DD Form 2216, titled Hearing Conservation Data, records the outcomes of periodic and follow-up audiometric testing for Department of Defense personnel. The form covers military members across all service branches, including the Army, Navy, Air Force, Marine Corps, and Coast Guard, as well as DoD civilian employees working in noise-hazardous environments.
Key information captured on DD Form 2216 includes hearing threshold values at standard test frequencies, personal hearing protection measures in use, and any significant threshold shifts detected during testing. The form works alongside DD Form 2215 (Reference Audiogram), which documents the initial baseline hearing assessment. When subsequent audiometric evaluations are required due to noise exposure or changes in hearing status, the results are recorded on DD Form 2216.
Administered under the Privacy Act of 1974, the form protects the privacy of individual health records while supporting the Department of Defense comprehensive hearing conservation program. Timely and accurate completion of DD Form 2216 enables appropriate follow-up actions and supports long-term hearing health for all personnel in noise-hazardous roles.
| Question | Answer |
|---|---|
| Form Name | Dd Form 2216 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | form hearing conservation data, dd 2216 data form, dd 2216 e, dd form 2216 get |