Jenkins Academy of Applied Technology

Actual protector selection, fitting and correct use

Hearing Conservation and Noise · v1.0.0 · October 21, 2026

Blank means pending. This local form does not save entries to an account. Print or save your completed employer copy. Record actual observation, correction and reassessment. Keep audiograms, hearing thresholds, diagnoses and clinical findings in the authorized private process. An LMS pass, appointment or signature does not establish actual exposure, fit or a hearing-test result.

Employer, task, exposure report, device make/model/type and actual manufacturer instructionsAppropriate assessor confirms attenuation method, measurement weighting, data, estimated protected exposure and limitsApplicable protection target supplied by authorized program contact — omit private clinical reasonsSuitable available choices, worker selection, no-cost/replacement arrangements as applicableActual initial fitting and correct-use supervision; construction competent person identity/role for inserted-device individual fitting or determinationFit observation with actual glasses, helmet and other PPE; compatibility and comfort issuesDevice-specific insertion/adjustment, inspection, care, storage and replacement demonstratedWarnings/radio/signals checked with actual devices and work conditionsOptional employer attenuation fit-test reference if used — do not label this a universal federal annual mandateObserved gaps, correction, reassessment and final allowed task/device limitations