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Contents of presentation:
Noise and Hearing Conservation
Sound and noise measurement
Hearing loss
Noise control and abatement
Noise and hearing conservation
Sound and Noise Measurement
Sound and Noise
Sound is our sensation of very small, rapid
changes in air pressure
Noise is any sound that you don’t want to
hear
-Vibrations that travel through the air or another
medium and can be heard when they reach a
person's or animal's ear
-A sound, esp. one that is loud or unpleasant or
that causes disturbance
The difference between
sound and noise
• Sound is a sensation caused in the ear by the vibration of the
surrounding air or other medium. It is clearly understood
from the definition that vibrations cause the sensation called
the sound.
• Noise is an unpleasant sound especially a loud one comprising
of shouts too. Thus it is understood that there is
unpleasantness about noise whereas there is no
unpleasantness about sound.
How is Sound Measured?
Sound is measured in two ways:
i) Decibels
- measure the pressure of sound.
ii) Frequency
- related to sound’s pitch and is measured in units called hertz (Hz) or
cycles per second.
- the pitch of sound (how high or low it seems) – is how you perceive its
frequency
- the higher the pitch, the higher the frequency
*High-frequency sounds are generally more annoying than low-frequency
sounds and can be more harmful to hearing
Sound-measuring Instruments
The instruments typically used to measure sound are :
i) Sound-level meter
- measures the pressure of sound in a specific area at a moment in time.
- good for estimating noise exposure in areas where noise levels are
relatively constant and workers are not mobile.
ii) Dosimeter
- measures the noise exposure for one worker over a longer “ cumulative”
time, such as an eight-hour day.
Sound-level meter
Measures noise at a moment in
time
Dosimeter
Measures noise exposure
over time
dBAs and dBCs
 Sound-level meters and dosimeters measure decibels in
different frequency ranges, typically a dBA scale and a dBC
scale.
 The dBA scale reflects measurements that emphasize higher
frequencies, closer to human hearing.
 The dBC scale measures the lower frequencies in the
environment, which our ears don’t perceive as very loud.
 We may not hear the lower frequencies, but we can feel
them.
Noise Permissible Exposure
Limits (PEL)
 Utilize administrative or engineering controls when sound
levels exceed Noise Permissible Exposure Levels
Exp: 8 hours permitted duration per workday for 90 dBA
sound level.
 Provide hearing protectors if above controls fail to reduce
sound levels within Permissible Exposure.
 Impulsive or impact noise should not exceed 140 dB.
Rule of thumb
“When you feel the need to shout in order to be
heard 3 feet away, the noise levels are probably 85
dB or more and hearing protectors are
recommended.”
How does hearing work?
The ear has three main parts:
i) The outer ear
- the outer ear (pinna) collects sound waves and directs the into the
external auditory canal.
- the eardrum separates the auditory canal from the middle ear.
ii) Middle ear
- small bones in the middle ear transfer sound to the inner ear.
iii) Inner ear
- the inner ear contains the cochlea, the main sensory organ for hearing,
and nerve endings leading to the brain.
Outer Ear
Middle ear
Inner ear
All sounds produce waves. Sound waves funnel
through the opening in your outer ear, travel down
the auditory canal, and strike the eardrum, causing it
to vibrate.
The vibrations pass the small bones of the middle
ear, which transmit them to sensory cells — called
hair cells — located in the cochlea.
The vibrations become nerve impulses and go
directly to the brain, which interprets the impulses as
sound.
How loud is too loud?
Because people differ in their sensitivity to sound, there’s no way to
predict who is at risk for hearing loss. Sound pressure, frequency,
and length of exposure all determine whether what you hear is
harmful or just annoying. However, the following are signs that noise
may be a problem where you work:
 You have to shout to make yourself heard during work
 You have ringing in your ears for several hours after you leave work
 You have difficulty hearing normal sounds for several hours after
you leave work
*Most hearing specialists agree: You can damage your
hearing if you’re continually exposed to noise greater
than 85 decibels over eight hours.
*As noise levels rise above 85 decibels, the safe exposure
time for unprotected ears falls dramatically. For
example, 110-decibel noise can impair hearing after just
15 minutes of exposure.
Hearing Loss
How does sound damage
hearing?
Very loud sounds can damage the sensitive hair cells in your inner ear. Hair
cells are the foot soldiers for your hearing.
As the number of damaged hair cells increases, your brain receives fewer
impulses to interpret as sound. When you damage hair cells, you damage
hearing.
Healthy Damaged
Effects of noise on
hearing
“How quickly hearing loss takes place depends
on the intensity of the noise, its duration, and
how often the exposure occurs.”
Effect of noise on people
Auditory effect:
i) Temporary threshold shift
-While a single exposure to loud noise can damage your hair cells, it
probably won’t destroy them.
- You may experience ringing in your ears and some sounds may be
muffled, but your hair cells will recover and so will your hearing.
ii) Permanent threshold shift
- But repeated exposures to loud noise can damage hair cells to the
point that they won’t recover.
- No treatment will restore it. When you destroy hair cells, you destroy
hearing.
How to know if your
hearing is damaged
 Hearing loss is painless and gradual. It usually develops over several
years — you might not even notice the loss during those years.
 Sometimes, overexposure to loud noise can trigger ringing or other
sounds in your ears, called tinnitus.
 While tinnitus may be a symptom of damaged hearing, it can also be
caused by infections, medications, and earwax.
 The only way to know for sure if noise has damaged your hearing is to
have a hearing examination by a certified audiometric technician,
audiologist, otolaryngologist, or physician.
Anatomy and Physiology
of Healthy Ear
Anatomy and Physiology
of Damaged Ear
Noise Induced Hearing Loss
Noise induced hearing loss stems from exposure to
loud noises.
• Constant exposure over a period of time
• Exposed to sound level over 140 dBA
• Tinnitus
Age Induced Hearing loss
• Exposure to high sound levels
• Hereditary
• Nerve damage
• Reduced neuronal response
Occupational/Non-Occupational
Hearing Loss
• Occupational Hearing Loss
– Results from constant exposure to sound levels above 85
dBA TWA
– Damage to hair cells in cochlea
• Non-Occupational Hearing Loss
– Results from constant exposure to sound levels above 85
dBA TWA
– Results from damage to outer, middle, or inner ear,
hereditary, ototoxic drugs
– Damage to hair cells in cochlea, damage to nerve cells
relaying sound message to brain, damage to structure of
ear
Types of noise
• Pitch
• Loudness
– Whisper 10 dB
– Street sound 70 dB
– Sander 85 dB
– Sporting Events 100dB
– Mowing the Lawn 101dB
– Motorcycle Riding 112dB
– Concerts 125dB
– Shooting Range 130dB
Recognizing Occupational
Hazardous Noise
When is workplace noise
dangerous
There are three basic types:
 Area monitoring.
Use a sound-level meter to identify areas in the workplace
that may put workers’ hearing at risk.
 Personal monitoring.
Use a sound-level meter and a dosimeter to estimate an
individual’s daily noise exposure.
 Engineering survey.
Measure noise levels produced by machinery in different
operating modes to find ways to eliminate or control the
noise.
Area monitoring
Noise Dose (Personal Monitoring)
Table of Permissible
Noise Exposure Limits
Do you need a hearing
conservation program?
Occupational noise exposure, says that your workplace must
have a hearing conservation program when employees are
exposed to noise levels that are equal to or greater than 85
dBA averaged over eight hours.
The basic elements of a hearing conservation program include:
 Exposure monitoring
 Audiometric testing
 Hearing protection
 Employee training
 Recordkeeping
 Access to information
Noise Control and Abatement
When other controls and
hearing protectors are required?
If your workplace has noise levels that are greater than
those shown in the table, you must use engineering
or administrative controls to reduce employee
exposures.
If these controls aren’t effective, your employees must
also use hearing protectors to reduce their
exposures to safe levels.
When engineering or administrative controls are
required
Engineering controls
When you replace a noisy machine with a quiet one, modify it
to make it quieter, or change the sound path so that the
noise never reaches the listener, you’re using an engineering
control.
You’re more likely to find a workable solution when you:
 Understand what’s causing the noise
 Determine how the noise is reaching the worker
 Identify where to control the noise: at the source, along the
sound path, or at the worker
Creative engineering solutions may also be the best ones. Here
are three examples:
i) Build an enclosure
- Construction workers were using a concrete mixer to de-
grease metal parts by tumbling them in sawdust —
effective but noisy.
- To reduce the noise level to below 85 decibels, the
employer built an enclosure around the mixer with two-by
fours and an acoustic sound board, sealing the access door
with polyurethane foam.
- The cost was minimal and the design was effective; it
lowered noise levels to a safe 78 decibels.
ii) Increase the distance
- When you double the distance between the worker and
the sound source, you decrease the sound pressure level
by six decibels. For example, a hazardous 96-decibel noise
source at five feet is a safe 84 decibels at 20 feet as shown
in the table below.
When engineering or administrative controls are
required
Administrative controls
 Unlike engineering controls, which keep hazardous noise from reaching a
worker, administrative controls change workers’ activities to lower their
exposure.
 Closely related to administrative controls are work-practice controls,
which emphasize safe practices.
 Administrative and work-practice controls are usually less expensive than
engineering controls because there is no cost in changing or modifying
equipment.
 However, administrative and work-practice usually aren’t as effective as
engineering controls because they don’t control the noise.
 Noisy machines are still noisy and the exposure is still present.
Examples of administrative controls:
i) Administrative controls
- Reduce the time workers spend in noisy areas; rotate two
or more workers so that each is exposed to noise less than
85 decibels, averaged over an eight-hour day.
- Shut down noisy equipment when it’s not needed for
production.
ii) Work-practice controls
- Maintain equipment so that it runs smoothly and quietly.
- Ensure that workers know how to perform their tasks and
operate equipment at safe noise levels.
- Use warning signs to identify work areas where noise
exceeds safe levels.
Hearing protectors
If an administrative control won’t reduce employee exposures to safe levels,
you’ll need to consider a third noise-control tool (hearing protectors).
There are two types of hearing protectors:
i) Earplugs
- Fit in the outer ear canal.
- To be effective, they must totally block the ear canal with an airtight
seal.
- They’re available in different shapes and sizes and can be custom
made.
- An earplug must be snugly fitted so that it seals the entire
circumference of the ear canal.
- An improperly fitted, dirty, or worn-out plug will not seal and can
irritate the ear canal.
ii) Earmuffs
- Fit over the entire outer ear — they won’t fit properly over
eyeglasses
or long hair — and are held in place by an adjustable headband.
- The headband must hold the earmuff firmly around the ear.
Hearing Protection Devices
(HPD)
• Employers shall provide to employees
exposed to 8 hr TWA of 85 dB at no cost.
• Employers shall ensure being worn:
– by employees exposed to 8 hr TWA of 90dB or
greater
– by employees exposed to 8 hr TWA of 85dB or
greater and:
• Whose baseline audiogram has not been established
• Who have experienced a threshold shift
Hearing Protection Use
• Voluntary Use
– Exposed to an 8 hr TWA of 85 dB
• Mandatory Use
– Exposed to an 8 hr TWA of 90 dB
– Exposed to an 8 hr TWA of 85 dB but have not had
a baseline hearing test
– Employees who have suffered STS hearing loss
and are exposed to an 8 hr TWA of 85 dB
Effectiveness
 Better earplugs and earmuffs are about equal in sound reduction, though
earplugs are more effective for reducing low-frequency noise and
earmuffs for reducing high-frequency noise.
 Using earplugs and muffs together increases protection against higher
noise levels (above 105 decibels) than either used alone.
Selecting hearing protectors
 Focus on the three Cs: comfort, convenience, and compatibility.
Employees won’t wear hearing protectors that are uncomfortable or
difficult to use or that interfere with their work.
 They should be able to choose, with the help of a person trained in fitting
hearing protectors, from among a variety of appropriate types and sizes.
Purpose of Hearing Protectors
Reduction of sound waves traveling to the inner ear.
Instructions on Selection, Fitting,
Use, and Care of Hearing Protectors
• Ear plugs
– Keep clean and free of materials
• Wash in mild liquid detergent and warm water
• Squeeze excess water and air dry
– Discard plugs when hardened or do not re-expand
• Ear Muffs
– Keep clean and free of debris
• Clean cushions with warm soapy water
– Do not tamper with the acoustic seal between the cushions and the
headband
– Do not modify the ear muffs in any way
– Do not stretch or abuse the headband
Employee Responsibility
• Understand the need for hearing protection
devices.
• Wear HPDs and seek replacements.
• Encourage co-workers to wear HPDs.
• Communicate problems to supervisors
Management Responsibility
• Provide occupational noise training.
• Provide hearing protection devices.
• Demonstrate commitment – wear HPDs.
• Enforce the use of HPDs.
• Keep up to date with HPD selection and use.
• Encourage questions and resolve problems.
Topic 7

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Topic 7

  • 1. Contents of presentation: Noise and Hearing Conservation Sound and noise measurement Hearing loss Noise control and abatement Noise and hearing conservation
  • 2. Sound and Noise Measurement
  • 3. Sound and Noise Sound is our sensation of very small, rapid changes in air pressure Noise is any sound that you don’t want to hear -Vibrations that travel through the air or another medium and can be heard when they reach a person's or animal's ear -A sound, esp. one that is loud or unpleasant or that causes disturbance
  • 4. The difference between sound and noise • Sound is a sensation caused in the ear by the vibration of the surrounding air or other medium. It is clearly understood from the definition that vibrations cause the sensation called the sound. • Noise is an unpleasant sound especially a loud one comprising of shouts too. Thus it is understood that there is unpleasantness about noise whereas there is no unpleasantness about sound.
  • 5. How is Sound Measured? Sound is measured in two ways: i) Decibels - measure the pressure of sound. ii) Frequency - related to sound’s pitch and is measured in units called hertz (Hz) or cycles per second. - the pitch of sound (how high or low it seems) – is how you perceive its frequency - the higher the pitch, the higher the frequency *High-frequency sounds are generally more annoying than low-frequency sounds and can be more harmful to hearing
  • 6. Sound-measuring Instruments The instruments typically used to measure sound are : i) Sound-level meter - measures the pressure of sound in a specific area at a moment in time. - good for estimating noise exposure in areas where noise levels are relatively constant and workers are not mobile. ii) Dosimeter - measures the noise exposure for one worker over a longer “ cumulative” time, such as an eight-hour day.
  • 7. Sound-level meter Measures noise at a moment in time Dosimeter Measures noise exposure over time
  • 8. dBAs and dBCs  Sound-level meters and dosimeters measure decibels in different frequency ranges, typically a dBA scale and a dBC scale.  The dBA scale reflects measurements that emphasize higher frequencies, closer to human hearing.  The dBC scale measures the lower frequencies in the environment, which our ears don’t perceive as very loud.  We may not hear the lower frequencies, but we can feel them.
  • 9. Noise Permissible Exposure Limits (PEL)  Utilize administrative or engineering controls when sound levels exceed Noise Permissible Exposure Levels Exp: 8 hours permitted duration per workday for 90 dBA sound level.  Provide hearing protectors if above controls fail to reduce sound levels within Permissible Exposure.  Impulsive or impact noise should not exceed 140 dB.
  • 10. Rule of thumb “When you feel the need to shout in order to be heard 3 feet away, the noise levels are probably 85 dB or more and hearing protectors are recommended.”
  • 11. How does hearing work? The ear has three main parts: i) The outer ear - the outer ear (pinna) collects sound waves and directs the into the external auditory canal. - the eardrum separates the auditory canal from the middle ear. ii) Middle ear - small bones in the middle ear transfer sound to the inner ear. iii) Inner ear - the inner ear contains the cochlea, the main sensory organ for hearing, and nerve endings leading to the brain.
  • 13. All sounds produce waves. Sound waves funnel through the opening in your outer ear, travel down the auditory canal, and strike the eardrum, causing it to vibrate. The vibrations pass the small bones of the middle ear, which transmit them to sensory cells — called hair cells — located in the cochlea. The vibrations become nerve impulses and go directly to the brain, which interprets the impulses as sound.
  • 14. How loud is too loud? Because people differ in their sensitivity to sound, there’s no way to predict who is at risk for hearing loss. Sound pressure, frequency, and length of exposure all determine whether what you hear is harmful or just annoying. However, the following are signs that noise may be a problem where you work:  You have to shout to make yourself heard during work  You have ringing in your ears for several hours after you leave work  You have difficulty hearing normal sounds for several hours after you leave work
  • 15. *Most hearing specialists agree: You can damage your hearing if you’re continually exposed to noise greater than 85 decibels over eight hours. *As noise levels rise above 85 decibels, the safe exposure time for unprotected ears falls dramatically. For example, 110-decibel noise can impair hearing after just 15 minutes of exposure.
  • 17. How does sound damage hearing? Very loud sounds can damage the sensitive hair cells in your inner ear. Hair cells are the foot soldiers for your hearing. As the number of damaged hair cells increases, your brain receives fewer impulses to interpret as sound. When you damage hair cells, you damage hearing. Healthy Damaged
  • 18. Effects of noise on hearing “How quickly hearing loss takes place depends on the intensity of the noise, its duration, and how often the exposure occurs.”
  • 19. Effect of noise on people Auditory effect: i) Temporary threshold shift -While a single exposure to loud noise can damage your hair cells, it probably won’t destroy them. - You may experience ringing in your ears and some sounds may be muffled, but your hair cells will recover and so will your hearing. ii) Permanent threshold shift - But repeated exposures to loud noise can damage hair cells to the point that they won’t recover. - No treatment will restore it. When you destroy hair cells, you destroy hearing.
  • 20. How to know if your hearing is damaged  Hearing loss is painless and gradual. It usually develops over several years — you might not even notice the loss during those years.  Sometimes, overexposure to loud noise can trigger ringing or other sounds in your ears, called tinnitus.  While tinnitus may be a symptom of damaged hearing, it can also be caused by infections, medications, and earwax.  The only way to know for sure if noise has damaged your hearing is to have a hearing examination by a certified audiometric technician, audiologist, otolaryngologist, or physician.
  • 23.
  • 24. Noise Induced Hearing Loss Noise induced hearing loss stems from exposure to loud noises. • Constant exposure over a period of time • Exposed to sound level over 140 dBA • Tinnitus Age Induced Hearing loss • Exposure to high sound levels • Hereditary • Nerve damage • Reduced neuronal response
  • 25. Occupational/Non-Occupational Hearing Loss • Occupational Hearing Loss – Results from constant exposure to sound levels above 85 dBA TWA – Damage to hair cells in cochlea • Non-Occupational Hearing Loss – Results from constant exposure to sound levels above 85 dBA TWA – Results from damage to outer, middle, or inner ear, hereditary, ototoxic drugs – Damage to hair cells in cochlea, damage to nerve cells relaying sound message to brain, damage to structure of ear
  • 26. Types of noise • Pitch • Loudness – Whisper 10 dB – Street sound 70 dB – Sander 85 dB – Sporting Events 100dB – Mowing the Lawn 101dB – Motorcycle Riding 112dB – Concerts 125dB – Shooting Range 130dB
  • 28. When is workplace noise dangerous There are three basic types:  Area monitoring. Use a sound-level meter to identify areas in the workplace that may put workers’ hearing at risk.  Personal monitoring. Use a sound-level meter and a dosimeter to estimate an individual’s daily noise exposure.  Engineering survey. Measure noise levels produced by machinery in different operating modes to find ways to eliminate or control the noise.
  • 30. Noise Dose (Personal Monitoring)
  • 31. Table of Permissible Noise Exposure Limits
  • 32. Do you need a hearing conservation program? Occupational noise exposure, says that your workplace must have a hearing conservation program when employees are exposed to noise levels that are equal to or greater than 85 dBA averaged over eight hours. The basic elements of a hearing conservation program include:  Exposure monitoring  Audiometric testing  Hearing protection  Employee training  Recordkeeping  Access to information
  • 33. Noise Control and Abatement
  • 34. When other controls and hearing protectors are required? If your workplace has noise levels that are greater than those shown in the table, you must use engineering or administrative controls to reduce employee exposures. If these controls aren’t effective, your employees must also use hearing protectors to reduce their exposures to safe levels.
  • 35. When engineering or administrative controls are required
  • 36. Engineering controls When you replace a noisy machine with a quiet one, modify it to make it quieter, or change the sound path so that the noise never reaches the listener, you’re using an engineering control. You’re more likely to find a workable solution when you:  Understand what’s causing the noise  Determine how the noise is reaching the worker  Identify where to control the noise: at the source, along the sound path, or at the worker
  • 37. Creative engineering solutions may also be the best ones. Here are three examples: i) Build an enclosure - Construction workers were using a concrete mixer to de- grease metal parts by tumbling them in sawdust — effective but noisy. - To reduce the noise level to below 85 decibels, the employer built an enclosure around the mixer with two-by fours and an acoustic sound board, sealing the access door with polyurethane foam. - The cost was minimal and the design was effective; it lowered noise levels to a safe 78 decibels.
  • 38. ii) Increase the distance - When you double the distance between the worker and the sound source, you decrease the sound pressure level by six decibels. For example, a hazardous 96-decibel noise source at five feet is a safe 84 decibels at 20 feet as shown in the table below. When engineering or administrative controls are required
  • 39. Administrative controls  Unlike engineering controls, which keep hazardous noise from reaching a worker, administrative controls change workers’ activities to lower their exposure.  Closely related to administrative controls are work-practice controls, which emphasize safe practices.  Administrative and work-practice controls are usually less expensive than engineering controls because there is no cost in changing or modifying equipment.  However, administrative and work-practice usually aren’t as effective as engineering controls because they don’t control the noise.  Noisy machines are still noisy and the exposure is still present.
  • 40. Examples of administrative controls: i) Administrative controls - Reduce the time workers spend in noisy areas; rotate two or more workers so that each is exposed to noise less than 85 decibels, averaged over an eight-hour day. - Shut down noisy equipment when it’s not needed for production.
  • 41. ii) Work-practice controls - Maintain equipment so that it runs smoothly and quietly. - Ensure that workers know how to perform their tasks and operate equipment at safe noise levels. - Use warning signs to identify work areas where noise exceeds safe levels.
  • 42. Hearing protectors If an administrative control won’t reduce employee exposures to safe levels, you’ll need to consider a third noise-control tool (hearing protectors). There are two types of hearing protectors: i) Earplugs - Fit in the outer ear canal. - To be effective, they must totally block the ear canal with an airtight seal. - They’re available in different shapes and sizes and can be custom made. - An earplug must be snugly fitted so that it seals the entire circumference of the ear canal. - An improperly fitted, dirty, or worn-out plug will not seal and can irritate the ear canal.
  • 43. ii) Earmuffs - Fit over the entire outer ear — they won’t fit properly over eyeglasses or long hair — and are held in place by an adjustable headband. - The headband must hold the earmuff firmly around the ear.
  • 44. Hearing Protection Devices (HPD) • Employers shall provide to employees exposed to 8 hr TWA of 85 dB at no cost. • Employers shall ensure being worn: – by employees exposed to 8 hr TWA of 90dB or greater – by employees exposed to 8 hr TWA of 85dB or greater and: • Whose baseline audiogram has not been established • Who have experienced a threshold shift
  • 45. Hearing Protection Use • Voluntary Use – Exposed to an 8 hr TWA of 85 dB • Mandatory Use – Exposed to an 8 hr TWA of 90 dB – Exposed to an 8 hr TWA of 85 dB but have not had a baseline hearing test – Employees who have suffered STS hearing loss and are exposed to an 8 hr TWA of 85 dB
  • 46. Effectiveness  Better earplugs and earmuffs are about equal in sound reduction, though earplugs are more effective for reducing low-frequency noise and earmuffs for reducing high-frequency noise.  Using earplugs and muffs together increases protection against higher noise levels (above 105 decibels) than either used alone. Selecting hearing protectors  Focus on the three Cs: comfort, convenience, and compatibility. Employees won’t wear hearing protectors that are uncomfortable or difficult to use or that interfere with their work.  They should be able to choose, with the help of a person trained in fitting hearing protectors, from among a variety of appropriate types and sizes.
  • 47. Purpose of Hearing Protectors Reduction of sound waves traveling to the inner ear.
  • 48. Instructions on Selection, Fitting, Use, and Care of Hearing Protectors • Ear plugs – Keep clean and free of materials • Wash in mild liquid detergent and warm water • Squeeze excess water and air dry – Discard plugs when hardened or do not re-expand • Ear Muffs – Keep clean and free of debris • Clean cushions with warm soapy water – Do not tamper with the acoustic seal between the cushions and the headband – Do not modify the ear muffs in any way – Do not stretch or abuse the headband
  • 49. Employee Responsibility • Understand the need for hearing protection devices. • Wear HPDs and seek replacements. • Encourage co-workers to wear HPDs. • Communicate problems to supervisors
  • 50. Management Responsibility • Provide occupational noise training. • Provide hearing protection devices. • Demonstrate commitment – wear HPDs. • Enforce the use of HPDs. • Keep up to date with HPD selection and use. • Encourage questions and resolve problems.