Download the form
Defense Department form, series DD, number 2216. Full title: DD Form 2216, Hearing Conservation Data, January 2000. Function: Hearing Conservation Data. Edition in force: not stated. Publisher 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.
Timing of submission is fixed by not stated and by the implementing guidance of the submitting organization. What follows describes the blank document, not agency procedure.
The download set covers PDF. Document length is 2 pages with about 153 entry fields.
Free download applies to every format listed. Any current pdf reader opens the pdf files, though field behaviour is most reliable in a full desktop reader rather than a browser preview.
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
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.
Edition in use: not stated. Because DD forms are revised at Department level and distributed to all services at once, an obsolete printing may not match the fields an office expects. The date is printed on the form face.
Certification requires a signature in the designated block — ink on paper, or a digital signature where the receiving office supports one. Typing a name into the field does not constitute execution. CAC-based signing is the usual digital method for Defense forms.
Privacy Act notice: DD forms that collect personal data carry a Privacy Act Statement stating the authority for collection, the principal purpose, routine uses and whether disclosure is voluntary or mandatory. The statement is part of the form and should be read before entry, not after.
Frequent defects: obsolete edition, unfilled required boxes, handwriting that fails on reproduction, non-conforming date format, and certification without a corresponding date.
Instructions printed on the form or in not stated govern individual field entries. Where the two differ, the governing publication controls.
After completion, the copy goes to the office designated by not stated or by local procedure. Retention of a personal copy is ordinary practice and costs nothing.
Associated forms are traced by number within the series. Because the DD sequence is common to all military departments, no service qualifier is needed to identify a referenced form.
Some procedures pair a DD form with a service form. The two numbering systems are separate — service forms answer to a service proponent, DD forms to not stated or another Department office — and a matching number in each system means nothing.
Revision occurs when the prescribing directive is reissued, when the data collected changes, or when statutory notice language is amended. Verification of the edition date at download addresses all three.
Scope of this page: distribution of a published form and description of its contents. It offers no legal guidance and no assurance regarding any particular submission. Direct procedural questions to not stated, to the servicing personnel office, or to the office designated 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?