Form FAA 3900-22 - AFS Hearing Conservation Program (HCP) Determination Form

Document Information

Number

FAA 3900-22

Title

AFS Hearing Conservation Program (HCP) Determination Form

Prescribing Order

3900.19B - Occupational Safety and Health Program

Status

Active

Edition date

2017-11-07

Orientation

Portrait

Unit of issue

EA

NSN/Stockpoint

N/A

Office of Primary Responsibility

AFS-110

Access Restriction

FAA Network Only

Description

This form has been created to meet the requirements of the Occupational Safety and Health Administration (OSHA) and industry standards. It will help the Hearing Conservation Program Manager delineate who in the Flight Standards Service Office are exposed to hazardous noise as defined by OSHA and the American Conference of Governmental Industrial Hygienists (ACGIH). If employee marks a certain box or boxes, the form will serve as their official notification that they will be enrolled in the Flight Standards Hearing Conservation Program. Once enrolled, they will receive hearing tests and training provided by the agency.

Contact information

Jan Peterson
jan.peterson@faa.gov
404-474-5905

Content

• FAA 3900-22 (PDF)

  This for is for use by FAA employees only. It is available in electronic format only.