AF Form 1753: Hearing Conservation Examination Guide 2026

AF Form 1753: Hearing Conservation Examination Guide 2026 – The U.S. Air Force operates in one of the noisiest environments in the world, with jet engines, aircraft ground support equipment, weapons systems, and industrial operations routinely exposing service members and civilians to hazardous noise levels. Protecting hearing is critical for mission readiness, operational effectiveness, and long-term health. AF Form 1753, titled Hearing Conservation Examination (LRA), is a key document in the Air Force Hearing Conservation Program (HCP).

This article explains what AF Form 1753 is, its purpose, when it is used, how it is completed, and its role alongside other forms like DD Form 2215 (Reference Audiogram) and DD Form 2216 (Hearing Conservation Data). Official download is available here: https://static.e-publishing.af.mil/production/1/af_sg/form/af1753/af1753.pdf.

What Is AF Form 1753?

AF Form 1753 is a one-page medical form used to document a patient’s audiometric case history and clinical examination results as part of the Air Force Hearing Conservation Program. It is an older form (edition May 1991) still referenced in current guidance and is subject to the Privacy Act of 1974 (use Blanket PAS – DD Form 2005).

The form has two main sections:

  • Section I: Audiometric Case History – Completed by the individual (patient/worker).
  • Section II: Clinical Examination – Completed by a provider when indicated.

It also includes patient identification, an audiogram profile (H-1 or better, change, stable, or Significant Threshold Shift/STS), disposition, and certification signatures.

Purpose of AF Form 1753 in the Air Force Hearing Conservation Program

The Air Force HCP implements DoDI 6055.12 (Hearing Conservation Program) and AFI 48-127 (Occupational Noise and Hearing Conservation Program). Its goals are to:

  • Prevent occupational noise-induced hearing loss.
  • Identify early changes in hearing (Standard Threshold Shift or STS).
  • Ensure proper use of hearing protection devices (HPDs).
  • Support fitness-for-duty evaluations in hazardous noise environments.

AF Form 1753 supports these goals by collecting self-reported history and clinical findings. It is typically used with:

  • DD Form 2215 — Baseline/reference audiogram.
  • DD Form 2216 — Annual/periodic audiogram results.
  • AF Form 1672 — For referrals to hearing conservation diagnostic centers when needed.

Data from these forms feeds into the Defense Occupational and Environmental Health Readiness System – Hearing Conservation (DOEHRS-HC) data repository.

When Is AF Form 1753 Required?

According to AFI 48-127 guidance:

  • Initial reference (baseline) audiograms — Section I is completed.
  • When a Significant Threshold Shift (STS) is identified on a periodic test (DD 2216) — The worker completes Section I before referral.
  • When hearing is worse than H-1 profile or asterisked (*) questions in Section I are answered “yes” — A clinical exam (Section II) by a provider is required.
  • Fitness and risk evaluations or re-establishing a baseline after PTS (permanent threshold shift).
  • Referral or diagnostic follow-up in certain cases.

A clinical exam is mandatory if there are red-flag responses (e.g., ear pain, recent loud noise exposure without adequate rest, asymmetric hearing complaints, or history of ear surgery).

How to Complete AF Form 1753 (Step-by-Step)?

Instructions printed on the form:

  • Complete the information in the lower right corner.
  • Answer all questions in Section I only (yes/no/don’t know).
  • Sign after being informed of your hearing test results.

Section I – Audiometric Case History (Patient Completes)

This section gathers information on:

  • Type of test (reference, annual, termination, etc.).
  • Recent loud noise exposure (last 15 hours?).
  • Difficulty hearing in various situations (warning signals, phone, noisy rooms, normal speech).
  • Whether hearing is getting worse, fluctuating, or asymmetric.
  • Current ear symptoms (pain, infection, drainage, wax, pressure, ringing/tinnitus, dizziness).
  • Medical history (ear surgery, allergies, childhood illnesses, diabetes).
  • Prior job restrictions or denials due to hearing.
  • Non-occupational noise exposures (firearms, loud music, power tools, motorcycles, etc.).
  • Current hearing protection used and whether new earplugs are needed.

Certification statement: The patient certifies the history is accurate and acknowledges understanding the requirement to wear hearing protection in hazardous noise areas. Both patient and examiner sign.

Section II – Clinical Examination (Provider Completes When Indicated)

  • Inspection of outer ears (pinna), ear canals, tympanic membranes, middle ear, Eustachian tube function, nose, and throat.
  • Marked as Normal / Abnormal / Not Examined.
  • Audiogram profile notation (H-1 or better; H-2 or worse; change; stable; STS).
  • Disposition: Clear for duty, Refer for earplug fitting, Other (specify).
  • Fitness and risk evaluation required or not.
  • Additional remarks.

The provider signs and dates, along with any required PAS code.

  • DD 2215 & DD 2216: Core audiometric records exported to the central repository.
  • Hearing Protector Fit-Testing (HPFT): DoDI 6055.12 (updated) requires quantitative fit-testing, especially for exposures ≥95 dBA 8-hour TWA. This helps ensure HPDs provide adequate protection.
  • H Profile: Hearing profiles (H-1 to H-4) are defined in AFI 48-123 and the Medical Standards Directory; they affect duty qualifications.

Why Hearing Conservation Matters in the Air Force?

Noise-induced hearing loss is permanent and can impair communication, situational awareness, and safety. The HCP combines engineering controls, administrative controls, hearing protection, education, and monitoring. AF Form 1753 plays a vital documentation role in identifying issues early and ensuring individuals understand their responsibilities.

Recent DoD emphasis on expanded hearing protector fit-testing underscores the commitment to preventing hearing loss while maintaining combat readiness.

Download and Access

Official AF Form 1753 PDF:
https://static.e-publishing.af.mil/production/1/af_sg/form/af1753/af1753.pdf

For the latest program guidance, consult:

  • AFI 48-127 (Occupational Noise and Hearing Conservation Program)
  • DoDI 6055.12
  • Your local Medical Treatment Facility (MTF) Public Health or Occupational Medicine clinic

Note: Always use the most current version of supporting instructions, as local supplements or updates may apply. Forms and data handling must comply with Privacy Act and HIPAA requirements.

If you are an Air Force member, civilian employee, or supervisor in a noise-hazardous area, ensure you complete required audiograms and understand your hearing protection responsibilities. Early detection through tools like AF Form 1753 helps preserve your hearing for a full career and life after service.

Questions about your specific situation should be directed to your unit’s Hearing Conservation Program Manager or Occupational Health provider.