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Occupational hearing loss is one of the most pervasive problems in today's occupational environment, affecting workers in manufacturing, construction, transportation, agriculture, and the military. Based on a NIOSH survey in the 1980s on exposed workers in all economic sectors and on the 1992 Statistical Abstracts of the United States accounting of production workers, it is thought that there are approximately 30 million American workers are exposed to hazardous noise levels alone or in combination with other ototraumatic agents that are potentially hazardous to their hearing. At present exposure limits, one in four will develop a permanent hearing loss as a result of their occupational exposure to these hazards. The gradual progression of hearing loss due to noise may be less dramatic than an injury resulting from a workplace accident, but it is a significant and permanent handicap for the affected individual. Loss of hearing denies people sensory experiences that contribute to the quality of their lives. For some, loss of hearing may impede their ability to be gainfully employed. This tragedy is preventable.

Through comprehensive and coordinated efforts on the part of managers, interested employees, and safety and health professionals, much has been learned over the last few decades about implementing hearing loss prevention programs. A good hearing loss prevention program has historically consisted of at least seven identifiable elements: monitoring hearing hazards, engineering and administrative controls, audiometric evaluation, personal hearing protective devices, education and motivation, record keeping, and program evaluation. To these seven elements, an eighth has been added that recognizes the need for a Hearing Loss Prevention Program Audit process. This is not a new process; it has typically been blended within the other program elements. Given all of the program elements that are essential to preventing hearing loss, adding an element that specifically addresses the program appraisal process seems warranted. This document summarizes the procedures involved in implementing these eight elements. They will be examined from the perspective of management, program implementors, and affected employees. The responsibilities of each category of participants will be outlined. The management category includes all of those in the position of generating or enforcing policy and authorizing the allocation of resources. Program implementors are those who are charged by management to make the hearing loss prevention program elements work, and the employees' category includes all persons who are exposed to hazardous levels of occupational noise and other ototraumatic agents.

The program is usually implemented by a team, whose composition and size tend to be related to the size of the company and the number of employees exposed to hearing hazards. Members of the team may include any or all of the following: physician, nurse, audiologist, industrial hygienist, company and/or union safety representative, hearing conservation technician, acoustical engineer, and the employee representative. The most important team members are the employees. While employees usually don't fund the hearing loss prevention program, decide its policies, or oversee its day-to-day operation, they are absolutely key to the success of the program. When employees know that they are full members of the hearing loss prevention program team and they are the keys to its success, they will usually work hard to see that all aspects of the program under their control are implemented. When employees feel that the program is being forced upon them, especially without their personal involvement and participation, they often react negatively and may work to circumvent the program.

It has become clear over recent years that the level of commitment displayed by management is directly related to the overall effectiveness of the hearing loss prevention program. A strong commitment to a hearing loss prevention program can be shown by following these policies:

Strive for excellence in the program rather than just meeting minimal requirements.

Ensure management and supervisors support hearing loss prevention goals and actively contribute to a safety climate that encourages and enables employees to engage in good hearing-health practices.

Integrate the program into the overall company safety and health program.

Educate and motivate employees, so that hearing loss prevention practices become an integral part of their behavior on and off the job.

Designate a key person to serve as implementor/coordinator of the program.

Strive for simplification and continuity of the program's operating procedures.

Involve the employees in the process of developing and implementing hearing loss prevention programs.

Establish quality assurance practices to make sure that all information used in the program is accurate and current.

Review the program's effectiveness no less than annually and make modifications when needed.

The nature and scope of the hearing loss prevention program recommended in this text go beyond the minimal requirements of federal and state regulations. The objective here is not to reiterate regulatory requirements, although we urge all readers to become thoroughly familiar with the noise standards and regulations for compliance purposes. Instead, the objective is to convey some of the characteristics of a good hearing loss prevention program that are not necessarily found in regulations, and yet which contribute substantially to the program's success. However, to facilitate compliance with Federal regulations for occupational noise exposure, we have included an OSHA Noise Standard Compliance Checklist as Appendix A, and we have listed the pertinent provisions of the OSHA standard at the end of each section. In addition, for those who wish to pursue certain areas further, we have listed suggested readings at the end of each section, many of which can also be found in the expanded list of suggested readings in Appendix D. The reader's attention should also be directed to: the checklist in Appendix B, which should be helpful in evaluating hearing loss prevention programs that are already in place; Appendix C, which gives a listing of audiovisual materials; and Appendix E, which lists resources in both government and the private sector for those who need further assistance.

As the title states, this is a practical guide, intended to assist employers and employees to develop and maintain hearing loss prevention programs that actually work, and are not just perfunctory measures. This guide is not meant to be technical in nature. The reader will find few formal citations to the scientific literature - only suggested readings at the end of each section. Support for the statements and recommendations made in the text are available in the scientific literature. The interested reader may pursue these concepts further in the suggested readings.

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