ETB-1014-APR -0030 Determination of Noise Level Test Data Sheet

[NIOSH] Information Collection Provisions in 42 CFR Part 84 - Tests and Requirements for Certification and Approval of Respiratory Protective Devices

Atch_22_Sound Level STP-30_STP-111

OMB: 0920-0109

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Form Approved

OMB No. 0920-0109

Exp. Date xx/xx/20xx


Determination of Noise Level Test Data Sheet

Task Number: ____________________________________ Date: _______________________________


Manufacturer: ____________________________________


Item Tested: ________________________________________________________________________________________________________




Room dba: _____________ Trial #1 Trial #2


NIOSH #

Subject

Left Ear

Right Ear

Left Ear

Right Ear


Max dba

PASS/FAIL


Manikin







85





#1







80




#2






80




#3






80




Comments: __________________________________________________________________________________________________________


____________________________________________________________________________________________________________________

ETB-1014-APR-0030 Rev 3

Public reporting burden of this collection of information is estimated to average 5 minutes per response, including the time for reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSD Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0109).


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