Sound Advice Note 6

Hearing health surveillance

This is the full text of the Sound Advice Working Group recommendations on hearing health surveillance for people who work in the music industry. It may help you make sure people at risk have their hearing regularly checked.

Providing health surveillance

6.1 Employers must provide health surveillance involving hearing checks for all employees who are likely to be frequently exposed at or above either upper exposure action value, or are at risk for any other reason, for example they already suffer from hearing loss or are particularly sensitive to damage. It is not a suitable substitute for controlling risk at source.

6.2 The purpose of health surveillance is to:

  • identify when employees are showing early signs of hearing damage;
  • provide an opportunity to do something to prevent the damage getting worse;
  • check whether control measures are working.

6.3 Employees must co-operate with their employer's health surveillance programme. Employers should consult their trade union(s) safety representative(s), or employee representative(s) and the employees concerned before introducing health surveillance. It is important that everyone understands that the aim of health surveillance is to protect their hearing. Understanding and co-operation are essential if health surveillance is to be effective.

6.4 There is no requirement for self-employed people to have health surveillance, however they are strongly advised to arrange it if they think their exposure frequently exceeds the upper exposure action value, they regularly have to wear hearing protection, or have other concerns about their hearing. If you are a freelancer, see Sound Advice Note 7 Freelancers.

Hearing checks

6.5 Hearing checks can be a matter of concern for those whose employment depends on their ability to hear. Musicians and sound engineers rely on good hearing and they may worry that any deterioration will affect their ability to carry out their work activities. Employees and freelancers should be encouraged to view health surveillance programmes (hearing checks) as a positive contribution to preserving their hearing.

6.6 For some, the check will show that there is no problem, while others may find that their hearing is in the early stages of damage. Some may already suspect that their hearing is deteriorating and check results may confirm these fears. These individuals may be worried that they will lose their jobs if their employer is informed that they are 'losing their hearing'. However disciplinary action cannot be based on the results of the hearing check.

6.7 Whatever the outcome, the check should be viewed as an opportunity to identify any deterioration at an early stage and to ensure that appropriate measures are taken to prevent any further harm.

What is health surveillance?

6.8 Health surveillance for hearing damage usually means:

  • regular hearing checks in controlled conditions which includes measuring hearing sensitivity over a range of sound frequencies;
  • telling employees about the results of their hearing checks;
  • keeping health records;
  • ensuring employees are examined by a doctor where hearing damage is identified.

6.9 Ideally health surveillance starts before people are exposed to noise (for new starters or those changing jobs) to give a baseline. Ensure this covers all those people who are employed on a regular basis.

6.10 Health surveillance can, however, be introduced at any time after exposure to noise. This would be followed by a regular series of checks, usually annually for the first two years and then at three-yearly intervals (although this may need to be more frequent if any problem with hearing is detected or where the risk of hearing damage is high).

6.11 Hearing checks should be carried out by someone who has the appropriate training. The whole health surveillance programme needs to be under the control of an occupational health professional (for example a doctor or a nurse with appropriate training and experience). Employers must make sure that any hearing health surveillance is carried out properly.

How is health surveillance arranged?

6.12 Larger companies or organisations may have access to in-house occupational health services which may be able to carry out the programme. An external contractor is necessary where there are no facilities in-house. Details of occupational health services may be found through trade associations or local business support organisations. The Musicians Union provides advice for freelancers.

What does an occupational health provider do?

6.13 Suitable occupational health service providers will be able to demonstrate they have the training and experience needed. They should be able to:

  • advise on a suitable programme;
  • set up the programme;
  • provide suitably qualified and experienced staff to carry out the work;
  • provide the employer with reports on employees' fitness to continue work with noise exposure;
  • provide employees with feedback on the state of their hearing including their results and general advice on how to look after their hearing.

What should be done with the results of health surveillance?

6.14 Analysing the results of health surveillance for groups of workers can give an insight into how well the programme to control noise risks is working. The results should be used to target noise reduction, education and compliance practices more accurately. This information should be made available to employees or safety representatives.

6.15 The employer needs to:

  • keep health records of the health surveillance and fitness-for-work advice provided for each employee (but not the confidential medical records which are kept by the doctor). A health and safety inspector can ask to see health records as part of their checks that you are complying with the Regulations;
  • make employees' records available to them;
  • act upon any recommendations made by the occupational health service provider about employees' continued exposure to noise;
  • ensure that any employee with suspected hearing damage is referred to a doctor, to ensure that the employee receives advice from an occupational health professional;
  • use the results to review and, if necessary, revise the risk assessment and plans to control risks.

CASE STUDY Health surveillance (audiometry)

A major multi-media company engaged an occupational health provider to cover their requirement for health surveillance.

The company implemented the following:

  • Occupational Health would be consulted for any staff who may be exposed to high noise levels with regard to the need for health surveillance. Job roles, identified as putting individuals at risk to high noise exposure, would have a baseline audiometric test on employment and subsequent hearing checks as part of the health surveillance programme.
  • All musicians and singers on employment and routinely throughout their work would be put into a health surveillance programme.
  • Other staff who may be regularly exposed to noise levels above 85 dB in the normal course of their work would also be included.
  • Hearing checks would be free of charge for staff.
  • Records would be held on behalf of the employer by the occupational health provider and would be held as 'Medical in Confidence'.
  • Results would be communicated to the individual and, if there were any anomalies or some hearing loss, appropriate medical advice and counselling (in confidence) would be provided.
  • Fitness for work would not be determined from the results but would continue to be determined by the individual's ability to do their job.
  • Managers would not have access to individual medical records, except where the individual consented directly to the disclosure, but would have a written statistical report of results to enable the manager to target noise reduction, education and compliance practices more accurately.

Several levels of health surveillance were also agreed with the occupational health provider:

Level 1: Noise exposure between 80 dB and 85 dB (the lower and upper action values)

Example: Wearing limited headphones/listening to noise level from a controlled output on a regular basis.


  • A baseline audiometry test when starting, or within 3 months of starting work.
  • Further audiometry tests depending on the result of the baseline test, or in the event of an adverse exposure to noise, eg a loud peak of sound through unlimited headphones.

Level 2: Noise exposure approaching, but not exceeding 85 dB (the upper action value)

Example: Working in areas with unlimited output and/or unlimited headphones.


  • A baseline audiometry test when starting, or within 3 months of starting work.
  • A re-test in 1 year to check that they are not 'hypersensitive' to noise damage.
  • Further tests depending on the audiometry results. Also in the event of an adverse exposure (as described above). If a significant deterioration in hearing has occurred then removal from that work, and/or more regular audiometry may be necessary.
  • The maximum interval between audiometry tests should not exceed 3 years in this situation.

Level 3: Noise exposure above 85 dB (exceeding the upper action value)

Example: Very noisy areas (festivals, live events etc); musicians, depending on risk assessment or noise measurement.


  • A baseline audiometry test when starting, or within 3 months of starting work.
  • A re-test in 1 year to check that they are not 'hypersensitive' to noise damage.
  • Further tests depending on the audiometry results. Also in the event of an adverse exposure (as described above). If a significant deterioration in hearing has occurred then removal from that work, and/or more regular audiometry may be necessary.
  • The maximum interval between audiometry tests should not exceed 2 years in this situation.

Note: The occupational health provider decided, in the case of Level 3 employees, to increase the degree of health surveillance beyond HSE's guidance.


For a more detailed explanation of terms see Useful information and glossary.

Exposure action values (EAV): Levels of exposure to noise at which certain actions need to be taken (see Useful information and glossary").

Freelancer: Someone who is not permanently employed full-time by any one employer. A freelancer may go through periods of self-employment or be employed by more than one employer.

Health record: Record of the person's details, work assignments and exposures, dates of any health surveillance procedures and information on the person's fitness to work in noisy environments. The record does not contain clinical details and must be kept by the employer. It is not a confidential document.

Health surveillance: For the purposes of this guidance, ongoing assessment of the state of aural health of an employee as related to exposure to noise.

Medical record: Account of a person's examination and treatment including their medical history, any medication, therapies and referrals. Medical records are confidential and may not be shown to the employer without the written consent of the individual. (See Useful information and glossary)

Musicians' Union: 60-62 Clapham Road, London SW9 0JJ. Tel: 020 7582 5566

Noise exposure: 'The noise dose', which can be calculated, takes account of the actual volume of sound and how long it continues. Noise exposure is not the same as sound level, which is the level of noise measured at a particular moment.


Control of noise in the music entertainment industry. Code of practice Worksafe Western Australia Commission 2003

The Control of Noise at Work Regulations 2005SI 2005 No 1643 The Stationery Office 2005 ISBN 978 0 11 072984 8 (also available from

Controlling noise at work. The Control of Noise at Work Regulations 2005. Guidance on Regulations L108 (Second edition) HSE Books 2005 ISBN 978 0 7176 6164 0

Listen while you work: Hearing conservation for the arts for performers and other workers in art and entertainment Safety & Health in Arts Production & Entertainment (SHAPE), Canada 2001 ISBN 978 0 7726 4643 9

Noise at work: Guidance for employers on the Control of Noise at Work Regulations 2005. Leaflet INDG362(rev1) HSE Books 2005 (single copy free or priced packs of 10 ISBN 978 0 7176 6165 7)

Protect your hearing or lose it! Pocket card INDG363(rev1) HSE Books 2005 (single copy free or priced packs of 25 ISBN 978 0 7176 6166 4)

Health surveillance at workHSG61 (Second edition) HSE Books 1999 ISBN 978 0 7176 1705 0

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