DA Form 7847 "Beauty Facility Risk Assessment Worksheet"

What Is DA Form 7847?

This is a military form that was released by the U.S. Department of the Army (DA) on May 1, 2019. The form, often mistakenly referred to as the DD Form 7847, is a military form used by and within the U.S. Army. As of today, no separate instructions for the form are provided by the DA.

Form Details:

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1. DATE (YYYYMMDD):
BEAUTY FACILITY RISK ASSESSMENT WORKSHEET
For use of this form, see TB MED 531; the proponent agency is OTSG.
2. FACILITY NAME
FACILITY LOCATION
3. PERIOD ASSESSED (Report Date - YYYYMMDD)
4. COMPLETETD BY:
1st Report:
Last Report:
5. FACILITY CHARACTERIZATION (Types of services offered within the operation. Check all that apply.)
A
Hair cutting – cut, shave, shampoo, dry, style (non-chemical treatments)
Extremely High (Monthly)
B
Hair removal – tweeze, pluck, threading, or waxing
High (Quarterly)
C
Hair treatment [using chemicals] – straightening, braiding, coloring, permanents, weaving
Moderate (Semi-annual)
D
Nail treatments – manicure, pedicure, extensions, polish, jewelry application
Low (Annual)*
Skin treatments (Check only one)
E
= facials, skin wraps, makeup application, hand & foot wax
E
= E
+ mud baths
F
Spray tanning
* The minimum inspection frequency
for Type III and V operations is semi-
G
Massage (whole body) – Do NOT select this category if the facility only conducts face, scalp, neck/shoulder, or hand/foot massage
annual regardless if rated Low Risk.
H
Ear piercing
I
Water or heat spa – facility maintains a hot tub/spa, sauna, or steam room as part of the operation
6. OPERATION TYPE (Check only one Operation Type that best summarizes the services checked in
7. PRIMARY POPULATION SERVED (Check only one item description that best characterizes the
item 5.)
primary customer base using this facility.)
Type I – A only or A B
Type II – A B C or D only
General population
TO&E units (not deployed)
Type IV – H only
High readiness TO&E (not deployed)
Deployment
Type III* – A B C D or A B C D E
IET/AIT; Mobilization
Hospital; Contingency Camp
Type V* – A B C D E
F or A B C D E
G or E
/E
F G or A B C D E
G/H/I
8. INSPECTION HISTORY (List each inspection document in the Inspection Report Review Log and refer to the instruction page to complete this section.)
a. Inspection Reports (
b. Calculations
AWARDED POINTS
BT
RF
CF
Non-conformance
BV
R
TV
CV
Base Total
Risk Factor
Critical Factor
BV x NCV
Baseline Value
# of Reports
Total # of Violations
# of Critical Violations
BV x R
TV ÷ BT
CV ÷ TV
BV = 20
R = _______
BT = _______
TV = _______
CV = _______
RF = _______
CF = _______
NCV = _______
9. TREND – Non-compliance weighted average during the
g
%
assessment period (NCV x 100 = %)
10. ADDITIONAL RISK POINTS (Select all that apply and award the specified points.)
OTHER POINTS
Note: Trends > 20% are indicative of poor active managerial controls within the operation.
Average daily facility patronage is greater than 100 (5 points)
Facility operates a food/nutrition bar (8 points)
Operation was implicated in an adverse health occurrence during this assessment
period (10 points)
Add the Awarded Points from item 8 and Other Points from item 10 to get the Total Points
11. FACILITY SCORE
TOTAL POINTS
The Facility Score is the represented by the Total Points. Use the Facility Score to determine the facility risk rating.
Determine the facility Risk Rating using the PROBABILITY and SEVERITY Tables.
Mark the appropriate box in block 12 at the top of this page for Risk Rating and Inspection Frequency.
DA FORM 7847, MAY 2019
APD AEM v1.00
1. DATE (YYYYMMDD):
BEAUTY FACILITY RISK ASSESSMENT WORKSHEET
For use of this form, see TB MED 531; the proponent agency is OTSG.
2. FACILITY NAME
FACILITY LOCATION
3. PERIOD ASSESSED (Report Date - YYYYMMDD)
4. COMPLETETD BY:
1st Report:
Last Report:
5. FACILITY CHARACTERIZATION (Types of services offered within the operation. Check all that apply.)
A
Hair cutting – cut, shave, shampoo, dry, style (non-chemical treatments)
Extremely High (Monthly)
B
Hair removal – tweeze, pluck, threading, or waxing
High (Quarterly)
C
Hair treatment [using chemicals] – straightening, braiding, coloring, permanents, weaving
Moderate (Semi-annual)
D
Nail treatments – manicure, pedicure, extensions, polish, jewelry application
Low (Annual)*
Skin treatments (Check only one)
E
= facials, skin wraps, makeup application, hand & foot wax
E
= E
+ mud baths
F
Spray tanning
* The minimum inspection frequency
for Type III and V operations is semi-
G
Massage (whole body) – Do NOT select this category if the facility only conducts face, scalp, neck/shoulder, or hand/foot massage
annual regardless if rated Low Risk.
H
Ear piercing
I
Water or heat spa – facility maintains a hot tub/spa, sauna, or steam room as part of the operation
6. OPERATION TYPE (Check only one Operation Type that best summarizes the services checked in
7. PRIMARY POPULATION SERVED (Check only one item description that best characterizes the
item 5.)
primary customer base using this facility.)
Type I – A only or A B
Type II – A B C or D only
General population
TO&E units (not deployed)
Type IV – H only
High readiness TO&E (not deployed)
Deployment
Type III* – A B C D or A B C D E
IET/AIT; Mobilization
Hospital; Contingency Camp
Type V* – A B C D E
F or A B C D E
G or E
/E
F G or A B C D E
G/H/I
8. INSPECTION HISTORY (List each inspection document in the Inspection Report Review Log and refer to the instruction page to complete this section.)
a. Inspection Reports (
b. Calculations
AWARDED POINTS
BT
RF
CF
Non-conformance
BV
R
TV
CV
Base Total
Risk Factor
Critical Factor
BV x NCV
Baseline Value
# of Reports
Total # of Violations
# of Critical Violations
BV x R
TV ÷ BT
CV ÷ TV
BV = 20
R = _______
BT = _______
TV = _______
CV = _______
RF = _______
CF = _______
NCV = _______
9. TREND – Non-compliance weighted average during the
g
%
assessment period (NCV x 100 = %)
10. ADDITIONAL RISK POINTS (Select all that apply and award the specified points.)
OTHER POINTS
Note: Trends > 20% are indicative of poor active managerial controls within the operation.
Average daily facility patronage is greater than 100 (5 points)
Facility operates a food/nutrition bar (8 points)
Operation was implicated in an adverse health occurrence during this assessment
period (10 points)
Add the Awarded Points from item 8 and Other Points from item 10 to get the Total Points
11. FACILITY SCORE
TOTAL POINTS
The Facility Score is the represented by the Total Points. Use the Facility Score to determine the facility risk rating.
Determine the facility Risk Rating using the PROBABILITY and SEVERITY Tables.
Mark the appropriate box in block 12 at the top of this page for Risk Rating and Inspection Frequency.
DA FORM 7847, MAY 2019
APD AEM v1.00
INSPECTION REPORT REVIEW LOG
(List the reports reviewed for this assessment period. Use to complete worksheet items 3 and 8)
Number of
Report Type
Number of Critical
Report Date
Violations
(form number/version)
Violations
(Critical + Non - critical)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Totals:
(R)
(AV)
(C)
Example:
DA Form 5402
14 Oct 2017
14
4
DA Form 5402
10 Apr 2018
3
0
DOEHRS
23 Sep 2018
6
1
Totals:
(R)
3
(AV)
23
(C)
5
DA FORM 7847, MAY 2019
APD AEM v1.00ES
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INSTRUCTIONS FOR COMPLETING THE BEAUTY FACILITY RISK ASSESSMENT WORKSHEET
1. DATE. Date risk assessment was completed.
2. FACILITY NAME. Name of the establishment or operation must be distinguishable from other similar operations. Include the building number or facility where located, as needed
(e.g., Beauty Shop-43501, Club barber, Barber/Beauty-Exchange). Provide the name of the military installation where the operation is located.
3. PERIOD ASSESSED. Provide the date of the first and last inspection report reviewed for the current risk assessment period. Only review reports for Routine and associated Follow-
up inspections. Complaint investigations are not included unless the inspector converted the investigation to an official (Routine) inspection due to significant violations found.
4. COMPLETED BY. Rank and full name of the person completing the risk assessment. The assessment should be conducted or reviewed for accuracy by a senior individual (EH
NCOIC or OIC).
5. FACILITY CHARACTERIZATION. Mark each activity group that describes one or more of the services offered through the operation.
6. OPERATION TYPE. The Operation Type represents the combined services that are available at the facility. Operational hazards and/or the complexity of the services offered
increase as the Operation Type increases from Type I to Type V. Distinguishing characteristics include --
- Type I: barber shop or beauty shop (services generally limited to shampoo and cut; no chemical hair treatments)
- Type II: beauty shop; combination barber/beauty shop; hair salon (weaving/braiding & other chemical treatments); or nail salon
- Type III: beauty shop (with nail services); or limited service beauty spa or day spa (no mud baths, no spray tanning, & no massage services)
- Type IV: ear piercing concession (no other services)
- Type V: beauty spa or day spa (full service spa facility includes 3 or more of the following: hair treatments, nail treatments, mud bath, spray tanning, whole body massage, ear
piercing, water spa, sauna)
7. PRIMARY POPULATION SERVED. The customer base primarily serviced by the facility due to proximity.
- General Population: Mixed customer base that does not distinguish a unique population; local community.
- TO&E Units (not deployed): Facility is located [CONUS or OCONUS] at home station and is situated in close proximity to TO&E units.
- High Readiness TO&E Unit: Facility is located [CONUS or OCONUS] at home station and close proximity to Special Operations, Division Readiness Brigade, or other specialty
unit with short notice deployment designation.
- Deployment Setting: Facility is located at a forward operating base, camp, or similar combat or contingency operation site. Note: This category does not include detainee/
prisoner sites [see “Hospital; Contingency Camps”].
- IET/AIT; Mobilization; Readiness Training Site: Facility is located in the battalion area of a basic training or advanced initial training school; or facility primarily supports an
active/reserve component mobilization site; or facility is located near a training site where exercises last more than 2 weeks or are utilized for deployment readiness validation
(e.g., NTC, JRTC).
- Hospital; Contingency Camp: Operation directly supports a medical facility, a displaced persons camp, or detainee camp.
8. INSPECTION HISTORY. The risk assessment consolidates an operation's performance data from all barber/beauty operation inspections conducted during the assessment period.
For initial assessment, review all routine and follow-up inspections conducted within the previous 24 months or the last 12 inspections, whichever method yields the greatest number
of reports. For periodic updates, only review inspection reports for the current assessment period. Update assessments annually for facilities rated Extremely High or High risk;
update every 2 years for Moderate or Low risk operations. Note: Use the Inspection Report Review Log (page 2 of the worksheet) to track the documents reviewed.
8a. Enter the reviewed inspection documents in the Inspection Report Review Log and complete the requested information.
- Baseline Value [BV]. Predetermined value represents the core sanitation and hygiene requirements (inspection criteria) that apply to all barber and beauty operations.
- # of Reports [R]. The total number of documents that were reviewed for the current risk assessment period.
- Base Total [BT]. The minimum number of possible violations from combined barber/beauty operation inspection reports. Calculate by multiplying the Baseline Value by the
total # of Reports: BV x R = BT
- Total # of Violations [TV]. Count the number of critical and non-critical items that were marked non-compliant for each inspection conducted during the risk assessment
period; record the numbers for each report on the Report Review Log (page 2 of the worksheet). Sum the column and mark the total in the space provided for TV in the
worksheet.
- # of Critical Violations [CV]. Count the number of CRITICAL items that were marked non-compliant on each inspection report and enter the number for each report on the
Report Review Log. Sum the column and mark the total in the space provided for CV in the worksheet.
Note: Critical inspection items are indicated by an asterisk (*) next to the item number on DA Form 5402 and are identified with the corresponding provision in TB MED 531.
Critical items are not distinguished on the DOEHRS Survey Report and must be identified using TB MED 531.
8b. Calculations. Round all values to 3 decimal places (e.g., 0.1357 = 0.136)
- RF - The Risk Factor is a decimal representation of the average rate of non-compliance during the current assessment period. Calculate by dividing the Total # of Violations by
the Base Total: TV ÷ BT = RF
- CF - The Critical Factor is a decimal representation of the percent of violations attributed to critical items. Calculate by dividing the # of Critical Violations by the Total # of
Violations: C ÷ TV = CF Note: When there are no critical violations, the CF value is zero and NCV does not need to be calculated.
- NCV - The Non-Compliance Value reflects the degree of non-conformance occurring within an operation. The weighted value accounts for the increased health risk attributed
to critical violations. Calculate by multiplying Risk Factor by Critical Factor and then adding the value to the Risk Factor: (RF x CF) + RF = NCV
*Note: When the CF value is zero, the NCV value is equal to the RF value.
- Awarded Points for Non-conformance. Multiply the Baseline Value by the Non-Compliance Value: BV x NCV [NOTE: Show up to 2 decimal places]
Example: When BV=20, R=4, BT=80, TV=17, and CV=6, then RF= TV ÷ BT = 17 ÷ 80 = 0.213; CF= CV ÷ TV = 6 ÷ 17 = 0.353;
NCV= (RF x CF) + RF = (0.213 x 0.353)+0.213 = 0.288; and Awarded Points= BV x NCV = 20 x 0.288 = 5.76
9. TREND. The “trend” reflects the operation's pattern of non-conformance to prescribed sanitation and hygiene standards. An intervention strategy should be applied by public health
regulators to help improve active managerial controls when the trend value is greater than 20%.
10. ADDITIONAL RISK POINTS. Enter the corresponding points in the column under Other Points. The pre-assigned values may not be increased or decreased.
- Facility Patronage: Determine the average number of customers serviced by the operation each day. When patronage rates vary significantly at different times during the year,
identify the period which represents the peak season and apply that value as the daily average for the operation. Do not prepare a separate risk assessment for the “off peak”
season.
- Nutrition Bar: An integrated food concession is generally limited to multifunctional facilities such as Day Spas. Points are only awarded when food is processed onsite and
involves cut fruits or vegetables, dairy products, or other time/temperature control for safety foods as defined in TB MED 530, Tri-Service Food Code.
- Illness Outbreak: Award additional points for operations that have been suspected or confirmed as the source of an adverse health outcome for 1 or more patrons.
11. FACILITY SCORE. Add up the Points from items 8 and 10 and round all decimal values up to the next whole number. Using the Probability table, find the point of intersect where
Facility Score and Operation Type meet and mark block 12 accordingly. Find the point of intersect in the Severity table where Primary Population Served and Operation Type
meet. Find the point of intersect in the Risk Rating table where the Severity and Probability values meet.
12. RISK RATING AND INSPECTION FREQUENCY. Mark the appropriate risk rating box located at the top of the worksheet. The number of inspections planned for the upcoming
year should correspond to the operation's Risk Rating. Note: Type III and Type V operations require semi-annual inspections regardless if rated Low Risk.
DA FORM 7847, MAY 2019
APD AEM v1.00ES
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