Get Hearing Conservation Data Dd Form 2216, Jan 2000 - Tripod

Filling out the Hearing Conservation Data DD Form 2216 is an essential step for individuals regularly exposed to hazardous noise. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently online.

Follow the steps to complete the form online.

1. Press the 'Get Form' button to access the form and open it in your preferred editor.
2. In the first section, titled 'ZIP CODE/APO/FPO/PAS', enter the nine-digit ZIP code or appropriate identifier of the location where the audiometric test will be conducted.
3. Next, find the 'DOD COMPONENT' section and select the letter that corresponds to the major organizational subdivision of the Department of Defense related to your assignment.
4. In 'SERVICE COMPONENT', indicate your primary military service subdivision with the respective letter code.
5. Enter your 'SOCIAL SECURITY NUMBER' in the designated field.
6. For 'NAME', input your last name followed by your first name and middle initial.
7. Record your date of birth in the format YYYYMMDD.
8. Select your sex by entering 'M' for male or 'F' for female.
9. For military personnel, fill in your 'PAY GRADE, UNIFORMED SERVICES' using the code that matches your rank.
10. Complete the 'GRADE, CIVILIAN' section by entering the relevant rank code if applicable.
11. In the 'SERVICE DUTY OCCUPATION CODE', enter the code that describes your job assignment.
12. Provide your current 'MAILING ADDRESS OF ASSIGNMENT' including installation name, unit, and ZIP code.
13. Next, enter the specific 'LOCATION - PLACE OF WORK' where you are routinely exposed to hazardous noise.
14. Identify your 'MAJOR COMMAND' by entering the authorized abbreviation of your commanding unit.
15. Enter your 'DUTY TELEPHONE' number.
16. Proceed to the 'AUDIOMETRY' section. For 'a. PURPOSE', indicate the reason for the audiogram by selecting the appropriate number.
17. In 'b. CURRENT AUDIOGRAM DATE', enter the date of the audiometric test.
18. For 'c. REFERENCE AUDIOGRAM DATE', indicate the date of the reference audiogram.
19. In 'd. SIGNIFICANT THRESHOLD SHIFT (STS)', select '1' if no STS is present or '2' if it is.
20. Document 'e. THRESHOLD SHIFT' by noting the difference in hearing thresholds as instructed.
21. In 'f. REMARKS', include any relevant additional details, such as exposure data.
22. Indicate the type of personal hearing protection used in section 'g'.
23. In 'h. EXAMINER NAME', enter the name of the individual conducting the audiometric test.
24. Record the audiometric technician's training certificate number in 'i'.
25. For 'j. SERVICE DUTY OCCUPATION CODE', enter the examiner's occupation code.
26. Complete the 'k. OFFICE SYMBOL' with the appropriate code.
27. In 'l. AUDIOMETER TYPE', choose the type of audiometer used for the test.
28. Document the model and manufacturer of the audiometer in 'm' and 'n' respectively.
29. Enter the serial number of the audiometer in 'o'.
30. Lastly, provide the date of last electroacoustic calibration in 'p'.
31. After completing all required fields, save your changes, and proceed to download, print, or share the completed form as necessary.

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