DD 2215 2000-2025 free printable template
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1. ZIP CODE/APO/FPO/PAS REFERENCE AUDIOGRAM This form is subject to the Privacy Act of 1974 - use Blanket PAS - DD Form 2005 2. FREQUENCY GLASSES WORN 1 - ALWAYS 2 - SELDOM 3 - N/A 25. REMARKS Include exposure data DD FORM 2215 JAN 2000 PREVIOUS EDITION MAY BE USED. Include the AFOSH Std. 161-17. individual s 8-hour TWA noise exposure when available. DD FORM 2215 BACK JAN 2000. DOD COMPONENT 3. SERVICE COMPONENT A - ARMY N - NAVY F - AIR FORCE M - MARINE CORPS 4. SOCIAL SECURITY NUMBER 8. PAY...
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How to fill out 2215 form pdf
How to fill out DD 2215
01
Obtain a blank DD Form 2215 from the appropriate source.
02
Fill in the service member's personal details in the designated sections, including name and rank.
03
Include the date the form is being filled out.
04
Document the specific noise exposure details in the appropriate parts of the form.
05
Provide the details of the examining audiologist or healthcare provider.
06
Have the service member and the healthcare provider sign and date the form.
07
Submit the completed DD Form 2215 to the relevant authority for record-keeping.
Who needs DD 2215?
01
Service members who are exposed to hazardous noise levels in their work environment.
02
Personnel undergoing auditory examinations as part of hearing conservation programs.
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People Also Ask about audiogram 2215 form
What are the results of the military hearing test?
The military accepts anyone that is able to pass their hearing exam at a “moderate level”. The current moderate level is 40-60 dB when all the hearing scores get averaged together. Those that score severe hearing loss (60-80 dB) and profound hearing loss (larger than 80 dB) do not pass the exam.
Can you join the army with hearing problems?
The cause for rejection for appointment and enlistment is a hearing loss greater than: Pure tone threshold average (of 500, 1000, and 2000 Hz) not more than 30 dB (each ear), with no individual level greater than 35dB at these frequencies.
What are the hearing disqualifications for the military?
The following conditions may disqualify you from military service: a. Hearing loss with the severity of: (1) Pure tone at 500, 1,000, and 2,000 cycles per second of not more than 30 decibels (dB) on the average (each ear), with no individual level greater than 35dB at these frequencies.
What are the hearing requirements for the military?
Current standards for all military branches require: “A hearing threshold level in either ear of greater than a pure tone of 500, 1,000, and 2,000 cycles per second for each ear of not more than 30 decibels with no individual level of greater than 35 dB at those frequencies.”
What is a DD 2216 form?
DD Form 2216. Non-hearing conservation test.
How to read military audiogram results?
The results of the hearing test are an indication for the degrees of hearing loss: Normal hearing: -10 to 20 dB. Mild hearing loss: 20 to 40 dB higher than normal. Moderate hearing loss: 40 to 70 dB higher than normal. Severe hearing loss: 70 to 90 dB higher than normal. Profound loss: 90 dB or more.
What is a DD 2215 form?
Purpose: conduct routine hearing tests to identify changes in hearing related to noise exposure. Creation of initial baseline hearing thresholds. DD Form 2215 required for all military and all DoD civilians exposed to hazardous noise (HCP Stressors)
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What is DD 2215?
DD 2215 is a Department of Defense form used to document an individual's audiogram results and assess hearing capability.
Who is required to file DD 2215?
Active duty service members and individuals in certain military occupational specialties that expose them to high levels of noise are required to file DD 2215.
How to fill out DD 2215?
To fill out DD 2215, individuals must include their personal information, date of the audiogram, results of the hearing test, and any medical remarks from the audiologist or healthcare provider.
What is the purpose of DD 2215?
The purpose of DD 2215 is to monitor and evaluate hearing capability among service members to prevent further hearing damage and to ensure proper care for those who are at risk.
What information must be reported on DD 2215?
DD 2215 must report personal identification details, date of the audiological evaluation, pure tone threshold results, and remarks regarding the assessment or recommendations.
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