File / Reference Number

Yarra Ranges Council Noise Nuisance Monitoring Sheet

Name:

Address:

File / reference number:

Date / Times / Property address for noise / Area of property where noise is occurring / Description of noise / Rate the noise on a scale of 1-10 / Nature of nuisance / Impact on you / Verification of offending person/s or general comments
Insert the date on which the activity occurs. / Insert the start and finish times. Where there is a break on the same date please insert a new start and finish time. / Provide address for location of offending noise. / Specify the part of the property where the noise was occurring at the time. / Outline the type of noise. / Rate the severity of the noise starting at ‘0’ to represent the background noise level.
E.g. Rating: 2 – easily able to hear another person over the noise using a speaking voice at a distance of 1m. / Describe how the nuisance is being created and for what reason. E.g. Amplified music being played at a party was at a high volume. / Describe the affect that the noise had on you. / Describe what you did to verify the person/s and from which property the noise was causing the nuisance and insert any additional information.
1/1/16 / 9:00am-11:00am / 15 Anderson Street, Lilydale, 3140 / Carpark / Music noise, loud music / 5 / At regular intervals at high volume could be heard in our living room / Needed to turn up volume whilst watching TV. Close window. / Went outside could see the lights and hear the music coming from the property. Spoke to owner, made no attempt to turn music down
Date / Times / Property address for noise / Area of property where noise is occurring / Description of noise / Rate the noise on a scale of 1-10 / Nature of nuisance / Impact on you / Verification of offending person/s or general comments
Date / Times / Property address for noise / Area of property where noise is occurring / Description of noise / Rate the noise on a scale of 1-10 / Nature of nuisance / Impact on you / Verification of offending person/s or general comments
Date / Times / Property address for noise / Area of property where noise is occurring / Description of noise / Rate the noise on a scale of 1-10 / Nature of nuisance / Impact on you / Verification of offending person/s or general comments
Date / Times / Property address for noise / Area of property where noise is occurring / Description of noise / Rate the noise on a scale of 1-10 / Nature of nuisance / Impact on you / Verification of offending person/s or general comments