Army Forms Archive

DD Form 2215 — DD Form 2215, Reference Audiogram, January 2000

Reference Audiogram

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Department of Defense form 2215. Official designation: DD Form 2215, Reference Audiogram, January 2000. Purpose: Reference Audiogram. Current edition not stated, status not stated.

Issued under not stated, with not stated as proponent. A DD number marks a Department-wide instrument: the same blank form serves every military department and the defense agencies, rather than one service alone.

The form reaches military personnel across the services, civilian employees of the Department, and the personnel and records specialists who receive it.

When the form is filed is a matter of not stated and local instruction. The description here covers the document itself and how to obtain a copy.

Available formats: PDF. The form runs 2 pages and contains approximately 50 fillable fields.

Pdf serves as the base format. In the fillable variant, each box is an interactive field that holds typed text inside the document. In the flat printable variant, no fields exist — the page prints as a blank to be completed by hand. Typed entries survive transmission; handwriting does not always survive scanning.

Every listed format is free to download. Modern pdf software handles the pdf files, with the caveat that browser-embedded viewers sometimes ignore field properties that a desktop reader honours.

What the form asks for

  • Press this reset button to clear the data from all fields
  • 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
  • 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).
  • 6. Date of birth. (4 digit year, 2 digit month, 2 digit day)
  • 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).
  • Audiometry Section. Item 15. Reason for conducting audiogram. Enter number in box for reason to complete reference audiogram. Enter 1 for individual has not yet worked in hazardous noise duty areas, and no reference audiogram has been accomplished. Enter 2 for individual has worked in hazardous noise duty areas but reference audiogram has been lost or was never accomplished. Enter 3 for individual has worked in hazardous noise duty areas and requires revised reference audiogram following completion of hearing conservation follow up program.
  • 17. Date of audiogram (4 digit year, 2 digit month, 2 digit day).
  • 16. Audiometric data. Left, 500.
  • Left, 1000
  • Left, 3000
  • Left, 4000
  • Left, 6000
  • Left, 2000
  • Right, 500

Completion runs in the order printed on the page: identifying data at the head, the body of the entry next, certification at the foot. Header data frequently governs what belongs in the fields below it.

The current edition is not stated. Superseded editions of DD forms are frequently rejected at the receiving office, since Department-wide forms change centrally and older layouts lose their field correspondence. Edition date appears in the lower corner of the printed blank.

Instructions printed on the form or in not stated govern individual field entries. Where the two differ, the governing publication controls.

The completed document moves to the office named in not stated or in local guidance. A retained copy is conventional practice.

Cross-referenced forms are found through the numbering system. The DD sequence is Department-level and unified, which means a number cited on the page identifies one document across the whole Department.

A DD number and a DA number may appear in the same instruction without being related. DA forms belong to the Army alone; DD forms belong to the Department and are administered at Department level. The sequences are independent.

Editions change because the underlying directive changes, because collection requirements are revised, or because Privacy Act language is updated. Checking the edition date at the point of download is the practical response.

This page distributes a published Department of Defense document and describes it. It is not a source of legal advice and makes no representation about acceptance of any completed form. Questions of applicability, eligibility or procedure belong to not stated, the servicing personnel office, or the office named in not stated.

Questions and answers

What is DD Form 2215?
DD Form 2215, Reference Audiogram, 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?
PDF

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