Download the form
Defense Department form, series DD, number 2493-2. Full title: DD Form 2493-2, Asbestos Exposure Part II - Periodic Medical Questionnaire, January 2000. Function: Asbestos Exposure Part II - Periodic Medical Questionnaire. Edition in force: not stated. Publisher status: not stated.
Governing directive: not stated. Responsible office: not stated. The DD designation signals joint scope — all military departments, combatant commands and defense agencies draw on a single edition of the document.
Common users: service members regardless of branch, Defense civilian staff, and the offices that file, verify or retain the finished document.
Submission follows the schedule set by not stated and by local implementing procedures. This page provides the blank form for download and general orientation only.
Available formats: PDF. The form runs 1 pages and contains approximately 53 fillable 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
- 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.
The document is filled from the top down. Identification precedes substance, substance precedes certification. Fields lower on the page are commonly keyed to entries made above them.
Verify the edition date against not stated before entry. Department-level revisions replace the blank across every service simultaneously, so an old copy in a desk drawer may no longer correspond to current field numbering.
Field-level instructions appear on the form itself and in not stated. The directive is the controlling text.
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.
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.
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 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?