Dd Form 2216 PDF Details

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.

QuestionAnswer
Form NameDd Form 2216
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesform hearing conservation data, dd 2216 data form, dd 2216 e, dd form 2216 get

How to Edit Dd Form 2216 Online for Free

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

  1. Enter personal information: Record the individual full name, Social Security Number (last four digits), branch of service, and unit or organization.
  2. Record the test date and facility: Enter the date of the audiometric examination and the name of the testing facility.
  3. 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.
  4. Identify hearing protection use: Check the boxes describing the type of hearing protective devices the individual uses on the job.
  5. Check for threshold shifts: Compare current results to the baseline audiogram on DD Form 2215. Mark any standard threshold shift in the appropriate fields.
  6. 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.