DD 2216 2000-2026 free printable template

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FOLLOWUP NO. 1 a. MINIMUM 14 HOURS NOISE FREE SINCE CURRENT AUDIOGRAM See item 15. b. k. MODEL DD FORM 2216 JAN 2000 PREVIOUS EDITION MAY BE USED. DD FORM 2216 BACK JAN 2000 15. c. Reference Audiogram Date. Enter year month and day reference test results w ere obtained. See DD Form 2215 Reference Audiogram or other appropriate source. HEARING CONSERVATION DATA 1. ZIP CODE/APO/FPO/PAS This form is subject to the Privacy Act of 1974 - use Blanket PAS - DD Form 2005 2. DOD COMPONENT 3. SERVICE...

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How to fill out dd form 2215 pdf

How to fill out DD 2216

01

Obtain a copy of DD Form 2216 from the appropriate military or official website.

02

Begin by filling out the top section with personal information such as your name, rank, and service number.

03

Indicate the date of the medical examination in the provided section.

04

Complete the health history section, answering all questions accurately.

05

If applicable, note any prior conditions or treatments related to hearing.

06

Have the conducting medical professional fill out the 'Results' section after the examination.

07

Review the form for completeness and correctness before submitting.

08

Submit the completed DD 2216 to the designated military health office or commander.

Who needs DD 2216?

01

Service members undergoing hearing examinations as part of their qualification for duty.

02

Individuals seeking to document their hearing ability for military records.

03

Personnel assigned to jobs with potential exposure to harmful noise levels.

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What is DD 2216?

DD Form 2216 is a U.S. Department of Defense form used for documenting an individual's hearing conservation program requirement and to assess hearing ability.

Who is required to file DD 2216?

Military personnel and Department of Defense (DoD) civilian employees who are exposed to hazardous noise levels in their work environment are required to file DD 2216.

How to fill out DD 2216?

To fill out DD 2216, the individual must provide personal information such as name, Social Security number, and other relevant details, and then complete sections regarding hearing evaluations and noise exposure.

What is the purpose of DD 2216?

The purpose of DD 2216 is to monitor and protect the hearing of military and DoD personnel by evaluating hearing ability and documenting potential exposure to hazardous noise.

What information must be reported on DD 2216?

The information that must be reported on DD 2216 includes personal identification details, hearing status, exposure to noise levels, and any recommendations or observations from hearing tests.

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