DD 2215 Form - Reference Audiogram

Dd 2215 Form PDF Details

The DD Form 2215, also called the Reference Audiogram, establishes the baseline hearing profile for military service members as part of the Department of Defense Hearing Conservation Program. It is completed before a service member is first exposed to noise levels at or above 85 decibels.

Who Needs to Complete This Form?

Any active-duty service member, Reserve, or National Guard member assigned to a noise-hazardous duty position must complete this form on initial assignment and annually thereafter. Applicable occupational specialties include aviation, artillery, armor, infantry, and vehicle operations across all branches of the U.S. military. Civilian Department of Defense employees in similar noise environments are also required to file this audiogram.

What Information Does It Record?

The form captures two categories of data. Personal information includes the service member's name, Social Security Number, service component, branch, rank, duty status, and occupation code. Audiometric data covers the audiometer type (manual or self-recording), model, manufacturer, serial number, and last calibration date. Hearing threshold levels are recorded for both ears at 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz, 4000 Hz, and 6000 Hz. The form also notes the type of personal hearing protection issued and whether it is being used.

Relationship to DD Form 2216

This baseline audiogram is always paired with the DD Form 2216 (Hearing Conservation Data), which records follow-up audiograms taken annually or after a significant noise exposure event. Comparing both forms allows medical providers to track changes in hearing over time and determine whether a service member qualifies for Noise-Induced Hearing Loss compensation. For general audiometric documentation outside the military context, see the audiogram form.

Privacy Act Notice

Information on this form is collected under the authority of 10 U.S.C. 3013, 5013, and 8013. The Privacy Act of 1974 protects all personal identifiers. The Social Security Number is used only for record identification and is not shared outside the Department of Defense without written consent, except as permitted by law.