Noise Log Record Form

Noise Log

(Should be kept by a person experiencing Noise Nuisance)

Name: ____________________________

Address:_____________________________________________________________________

Address of Suspected noise Source: ______________________________________________

Date

Start

Finish

Description of Noise

Other Comments

(e.g.

Intensity)

Start

Time

(Tonal or Impulsive)

e.g. Noise woke me up.

e.g. Noise all day but worse

after 8.00pm

Do not forget to complete the declaration of record details.

Declaration of True Record

I (Name) ______________________ confirm that the above list is a true record of events

recorded from (Date) ___________ to (Date) ___________.

Signature:_________________________________ Date:___________________

I am/am not* prepared to appear in court to give evidence if required (*please

delete as appropriate).

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Parent category: Miscellaneous