Table 1:
Items that did not achieve an acceptable percentage of absolute agreement in relation to the content validity criteria regarding the structure and process indicators of the hearing conservation program
Table 2:
Items that did not achieve an acceptable percentage of absolute agreement in relation to the layout validity criteria regarding the structure and process indicators of the hearing conservation program
INFORMATION ABOUT THE COMPANY
CNPJ: ________________ COMPANY NAME: ____________________________________________________________ TRADE NAME: _____________________________________________________________________________________ CONTACT (Name/Position/Phone): ______________________________________________________________________ TYPE: ( ) Manufacturing ( ) Commerce ( ) Services ( ) Other: ________________________________ AVERAGE NUMBER OF EMPLOYEES: ( ) Up to 10 ( ) 11 to 100 ( ) 101 to 500 ( ) More than 500 Is there an Environmental Risk Prevention Program (ERPP): ( ) Yes ( ) No Is there an Occupational Health Medical Control Program (OHMCP)? ( ) Yes ( ) No Is there a Hearing Conservation Program (HCP) at the company? ( ) Yes ( ) No In case there is a Hearing Conservation Program at the company, fill in the date when the service was first implemented: _____________________________________________________ In case there is a Hearing Conservation Program at the company, fill in the name and position of the administrator of the program: _________________________ /___________________________
INFORMATION ABOUT THE ASSESSMENT
DATE OF THE ASSESSMENT: _________________________________________________________________________ NAME OF THE ASSESSOR: ___________________________________________________________________________ CPF/CNPJ: _______________________________ CONTACT: ________________________________________________ TYPE OF ASSESSOR: ( ) EXTERNAL ( ) INTERNAL (Position in the company: ______________) REQUESTER: _______________________________________________________________________________________ CPF/CNPJ: __________________________________________________________________________________________ TYPE OF ASSESSMENT: ( ) First implementation of the Hearing Conservation Program ( ) Implementation monitoring of the Hearing Conservation Program with a new administration ( ) Implementation monitoring of the Hearing Conservation Program with the current administration ( ) Annual assessment of the Hearing Conservation Program ( ) Normative basis for evaluative research of the Hearing Conservation Program FORM OF ASSESSMENT ( ) Self-assessment ( ) Direct observational ( ) Indirect - Questionnaire filled in by the administrator of the program INTERVIEWEE: ____________________________________________________________________________________ POSITION IN THE COMPANY: _______________________________________________________________________
INSTRUCTION TO FILL IN THE INSTRUMENT
This assessment instrument was developed considering structure (resources) and process (activities) indicators that make up the Hearing Conservation Program, based on the existing national law and with a consultation to scientific evidence and documents.
This questionnaire was constructed based on the following documents: Regulatory Norm No. 6 of the Ministry of Labor and Employment (NR 6); Regulatory Norm No. 7 of the Ministry of Labor and Employment (NR 7); Regulatory Norm No. 9 of the Ministry of Labor and Employment (NR 9); Regulatory Norm No. 15 of the Ministry of Labor and Employment (NR 15); Norm of Occupational Hygiene 1 (NHO-1) of FUNDACENTRO; Service Order 608 (OS 608) of the National Social Security Institute; Manual of Guidelines and Minimal Parameters to Develop and Administer the Hearing Conservation Program of FUNDACENTRO.
The instrument aims to estimate the degree of implementation of the HCP - i.e., the condition/level in which the program was/is being implemented.
The instrument is divided into two sets. In the first assessment set, there are 26 questions on the resources necessary to effectively implement the Hearing Conservation Program. These are the basis for the actions that will be implemented. The second set comprises 36 questions on the processes (actions) to be implemented - i.e., the activities that need to be developed in the program.
Each question has a description of the expected answer, setting an assessment parameter. In the assessment of resources, the maximum expected score is 55.0 points. As for the processes, the maximum expected score is 87.0 points. The total expected score for the instrument is 142 points, which would reflect a fully implemented Hearing Conservation Program.
The existence of resources and the implementation of processes following the parameters specified in the instrument must be given the total expected score for each question. The absence or non-presentation of the resources, as well as the non-implementation or partial implementation of processes, are not given any score.
The information can be collected from the administrator of the Hearing Conservation Program or the administrator of the Occupational Health Medical Control Program, depending on the type and form of assessment.
For the analysis of the answers, the scores obtained in each set are summed, and these results are applied in the formula to achieve the degree of implementation of the Hearing Conservation Program, as presented in the sheet for Interpretation and Analysis of the results.
Lastly, the sheet with Results of the Assessment of the Degree of Implementation of the Hearing Conservation Program is filled in, in which the assessor presents the final result of the assessment, the aspects that need improvement, complementary observations, and further instructions aiming at the improvement of the program.
SET I - ASSESSMENT OF THE STRUCTURE OF THE HEARING CONSERVATION PROGRAM
PHYSICAL, HUMAN, AND ORGANIZATIONAL RESOURCES
EVALUATIVE QUESTION
EXPECTED STANDARD/NORM
EXPECTED SCORE
SCORE OBTAINED
Is there a person or position in the company responsible for ensuring the resources and administrative measures to carry out the Hearing Conservation Program?
Existence of (1) Specialized Safety Engineering and Occupational Medicine Services (SESMT) and/or (2) at least one department, person, or representative directly related to the company.
3.0
Is there in the company a Specialized Safety Engineering and Occupational Medicine Service (SESMT), or person or team that can develop engineering projects and measures?
Existence of an engineer specialized in occupational safety or an interdisciplinary team that includes this professional
2.0
Does the company have an occupational physician responsible for the occupational health medical control program?
Existence of an occupational physician
3.0
Does the company have a professional or team technically qualified to develop the Hearing Conservation Program?
Existence of an occupational physician and/or speech-language-hearing therapist and/or occupational safety engineer
3.0
Does the company have a risk analysis report?
Existence of an annual risk analysis report, presenting at least general data of assessment and description of the exposure risks and conditions.
3.0
Does the company have an Environmental Risk Prevention Program planning report?
Existence of an annual report or whenever there is any change in the risk analysis report, presenting the (1) definition of goals, priorities, and schedule; (2) action strategy and methodology (according to the hierarchy of the control measures); (3) form of the registry, maintenance, and communication of the data; (4) Periodicity and form of assessment of the development.
3.0
Does the company have a report on the occupational health medical control program?
Existence of an annual report on the occupational health medical control program, presenting data from the administration of audiological diagnoses, with statistics of the results of nosologic diagnoses and evolution diagnoses by departments of the company.
3.0
Does the company have an implementation report of the Hearing Conservation Program?
Existence of an annual report and/or when there is a new administration of the Hearing Conservation Program, presenting the (1) contextualization of the company and objectives to be reached; (2) company’s policy regarding the Hearing Conservation Program; (3) responsibilities and competences; (4) analysis of the risks of occupational hearing loss; (5) suggestions of collective and/or personal control measures; (6) data of the administration of diagnoses (statistics of the results of nosologic diagnoses), audiological monitoring (evolution diagnoses); and (7) assessment of the program, in case it has been implemented before.
3.0
Is there any proof that the audiometric examination is performed in an audiometric booth or an acoustically treated environment?
Existence of a review of the sound booth or acoustically treated environment to perform the audiometric examinations, in compliance with ISO 8253-1.
3.0
Does the company provide informational material in its facilities?
Existence of bulletin boards and/o risk maps in the facilities of the company, presenting the risks to hearing health, indicating areas with high sound pressure levels.
2.0
Does the company have an attenuation review of the personal protective equipment (PPE) used by the employees?
Existence of an annual attenuation review of the personal protective equipment used by the employees, presenting the techniques used, the equipment analyzed, and the results obtained.
3.0
Does the company have personal protective equipment adequate to the risk of each activity?
Existence of hearing protection device(s), which can be circumaural hearing protection, insert hearing protection, or semi-auricular hearing protection.
1.0
Does the company have a Certificate of Approval of the personal protective equipment used by the employees?
Existence of a certificate of approval of the PPE, issued by the national department responsible for occupational health and safety issues in the Ministry of Labor and Employment.
2.0
Does the company have proof of receipt of the hearing protection devices?
Existence of a registry form of delivery/maintenance of the personal protective equipment.
1.0
Are there forms in the company to communicate accidents at work?
Existence of forms to communicate accidents at work related to the data in the reports of the Hearing Conservation Program and the Occupational Health Medical Control Program, to control employees with occupational hearing loss
1.0
Are there individual clinical records of the employees?
Existence of individual clinical records, presenting at least the analysis of the results obtained in the audiometric examinations, the definition of the nosologic examination, and analysis of the evolution and definition of the evolution diagnosis of occupational hearing losses.
2.0
Is there a specialized professional to carry out the audiological examinations?
Existence of a professional specialized in audiology to carry out the audiological examinations.
2.0
Has the professional proved their qualification to carry out the audiological examinations?
Existence of a receipt from the pertaining professional council proving the qualification as a physician or speech-language-hearing therapist who carries out the audiometric examinations.
3.0
Is there any proof that the audiometric examination is carried out with duly calibrated measuring equipment?
Existence of updated measuring/calibration certificate(s) of the equipment used for the audiometric examinations.
3.0
Does the service have a clinical-occupational questionnaire/anamnesis?
Existence of clinical-occupational questionnaire, including (1) occupation and position in the company; (2) current and previous exposure to high sound pressure levels; (3) exposure to other risks related to occupational hearing loss; (4) use of hearing protection device; (5) use of ototoxic medication; (6) family history of hearing loss; (7) non-occupational exposure to high sound pressure levels; (8) auditory and extra-auditory symptoms.
1.0
Does the service have audiometric examination forms?
Existence of audiometric examination forms complying with Table II, Annex I of NR7.
1.0
Are there proofs that a duplicate of the audiometric examination has been delivered to the employee?
Existence of proofs that a duplicate of the audiometric examination has been delivered and signed by the employee.
1.0
Does the service have qualified professionals to carry out educative actions?
Existence of a specialized and qualified professional in the field in question to carry out training programs.
1.0
Is there educational material in the company?
Existence of user’s, procedure, and norm manuals, booklets, and pamphlets
2.0
Are there minutes in the company of the educative actions?
Existence of minutes of the training and meetings carried out with the employees, presenting at least (1) date, (2) content approached, and (3) signature of the employees that participated.
1.0
Does the service have an assessment instrument of the Hearing Conservation Program?
Existence of an assessment instrument of the Hearing Conservation Program. It can be audit protocols, checklists, and/or assessment questionnaires.
2.0
TOTAL EXPECTED/OBTAINED SCORES IN THE ASSESSMENT OF RESOURCES
55.0
SET II - ASSESSMENT OF THE PROCESSES OF THE HEARING CONSERVATION PROGRAM
RISK ANALYSIS AND PLANNING
EVALUATIVE QUESTION
EXPECTED STANDARD/NORM
EXPECTED SCORE
SCORE OBTAINED
Have the responsibilities, goals, and priorities of the Hearing Conservation Program been defined or are they being defined?
Responsibilities, goals, and priorities in the period encompassing the implementation of the Hearing Conservation Program and/or its annual monitoring.
3.0
Is a preliminary assessment of noise exposure at the company conducted/has it been conducted?
Characterization of the risk exposure, applied to all the operational and habitual conditions of the employees when performing their duties, either annually or whenever there is a change in the environment.
3.0
Have homogeneous groups with similar exposure characteristics been identified/are they identified?
Identification of homogeneous groups with similar exposure characteristics, considering all those exposed in the group in question or covering one or more employees whose situation corresponds to the “typical” exposure of each group in question.
2.0
Is there/has there been an analysis of (co)existence of other risk agents (chemical, physical, and biological)?
Recognition and assessment of the employees’ exposure to chemical, physical, and/or biological agents that might trigger an occupational hearing loss.
2.0
Is the noise exposure in the company quantitatively assessed/has it been assessed?
Obtention of an estimate of the employees’ exposure, according to (1) the established daily dose of noise exposure, considering 100% as the limit of daily occupational continuous or intermittent noise exposure and 50% as the daily dose for the action level of occupational noise exposure; (2) the established exposure level and normal exposure level, considering his one equal to 80 dB(A); (3) the established correlation between maximum admissible peak levels and the number of impacts occurred during the workday, considering the peak level of 140 dB(Lin) as the tolerance limit of impact noise.
3.0
Have the action strategies and methodologies of the Hearing Conservation Program been established/are they being established?
Established action strategies and methodologies and the annual schedule or the one regarding the time encompassed in the current implementation of the Hearing Conservation Program.
3.0
Is the annual planning of the Hearing Conservation Program presented to and discussed with the departments involved in it/has it been presented and discussed?
Yearly presentation of the annual planning of the Hearing Conservation Program to the departments involved in it, having it discussed with them.
2.0
ENVIRONMENTAL CONTROL
EVALUATIVE QUESTION
EXPECTED STANDARD/NORM
EXPECTED SCORE
SCORE OBTAINED
Is there/has there been participation in the implementation of the engineering measures?
Participation on the part of the administrator of the Hearing Conservation Program, along with the person or team responsible for it, in the implementation of intervention measures (1) on the issuing source (changes in or replacement of equipment, machinery, and tools); and/or (2) implementation of measures to reduce the sound pressure level in the transmission (isolating or muffling vibrating surfaces, reducing the reverberation, adjustment or improvement in the preventive maintenance, changes in the paces and processes of operation, conception, and changes of the layout of the work settings).
2.0
Is there/has there been participation in the implementation of administrative measures?
Participation on the part of the administrator of the Hearing Conservation Program, along with the administrator of the company/organization, in the implementation of administrative measures, involving (1) changes in the operations; and/or (2) changes in the work procedures; and/or (3) employee’s leave of absence from the workplace or the risk source.
2.0
Is the personal protective equipment properly selected/has it been properly selected?
Selection of hearing protection devices technically adequate to (1) the characteristics of the environment and activity; (2) characteristics of the user; (3) characteristics of hearing protection; (4) required noise reduction level; (5) noise reduction level of the protection; (6) exposure level with the protection; (7) annual personal attenuation review, or whenever the model or size is changed.
2.0
Is the personal protective equipment supplied to the employees and replaced/has it been supplied and replaced?
Supply of hearing protection devices approved by the national department responsible for occupational safety and health and immediate replacement of the equipment when it is damaged or lost.
2.0
Is there/has there been an inspection of the use of the personal protective equipment on the part of the employees?
Inspect the use of personal protective equipment on the part of the employees, making use of (1) monitoring protocol of the use of hearing protection and the necessary periodicity, and (2) communicate to the Ministry of Labor and Employment any irregularity observed.
2.0
Have the employees who are entitled to a hazard pay or special retirement due to noise exposure defined/are they defined?
Aid the team to define the employees who must receive a hazard pay or special retirement due to noise exposure and refer them to Social Security.
2.0
HEARING HEALTH ADMINISTRATION
EVALUATIVE QUESTION
EXPECTED STANDARD/NORM
EXPECTED SCORE
SCORE OBTAINED
Are verification and control procedures regarding the functioning of the audiometer periodically conducted/have they been conducted?
(1) Submit the audiometer to annual electroacoustic verification, in compliance with norm ISO 8253-1; (2) Perform biological verification of the audiometer(s) before the audiometric examinations.
3.0
Are the employees submitted to occupational anamnesis/have they been submitted to it?
Clinical occupational anamnesis conducted in the audiometric assessment, in all types of examinations (pre-employment, sequential, post-leave of absence, and post-employment examinations).
2.0
Are the employees’ ears examined (meatoscopy)/have they been examined?
Examination of the external acoustic meatus of both ears by the person responsible for the audiometric examination, (1) when performing an audiometric assessment, in all types of examinations (pre-employment, sequential, post-leave of absence, and post-employment examinations) and (2) writing the findings in the audiometric examination form.
2.0
Are all the employees submitted to the pre-employment audiometric examination/have they been submitted to it?
Submitting the employees to pre-employment audiometric examination.
3.0
Are the audiometric examinations classified as a reference?
Establishing the reference audiometric examination when the employee does not have one or whenever an occupational hearing loss is triggered or worsened.
3.0
Are sequential audiometric examinations conducted/have they been conducted?
Conducting sequential audiometric examinations (1) in the 6th (sixth) month after employment or based on the reference audiometric examination; (2) annually, beginning in the 6th (sixth) month after employment.
3.0
Are post-employment audiometric examinations conducted/have they been conducted?
Conducting audiometric examination when the employee is dismissed, except for the situations provided in the Regulatory Norm no. 7.
3.0
Is speech audiometry conducted/has it been conducted?
Conducting speech audiometry (Speech Recognition Percentage, Speech Recognition Threshold, and/or Voice Detection Threshold) in the pre-employment examination and/or when occupational hearing loss is triggered.
2.0
Are they referred to complementary audiological examinations/have they been referred?
Performing other complementary audiological examinations, required by the physician who coordinates the Occupational Health Medical Control Program, to have a differential diagnosis.
2.0
Are they referred to specialized assessment/have they been referred?
Referring to other medical specialties or sectors, if necessary, when non-occupational hearing loss occurs.
2.0
Are criteria established/have they been established for a differential diagnosis of occupational/non-occupational hearing losses?
Referring the patient to the physician who coordinates the Occupational Health Medical Control Program or the one responsible for it to conduct the medical examination or, if they are absent, to the physician who assists the employees.
2.0
Is the evolution of hearing loss analyzed and diagnosed/has it been analyzed and diagnosed?
Referring the employee to the physician who coordinates the Occupational Health Medical Control Program to (1) analyze the evolution and define the evolution diagnosis of all the examinations performed, classifying the results as “normal hearing”, “occupational hearing loss”, or “non-occupational hearing loss”; (2) characterize the causal nexus between auditory damages and environmental risks, to guide the environmental control measures.
3.0
Are the results coming from the audiological diagnosis administration registered/have they been registered?
Including the cases suggestive of hearing loss induced by high sound pressure levels in the annual report of the Occupational Health Medical Control Program.
2.0
Are accidents at work communicated/have they been communicated?
Communicating the accidents at work suffered by employees with occupational hearing loss.
3.0
Are the employees given a duplicate of the examinations and certificates/have they been given them?
Making available (1) duplicates of audiometric examinations and (2) occupational health certificates to all the employees.
2.0
Are the records coming from the implementation of the program being administered and saved?
Maintaining, for at least 20 (twenty) years after the employee has been dismissed, the records of the results of the audiometric examinations, environmental assessments, and measures used for collective protection.
2.0
Are there/have there been training programs, debates, commissions, participation in events, and/or other appropriate forms involving the effects on health caused by the exposure to high sound pressure levels to all those involved in the Hearing Conservation Program?
Having carried out at least one of the actions in the previous 12 (twelve) months, involving the effects on health caused by the exposure to high sound pressure levels.
3.0
Are the employees trained about the implementation of collective and individual measures/have they been trained?
Having carried out at least one of the actions in the previous 12 (twelve) months, involving the procedures that ensure its effectiveness with hearing protection adjustment test, maintenance, replacement, hygiene, and information procedures regarding the possibly limited protection they provide.
3.0
Are the employees’ suggestions welcomed/have they been welcomed?
Welcoming and registering the employees’ suggestions brought up in meetings and debates.
2.0
ASSESSMENT
EVALUATIVE QUESTION
EXPECTED STANDARD/NORM
EXPECTED SCORE
SCORE OBTAINED
Are quantitative analyses of prevalence and incidence of the results of the audiological examinations carried out/have they been carried out?
Annually presenting statistics of the results of nosologic diagnoses (prevalence: normal hearing, occupational hearing loss, or non-occupational hearing loss) and evolution diagnoses (incidence: triggering or worsening of occupational hearing loss).
3.0
Is the employees’ degree of satisfaction assessed/has it been assessed?
Annually assessing the employees’ degree of satisfaction, based on their opinions regarding the implementation of the Hearing Conservation Program.
2.0
Is the degree of implementation of the Hearing Conservation Program being estimated with audits/has it been estimated?
Measuring the degree of implementation of the components of the Hearing Conservation Program systematically before, during, or after implementing the program, at least once a year.
3.0
Are the contextual factors that can influence the implementation of the Hearing Conservation Program being considered and analyzed/have they been considered and analyzed?
Conducting overall and contextual analyses, identifying the favorable or unfavorable factors to the ideal implementation of the Hearing Conservation Program in the company, relating them to the results of the audits.
2.0
TOTAL EXPECTED/OBTAINED SCORES IN THE ASSESSMENT OF PROCESSES
87.0
ANALYSIS AND INTERPRETATION OF THE RESULTS
FORMULA TO CALCULATE THE WEIGHTED MEAN OF THE ANSWERS TO OBTAIN THE DEGREE OF IMPLEMENTATION OF THE HEARING CONSERVATION PROGRAM Total DI=4∑S1+6∑P1∕104∑S2+6∑P2∕10*100
Caption: Σ S¹ = Sum of the scores obtained in the indicators that made up the structure dimension. Σ P¹ = Sum of the scores obtained in the indicators that made up the process dimension. Σ S² = Sum of the scores expected for the indicators that made up the structure dimension. Σ P² = Sum of the scores expected for the indicators that made up the process dimension. Observation: The formula above represents the calculation of the weighted mean of the answers, considering the score obtained with the application of the instrument in relation to the total expected score. The items that make up the structure (resources) are multiplied by 4 (four), while the items that make up the processes (activities) are multiplied by 6 (six).The result obtained with the formula is presented in percentage.
CUTOFF SCORES
< 25.0%
Not Implemented
25.1% to 50.0%
Incipient Implementation
50.1% to 75.0%
Partially Implemented
> 75.1%
Implemented
PERCENTAGE OBTAINED IN THE DEGREE OF IMPLEMENTATION
RESULTS OF THE ASSESSMENT OF THE DEGREE OF IMPLEMENTATION OF THE HEARING CONSERVATION PROGRAM
Percentage obtained: ______ % Degree of Implementation of the Program: ___________________________________________ Aspects that need improvement: • ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ • ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ • ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ • ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ • ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ • ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ • ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ Complementary observations of the assessor: ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Instructions/Suggestions: ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Date:____________________ Signature: ______________________________________
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Caption: n = number of participants.Source: Developed by the author