and the employee is no longer a member of a similar exposure group
included in the HCP.
3. Notification that the employee has terminated employment

D. Audiometric Testing Program

All employees exposed to noise at or above 85 dB(A) are required to participate in the
program. This program consists of:
1. A baseline test to be completed within 6 months of the employee’s first exposure above
85 dB(A). This test must be preceded by at least 12 hours without exposure to
workplace noise at or above 85 dB(A) or hearing protection devices must be used prior
to testing.
2. Annual testing thereafter provided that exposure at or above 85 dB(A) is expected.
3. A follow-up audiogram shall be provided within 30 days if a standard threshold shift
has been identified. The employee shall be informed in writing within 21 days of the
determination.
4. Audiometric testing reviewed by an audiologist. The audiologist will determine if further
evaluation or retraining is needed.
5. Maintenance of audiometric testing equipment in accordance with the requirements of
the OSHA Occupational Noise Standard (29 CFR 1910.95 and its appendices).
E. Noise Control & Training
Where noise levels for non-mobile sources are found to be in excess of 85 dB(A) or above
the Permissible Noise Exposure as listed in Table 1 on a continuous basis and employees
are required to work in such areas the following measures shall be taken:
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 1. Engineering controls will be reviewed for feasibility in noise reduction. Until they are
implemented or if adequate controls are not feasible then;
2. Hearing protection devices shall be worn by employees whose exposure is at or above
85 dB(A) as an 8 hour TWA. Hearing protection devices will be made available to
exposed employees at no cost. Hearing protection attenuation shall reduce the
exposure below 85 dB(A) as an 8 hour TWA using the NRR of the rated device.
3. Training of affected employees regarding the hazards of noise exposure, and where
necessary the fitting of employees with appropriate hearing protection devices and
training about their use, care and limitations

F. Record-keeping
The audiometric testing clinic shall maintain audiometric exams for each tested employee for
the duration of that employee’s participation in the program. WorkMed shall maintain
audiometric test results for the duration of employment plus 30 years. EHS shall maintain all
noise monitoring data and audiometric test results for the duration of employment plus 30
years.

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 TABLES

TABLE 1: ACGIH THRESHOLD LIMIT VALUES FOR AUDIBLE SOUND

Duration Per Sound Pressure Level
Day dB(A) The noise level should be determined by a sound level
Hours 24 80 meter, integrating sound level meter or dosimeter. When
16 82 the daily noise exposure is composed of two or more
8 85 periods of noise of different levels, their combined effect
4 88 should be considered rather than the individual effect of
2 91 each. If the sum of the following fractions,
1 94
Minutes 30 97 C1 + C2 +…Cn
15 100 T 1 T2 Tn
7.50 103
3.75 106 exceeds unity, then the combined exposure should be
1.88 109 considered to exceed the TLV. C indicates the total
0.94 112 duration of exposure at a specific noise level, and T
Seconds 28.12 115 indicates total duration of exposure permitted at that level.
14.06 118 All on-the-job noise exposure of 80-140 dBA should be
7.03 121 used in the above calculations.
3.52 124
1.76 127 For more variable sound pressure levels and when brief,
0.88 130 impulsive or impact sounds are present a dosimeter or an
0.44 133 integrating sound level meter must be used. The limit is
0.22 136 exceeded when the dose is more than 100% as indicated
0.11 139 on a dosimeter set with a 3 dB time intensity exchange
0.08 140 rate and an 8-hour criteria level of 85 dBA.
No exposure to continuous, intermittent or impact noise (e.g. audible sound between the frequencies of 20 to
20,000 Hz) is permitted in excess of a peak C-weighted level of 140 decibels (dB).
Noise levels in dB are measured on a sound level meter, conforming, as a minimum, to the requirements of the
American National Standards Institute Sound Level Meters – Part 1: Specifications S1.4 (ANSI, 2007) Type 2,
and set to use the A-weighted network with slow meter response.

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 TABLE 2: OSHA 8- HOUR TWA SOUND LEVELS & ALLOWABLE EXPOSURE TIMES
Allowable For brevity, only dB(A) values that are multiples of 5 are shown.
Sound Level
Exposure Shaded areas represents OSHA defined exchange rate. The complete
(dB(A))
Duration table G- 16A at 29 CFR 1910.95 App A will be used. Allowable
(loudness)
(Hours) exposure duration is time in hours at a dB(A) level, which constitutes an
exposure equivalent in energy and sound dose to 90 dB(A) for 8 hours.
80 32
85 16 Calculations/Definitions:
90 8 Allowable exposure time may be calculated using the following equation
95 4 for sound levels not specified in this table:
100 2
105 1
110 0.5 T = 8/2(L-90)/5
115 0.25
120 0.125
Where T = Allowable Exposure Duration and
125 0.063 L = measured A-weighted sound level.
130 0.031
Sound levels below 80 dB(A) are not included
Example: measured in sound
exposure calculations.
level = 75 dB(A) A dose of 50% or more, or
an 8h-TWA of 85 dB(A) or higher,
T =8/2 triggers
(75-90)/5 the Action Level requirements and mandates an
= 64 hours Allowable Exposure Duration
employee's participation in the UVA Hearing Conservation Program.

TABLE 3: OSHA PERCENT NOISE EXPOSURE (DOSE) AND EQUIVALENT 8-HOUR

TWA
Dose 8-Hour For brevity, a shorten selection of dose values are shown. The
(%) TWA complete list is given in table A-1 of 29 CFR 1910.95, Appendix A.
10 73.4
20 78.4 The dose may be calculated using the following formula:
30 81.3 Dose = 100 x {(CLevel1)/(TLevel1)+(CLevel2)/(TLevel2)+(CLevel n)/(TLevel
40 83.4 n)}

50 85.0 Where C = time of exposure at any noise level and

60 86.3 T = allowable exposure time, in hours given by Table 1.
70 87.9
80 88.4 Example: 100 dB(A) for 1 hour, 95 dB(A) for half hour, and 80 dB(A) for
90 89.2
100 90.0 4h Dose = 100x{1/2 + 0.5/4 + 4/32} = 100x(0.5 + 0.125 + 0.125} = 75%
120 91.3
140 92.4 For a dose greater than or less than the values printed in the
160 93.6 chart use the following equation to calculate the TWA:
8h-TWA = 16.61 log(10) (D/100) + 90
180 94.2
Where D = accumulated dose in percent exposure.
200 95.0
240 96.3
Example: Dose = 75%
280 97.9
300 97.9
8h-TWA = 16.61 log(.75) + 90 = 16.61(-.1249) + 90 = -2.07 + 90 =
400 100.0
87.93 dB(A)
500 101.6

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APPENDICES
 APPENDIX A: NOISE DOSIMETRY DATA SHEET

OFFICE OF THE VICE PRESIDENT FOR RESEARCH

ENVIRONMENTAL HEALTH & SAFETY
AUDIODOSIMETRY SURVEY
Date: Department: Supervisor:
Test Location: Task: Audiodosimetry Performed By:
PRE/POST CALIBRATION: Audiodosimetry Reviewed By:
Source: Quest QC-30 Calibrator 114 dB Source: 3M Edge eg5 dosimeter
OSHA Hearing Conservation Cutoff OSHA PEL (Compliance)

Dosimeter Employee & Job Title Time Time Total Sample TWA Dose Lmax LPeak LAvg
# Computing ID or On Off Time:
Location

Observations: Projected Projected

TWA: Dose:

Recommendations:

Notes
 Noise Dosimetry Additional Information

1. Reason for monitoring?

a. Random selection in area above 85 dB(A).

b. Because of mobility or intermittent exposure.
c. Has experienced TTS.
d. Other Explanation:

2. Indicate the degree of reliability in the data collection.

Check: Very Unreliable Very Reliable

1 2 3 4 5 6 7 8 9 10

3. Were there any adverse environmental conditions that might have affected the readings during the
wearing period? If yes, explain.

4. Did you suspect any tampering with the dosimeter during the time period it was worn?

5. Does this individual currently use any type of hearing protection device?
If yes, what is the type, manufacture and NRR?

6. Calculate the attenuation using (NRR –7)/2 in comparison to dB equivalent exposure %.

 APPENDIX B: AREA NOISE SURVEY DATA FORM

SOUND LEVEL MEASUREMENTS Date:

Location:____________________________________________ PI:_____________________________________________________
Process:____________________________________________ Individual Performing Survey: _______________________________
Sound Level Instrument: ______________________________ Settings: (Fast,Slow,Impulse,Peak) _____________ Weighting scale _______
Calibrator, Level, Hz: _______________________ Result: ________________ Meets +/- 0.5 dB Y/N
Measurement ID/Activity Equipment Sound Level Comments
No.

Environmental Health and Safety –UVA OCCUPATIONAL HEALTH

Notes:
Sketch noise source & room layout.
APPEND

APPENDIX C: STS NOTIFICATION LETTER

Office of the Vice President for Research

Environmental Health and Safety

TO: _____________________________________
FROM: _____________________________________
DATE: ______________________________________

SUBJECT: Standard Threshold Shift in Hearing

The results of your recent hearing test as part of your OSHA physical examination indicates you have sustained a Standard
Threshold Shift (STS) in your hearing ability. An STS is a permanent loss of 10 decibels or greater averaged over the 2000, 3000,
4000 hertz frequency ranges in either ear. This is based on a comparison of your most recent audiogram with your initial
baseline audiogram. Allowances have been made for the contribution of aging to the change in hearing level.

The 2000 to 4000 hertz frequency range is considered to be part of the speech frequency range. Losses in this range will
eventually make it difficult to understand normal conversation. You may start to notice that people have to shout to make you
understand. Telephone and radio use will be affected due to the absence of face-to-face contact. Reduction of these types of
problems with the use of effective hearing conservation methods will enhance your quality of life.

As your employer, it is our responsibility to inform you of this hearing loss and provide you with information to preserve your
present hearing level without additional losses. It is necessary to continue to wear effective haring protection, earplugs or muffs,
when working in noisy environments. Noise induced hearing loss is a gradual process that you may not realize is occurring until
it’s too late and there is no treatment for it.

A meeting was held with you on _______________ to discuss information related to your noise exposure on and off the job, methods
of controlling your personal noise exposure, the effective use of hearing protection. EHS may also conduct additional monitoring
of workplace noise exposure levels in your area in the future. If so, you will be provided a copy of the results.

The following items were discussed:

 Explanation of STS and ways to prevent hearing loss
 Use of properly fitted hearing protection
 Workplace noise levels data and future monitoring

Criterion Met: _____ STS _____OSHA Reportable STS

EHS Representative: ____________________________________________________________________Date:__________________________

Employee: _______________________________________________________________________________Date: ________________________

CC: Employee’s Department Supervisor or HR Representative_______________________________________________________

.
APPEND

APPENDIX D: Audiometric Testing Letter of Agreement

OFFICE OF THE VICE PRESIDENT FOR RESEARCH

ENVIRONMENTAL HEALTH & SAFETY

Date:
Subject: Audiometric Testing Letter of Agreement
Between the University of Virginia’s Office of Environmental Health & Safety (EHS),
the ___________________________________________________________ and
(UVA Department requesting audiometric testing)

______________________________________________________________
(Audiological Health Care Provider)

Purpose: To establish a letter of agreement between the above named parties pertaining to each organization’s duties and
responsibilities in fulfilling the University of Virginia’s Occupational Safety and Health Administration (OSHA) requirements
for medical surveillance as outlined in the Occupational Noise Exposure Standard, 29 CFR 1910.95, the Recording Criteria
for Cases Involving Occupational Hearing Loss, 29CFR1904.10, and Determination of Work-relatedness, 29 CFR 1910.5.
Copies of these standards can be requested from EHS.

A. UVA Office of Environmental Health & Safety (EHS)

The role and responsibilities of UVA EHS as coordinator of the UVA OSHA Hearing Conservation Program are
detailed in the UVA Hearing Conservation Program (HCP) Section V.1. In summary, the main tasks are
HCP program oversight, the completion of noise surveys, identification of job titles to enroll in HCP or
remove from the HCP, tracking audiometric test results, annual training, and evaluating hearing protection,

B. Departments
The UVA Departments that fall under this UVA HCP include UVA research departments, UVA Health System,
Athletics and Parking & Transportation. UVA Facilities Management manages its own HCP. The
responsibility of departments and staff are detailed in the UVA HCP Section C. In summary these are;
identify potentially high noise areas and contact EHS for noise monitoring, work with the AHCP (see below)
to ensure that staff enrolled in the HCP obtain audiometric testing within 6 months of hire, ensure staff in the
HCP obtain annual audiometric testing, provide hearing protection for staff and ensure staff receive hearing
protection training.

C. Audiological Health Care Provider (AHCP) accepts the following duties and responsibilities:

1. Conduct or oversee the audiometric testing program for all active employees identified by EHS and UVA
Departments for enrollment in the UVA Hearing Conservation Program (HCP). These employees are enrolled in the
HCP as a result of noise monitoring which indicates their time weighted average noise exposures exceeds the
action level (85 dBA).
a. Schedule all baseline, annual and follow-up audiometric tests, in accordance with the UVA HCP Section
B.1. Send appointment notices to employees through their respective departments
b. Ensure audiometric tests are administered by a certified and licensed audiologist or a graduate
audiologist under the supervision of an audiologist or an occupational hearing conservationist certified
by the Council for Accreditation in Occupational Hearing Conservation (CAOHC) working under the
supervision of an audiologist or physician.
c. Ensure the time of day of audiometric testing complies with the UVA Hearing Conservation Program
Section B.1.1-B.1.2.
d. Ensure that audiometric testing follows all requirements specified in Section B2 of the UVA HCP.
APPEND
e. Ensure the following OSHA 29CFR1910.95 requirements are met for audiometric testing; Measuring
Instruments (Appendix C), Test Rooms (Appendix D), Calibration (Appendix E), Calibration
Recordkeeping (29CFR1910.95 (h) (5)).
f. Review and evaluate the audiograms. Notify employee when there is a new audiometric interpretation,
identify when a standard threshold shift (STS) has occurred and refer employees to audiological
specialists as needed. Audiometry should be conducted again within 30 days of any monitoring or
retest audiogram that shows a significant threshold shift. A minimum of 12 hours of quiet shall precede
the confirmation audiogram. Notify EHS when an STS has occurred.
g. Maintain audiometric test records for all active and newly identified employees as designated by EHS
for participation in the HCP.
h. Send copies to EHS of all baseline, annual and follow-up audiometric test results with outcome
interpretation for each UVA employee in the HCP, including time the test was completed.
i. Meet with EHS annually to review occupational noise environments in UVA workplaces and the medical
surveillance program of the HCP.
j. Contact EHS with any problems or concerns regarding the fulfillment of any of these responsibilities.

2. Sound level monitoring and noise surveys are completed by EHS in those departments identified with the potential
to exceed the action level. The AHCP shall notify EHS of any work-related noise exposure complaints received by
UVA employees during clinic visits. This will allow EHS to perform noise surveys as needed.

Signatures

______________________ ______________________ ___________________________

Director AHCP UVA EHS HCP Program Coordinator UVA Department in HCP

Printed Names

______________________ ________________________ __________________________

Director AHCP UVA EHS HCP Program Coordinator UVA Department in HCP
 APPENDIX E: Relevant OSHA, ANSI and
ACGIH Standards, Appendices &
Guidelines

1) OSHA Occupational Noise Exposure Standard and Appendices 29CFR 1910.95

2) OSHA Determination of Work Relatedness 29CFR 1904.5
3) OSHA Recording Criteria for Cases Involving Occupational Hearing Loss 29CFR
1904.10
4) ANSI S1.11-1971 "Specification for Octave, Half-Octave, and Third-Octave Band
Filter Sets"
5) ANSI S1.25-1978 "Specification for Personal Noise Dosimeters"
6) ANSI S1.4-1971 "Specification for Sound Level Meters"
7) ANSI S3.6-1969 "Specifications for Audiometers"
8) ACGIH “Threshold Limit Values for Chemical Substances and Physical Agents”