You need DD Form 2216, and this page gives you the blank plus the steps for handling it. Start with what the form does: Hearing Conservation Data. Its official title is DD Form 2216, Hearing Conservation Data, January 2000.
Next, check the edition. You want not stated, currently carried as not stated by the publisher. Then confirm the form applies to you — this is a Department of Defense form, so you use it whether you serve in the Army, Navy, Air Force, Marine Corps, Space Force or Coast Guard under Defense jurisdiction.
Then settle the schedule. You are working under not stated, with not stated responsible for the document, and your organization layers its own deadlines on that. Ask before you assume a date.
Last in this stage, choose your method: complete it on screen, or print the blank form and fill it out in pen. The sections below take each route step by step.
Now fill it in. Work from the top of the page downward, and do not jump ahead — the identifying block comes first, the substance of your entry second, the certification last. Later boxes often depend on what you put at the top.
Before your first entry, look at the corner of the page and compare the printed date with not stated. If they do not match, stop and download again. Old copies circulate in shared drives for years, and a DD form is revised centrally for every service at once, so a superseded blank may not carry the fields your reviewer expects.
Look up an unclear item on the form face before anywhere else, then in not stated. Should the two texts conflict, the directive is the one you follow.
Download the form
Begin by choosing a file. Available here: PDF. Plan for 2 pages and about 153 entries.
Choose pdf as your default. Next, click inside a box. A fillable pdf responds by outlining the field and letting you type; the text stays in the document when you save it. A printable pdf does not respond, which tells you to print the page and complete it by hand.
Go with the typed route whenever the choice is yours. Consider what happens after you submit: the copy gets scanned, forwarded and filed, and each pass costs handwriting some legibility. Block letters help if you are stuck with a pen.
Handle xfdl in two steps. First confirm you have IBM Lotus Forms Viewer or a compatible reader on your machine; ordinary pdf software will report the file as broken. Once the viewer is running, download and fill the form.
All of it downloads free. When you are ready to work, do this: save the file locally, then open it in a full pdf application. Browsers often ignore field properties, and you can lose everything you typed.
What the form asks for
- 1. Zip code, A. P. O., F. P. O., P. A. S.
- 2. D. O. D. component. Enter A. for army, F. for air force, N. for navy, M. for marine corps, or 1 for other DoD activity.
- 3. Service component. Enter R for Regular, V for Reserve, G for National Guard, or 1 for other.
- 4. Social security number. Do not include dashes.
- 5. Name (last, first, middle initial).
- 7. Sex. Enter M if male, F if female.
- 8. Pay grade, uniformed services.
- 9. Pay grade, civilian.
- 10. Service duty occupation code.
- 11. Mailing address of assignment.
- 12. Location - place of work.
- 13. Major command.
- 14. Duty telephone (include area code).
- 15. Audiometry. a. Purpose. Enter 1 if 90-day, 2 if Annual, 3 if Termination, or 4 if Other.
- 6. Date of birth. (4 digit year, 2 digit month, 2 digit day)
- f. Remarks. Include exposure data.
- g. Type of personal hearing protection used. Enter 1 for single flange (V. S. 1. R), 2 if triple flange, 3 if hand formed earplug, 4 if ear canal caps, 5 if noise muffs, or 6 if other.
- b. Current audiogram date. (4 digit year, 2 digit month, 2 digit day)
- Audiometric data. Left, 500.
- Left, 1000
- Left, 2000
- Left, 3000
- Left, 4000
- Left, 6000
Now that it is complete, send it where not stated or your local procedure says it goes. Before you do, make yourself a copy — scan it or save the file elsewhere. It costs you nothing and saves you the whole exercise if the original goes missing.
When DD Form 2216 references another form, search on the series and number. Because DD numbers are common to every military department, the number by itself identifies exactly one document.
Be careful when a procedure pairs this form with a service form. Read the prefix, not just the digits. Service forms answer to a service proponent, while DD forms answer to not stated or an equivalent Department office, and the two sequences were never aligned. Grabbing the wrong prefix gets you a form that has nothing to do with your task.
Do not archive this file and reuse it in a year. Forms are reissued as directives are revised, as data requirements shift, and as statutory notice text is amended. Your protection is simple: download fresh each time and confirm the edition date.
One thing this page does not do: tell you whether your submission will be accepted. We publish the document and explain how to complete it, and that is where our role ends. Nothing here is legal advice. Take questions about eligibility, applicability or procedure to not stated, to your servicing personnel office, or to the office named in not stated.
Questions and answers
- What is DD Form 2216?
- DD Form 2216, Hearing Conservation Data, January 2000
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?