Noise Pollution EIA Worksheet
Project Name
Project Location
Project Description
1. Baseline Noise Survey
Date(s) of Survey
Surveyed Locations & Descriptions
Measured Baseline Levels (dB)
Location
Leq Day
Leq Night
Remarks
2. Sources of Noise
3. Sensitive Receptors
Receptor Name/Location
Type (e.g., School, Hospital)
Distance from Source (m)
Remarks
4. Predicted Noise Levels
Prediction Method/Model
Location
Predicted Level (dB)
Day
Night
Exceeds Standard?
5. Mitigation Measures
6. Monitoring Plan
Parameter
Method/Frequency
Responsible Person
7. Remarks/Notes