DD Form 2216 documents the results of audiometric testing for Department of Defense personnel enrolled in a hearing conservation program. The guide below explains how to complete the form, who is required to use it, and what related forms you may need.
Who Needs DD Form 2216
This form is required for all DoD personnel with occupational noise exposure at or above the 85-decibel action level. This includes active-duty Army, Navy, Air Force, Marine Corps, and Coast Guard members, as well as DoD civilian employees and contractors in noise-hazardous positions. Annual audiometric testing is mandatory for all enrolled personnel.
How to Fill Out DD Form 2216
- Enter personal information: Record the individual full name, Social Security Number (last four digits), branch of service, and unit or organization.
- Record the test date and facility: Enter the date of the audiometric examination and the name of the testing facility.
- Document hearing threshold levels: Record the threshold values in decibels for both ears at the standard test frequencies: 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz, 4000 Hz, and 6000 Hz.
- Identify hearing protection use: Check the boxes describing the type of hearing protective devices the individual uses on the job.
- Check for threshold shifts: Compare current results to the baseline audiogram on DD Form 2215. Mark any standard threshold shift in the appropriate fields.
- Obtain required signatures: The audiometric technician and reviewing audiologist or medical officer must sign the form before submission.
Related Forms
DD Form 2216 is used together with the DD Form 2215, which records the initial baseline reference audiogram. You may also use a standard audiogram form for general hearing evaluation documentation. For other Department of Defense administrative forms, see DD Form 1351-2 and DD Form 2870.