Printable blank DD Form 2216

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The DD Form 2216 is used for providing audiometric tests within the U.S. Army. This form was released by the US Department of Defense on January 1, 2000.

What I need the DD Form 2216 for?

The form is needed if you’ve been recently exposed to hazardous noise.

How to fill out DD Form 2216?

The fillable DD Form 2216 should be completed by the person and the medic who takes the test. As a person on military service or a civilian individual, you have to provide the following information:

  1. Your SSN number;
  2. Basic information (name, date of birth, sex, etc);
  3. Pay grade, Uniformed services (for military personnel only);
  4. Civilian grade;
  5. Service duty occupation code;
  6. The mailing address of assignment;
  7. Place of work;
  8. Major command;
  9. Duty telephone number.

The form should be completed with two Follow-ups that are provided by a medic.

Organizations that work with DD Form 2216

  • DoD Hearing Center of Excellence

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