You need DD Form 2493-2, and this page gives you the blank plus the steps for handling it. Start with what the form does: Asbestos Exposure Part II - Periodic Medical Questionnaire. Its official title is DD Form 2493-2, Asbestos Exposure Part II - Periodic Medical Questionnaire, January 2000.
Your second step is the edition, not stated, listed as not stated. Your third is scope. Because the number carries a DD prefix, you use the same blank as every other military department and defense agency; no service-specific version exists for you to hunt down.
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.
Finally, decide how you will complete it. You can type into a fillable file or print a blank and write by hand, and the rest of this page walks you through both paths in order.
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.
Check the edition before you type a word. The date appears on the face of the form; it should read not stated. When it does not, discard the file and take a fresh copy from this page. Department-level revisions replace the blank across all services simultaneously, which means an old printout can be out of step everywhere.
For questions about a specific entry, check the form's own instructions, and if that does not settle it, open not stated. The directive controls where they differ.
Download the form
First, look at what you can download. The set covers PDF, the form runs 1 pages, and you will complete roughly 53 fields.
Take the pdf if you are unsure. Then check which kind you have: if the boxes highlight when you click them, you have a fillable pdf and can type straight into it, and your entries save with the file. If nothing highlights, you have a printable pdf — send it to a printer and use black ink.
Prefer typing over writing. Your form will likely be scanned and emailed onward, and typed text reproduces at every stage while pen strokes fade or blur. When you do write, print in capitals so the receiving clerk can read it.
What the form asks for
- Identification section. 1. Name (last, first, middle initial).
- 2. Social security number. Do not include dashes.
- 3. Clock number. Enter 5 digit number.
- 4. Present occupation.
- 5. Name of plant.
- 6. Street address of plant.
- 7. Plant city, state and zip code.
- 8. Telephone number, include area code.
- 9. Name of interviewer.
- 10. Date of interview (4 digit year, 2 digit month, 2 digit day).
- 11. Marital status. Press space bar to mark X in first box if single, second box if married, third box if widowed, or fourth box if divorced/separated.
- 12. Occupational history. a. In the past year, did you work full time (30 hours per week or more) for six months or more? X first box if yes, second box if no.
- b. Did you work at any dusty job during the past year? X first box if yes, second box if no.
- c. If yes, was exposure: X first box if mild, second box if moderate, third box if severe, or fourth box if not applicable.
- d. In the past year, were you exposed to gas or chemical funes in your work? X first box if yes, second box if no.
- e. If yes, was exposure: X first box if mild, second box if moderate, third box if severe, or fourth box if not applicable.
- f. In the past year, what was your (1) Job or occupation.
- (2) Position or job title.
- 13. Medical history. a. Do you consider yourself to be in good health? X first box if yes, second box if no.
- If no, state reason.
- b. In the past year, have you developed: (1) Epilepsy (or seizures, fits or convulsions). X first box if yes, second box if no.
- (2) Rheumatic fever. X first box if yes, second box if no.
- (3) Kidney disease. X first box if yes, second box if no.
- (4) Bladder disease. X first box if yes, second box if no.
With the form finished, route it to the office named in not stated or in your organization's own instruction. Keep a copy first. People rarely regret having one and frequently regret not having one.
Should you need a related form, look it up by its number. The DD sequence is Department-wide, which makes your search simple: no service qualifier, no branch-specific variant to track down.
Watch out for one trap here. If your instructions cite a DA form as well, do not assume the numbers are connected. DA numbering belongs to the Army alone; DD numbering belongs to the Department and is administered by not stated or another Department office. The same number in each system means two unrelated forms, so read the prefix before you download.
Plan to repeat this step whenever the form comes up again. Revisions follow directive changes, changes in what data is collected, and updates to notice language. Since nobody notifies you, check not stated at download and you have covered it.
Finally, understand the limits of what you have read. This page distributes a published Department of Defense form and describes how to fill it out. It does not give legal or procedural advice, and it cannot promise any outcome for your particular case. For that, contact not stated, your administrative office, or the authority identified in not stated.
Questions and answers
- What is DD Form 2493-2?
- DD Form 2493-2, Asbestos Exposure Part II - Periodic Medical Questionnaire, 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?