Noise diary - log sheet for noise complaints
CONTROLLING NOISE IN BOROONDARA: LOG SHEET
COMPLAINANT DETAILS
|NAME |Kate Smith |
|ADRESS |55 Smith St, Smithville 3155 |
|PHONE |99887766 |
NUISANCE DETAILS
|SOURCE OF NOISE |Air conditioning unit |
|TYPE OF NOISE |cranking sound |
|LOCATION/ADDRESS OF NOISE |Next to fence at rear of property at 57 Smith St, Smithville |
| |TIME |INTENSITY | |AFFECT ON MYSELF AND OTHERS (if applicable) |
|DATE | | |DURATION | |
| |START |FINISH |LOUD |MEDIUM |SOFT | | |
|1/2/05 |5am |9am |X | | |4 hrs |Woke me, couldn’t get back to sleep. |
|1/2/05 |9:30am |1:30pm | |X | |4 hrs |Could not study even with window closed. |
|1/2/05 |2pm |6pm | |X | |4 hrs | |
|1/2/05 |11pm |3am |X | | |4 hrs |Could not sleep |
|1/2/05 |3:30am |7:30am |X | | |4 hrs |Woke me up. |
|2/2/05 | | | | | | |- Not home |
|3/2/05 |5am |9am |X | | |4 hrs |Couldn’t sleep. |
FURTHER COMMENTS
|This on-going interruption of my sleep has made me very stressed, sleep deprived, and it's now affecting my daily activities such as studying and even just |
|relaxing. |
COMPLAINANTS SIGNATURE: K.Smith
NOTE: Log Sheets should be completed for a period of at least 2 (two) weeks and then sent back to Health Services. Log Sheets play an important role in assisting Environmental Health Officers in the investigation of your complaint. They can also be used as evidence if your case is settled in court.
NOISE LOG SHEET
COMPLAINANT DETAILS
|NAME | |
|ADRESS | |
|PHONE | |
NUISANCE DETAILS
|SOURCE OF NOISE | |
|TYPE OF NOISE | |
|LOCATION/ADDRESS OF NOISE | |
| |TIME |INTENSITY | | |
|DATE | | |DURATION |EFFECT |
| |START |FINISH |LOUD |MEDIUM |SOFT | | |
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NUISANCE DETAILS CONTINUED:
| |TIME |INTENSITY | | |
|DATE | | |DURATION |EFFECT |
| |START |FINISH |LOUD |MEDIUM |SOFT | | |
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FURTHER COMMENTS
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COMPLAINANTS SIGNATURE: ________________________________________
NOTE: Log Sheets should be completed for a period of at least 2 (two) weeks and then sent back to Health Services. Log Sheets play an important role in assisting Environmental
Health Officers in the investigation of your complaint. They can also be used as evidence if your case is settled in court.
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Example
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