Audiometry Questionnaire

I confirm that to the best of my knowledge, the above information is true and accurate and I will report immediately any changes to the Occupational Health Advisor or line manager.

I am aware that I work in a workplace where there are noisy areas and that not wearing my hearing protection could result in a noise induced hearing loss.

I confirm that I have been instructed, and am competent, in the correct use of hearing protection. I agree to wear, and keep in good order, any protective equipment that might be provided by my employer as identified in their risk assessment and also to use all other preventative measures that may be identified.

I am also aware that as a result of a risk assessment under the Noise at Work Regulations, officially known as the Control of Noise at Work Regulations 2005, Regulation 4, I will be subject to regular health surveillance, the results of which will form part of my management records and I consent to the results being sent to my line manager and/or company HR advisor.

I have read and understood the OHBM Ltd privacy notice.