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DD Form 2215 — DD Form 2215, Reference Audiogram, January 2000

Reference Audiogram

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Treat DD Form 2215 as Department-level, which changes how you look for it. Title: DD Form 2215, Reference Audiogram, January 2000. Function: Reference Audiogram. Because the number carries DD rather than a service prefix, the same edition covers all military departments and the defense agencies at once. Nobody issues a Navy copy or an Air Force copy.

Requirement traces to not stated; the form belongs to not stated. Everything about schedule sits below that in local instruction, which is where to ask if a date matters.

Current edition is not stated, carried as not stated. Check that against any copy you already hold before doing anything else — Department-level revisions land everywhere simultaneously, so a stale file is stale across the whole Department.

Available: PDF, across 2 pages, roughly 50 fields.

Nothing costs anything here. Work in a full desktop pdf application rather than a browser preview; field behaviour in browsers is unreliable.

What the form asks for

  • Press this reset button to clear the data from all fields
  • 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
  • 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).
  • 6. Date of birth. (4 digit year, 2 digit month, 2 digit day)
  • 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).
  • Audiometry Section. Item 15. Reason for conducting audiogram. Enter number in box for reason to complete reference audiogram. Enter 1 for individual has not yet worked in hazardous noise duty areas, and no reference audiogram has been accomplished. Enter 2 for individual has worked in hazardous noise duty areas but reference audiogram has been lost or was never accomplished. Enter 3 for individual has worked in hazardous noise duty areas and requires revised reference audiogram following completion of hearing conservation follow up program.
  • 17. Date of audiogram (4 digit year, 2 digit month, 2 digit day).
  • 16. Audiometric data. Left, 500.
  • Left, 1000
  • Left, 3000
  • Left, 4000
  • Left, 6000
  • Left, 2000
  • Right, 500

Edition check comes first, ahead of any entry. Compare the printed date to not stated and replace anything older. Department-level supersession is simultaneous across the services, so a superseded blank is not merely out of date locally; the office receiving it is already working from the new field structure whichever branch it belongs to.

Field-level questions go to the printed instructions, then to not stated, which is authoritative.

Submit to the office named in not stated or in local instruction; retain a duplicate before it leaves. Joint routing often sends a DD form across organizational boundaries, and tracing one afterward is not a same-day matter.

Look up cross-referenced forms by series and number. DD numbering is unified across the Department, which removes the usual step of identifying which service issued the thing.

Prefix before number. A DA citation and a DD citation in the same instruction point at separate systems — one Army, administered by an Army proponent, one Department-wide under not stated — and there is no correspondence between them at any number.

Editions change when the prescribing directive is reissued, when the data collected changes, or when notice language is amended. None of that reaches you. Checking not stated at download is the entire defence, and it is cheaper than repeating a submission.

This page publishes a Defense document and explains its contents. It does not advise, does not rule on applicability, and determines nothing about how a completed form will be treated. Direct such questions to not stated, to the servicing personnel office, or to the office designated in not stated.

Questions and answers

What is DD Form 2215?
DD Form 2215, Reference Audiogram, 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?
PDF

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