MSHA 5000-23 Form PDF Details

The Certificate of Training (MSHA Form 5000-23), a critical document mandated by the U.S. Department of Labor Mine Safety and Health Administration (MSHA), serves as a fundamental component in ensuring the safety and compliance of workers within the mining industry. This form, rooted in the requirements set forth by Public Law 91-173 as amended by Public Law 95-164, aims to certify the completion of mandatory training for miners, a step that cannot be overlooked due to its significance in promoting safety and prevention methods in mining operations. Designed to be a versatile record, the 5000-23 form encompasses various types of approved training sessions, including annual refresher courses, newly employed miner orientation, hazard training, and training for experienced miners embarking on new tasks. Importantly, this form functions not only as a compliance tool, aligned with the regulations outlined in 30 CFR Part 48.9 and 48.29 but also as a proactive measure for minimizing risks and fortifying the health and safety environment of mining operations. The form necessitates detailed documentation, including the type of operation, subjects covered, and the verification of training completion by both the instructor and the miner, thereby underscoring the collaborative effort required to uphold safety standards in the mining sector.

QuestionAnswer
Form Name MSHA 5000-23 Form
Form Length 2 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 30 sec
Other names 5000 23 msha form, fillable msha 500 23, msha 5000 23 pdf, msha 5000 23 form online

Form Preview Example

U.S. Department of Labor

Mine Safety and Health Administration

Certificate of Training

MSHA Form 5000-23, Jan. 99 (revised)

Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number.

Public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining data needed, and completing and reviewing the collection of information. This is a mandatory collection of information as required by 30 CFR Part 48.9 and 48.29. The information provides MSHA with a monitoring tool for determining compliance requirements. The Certificate of Training provides a means for operators to record and certify mandatory training received by miners. Send comments regarding the collection of information, including suggestions for reducing this burden to the U.S. Department of Labor, Mine Safety and Health Administration, Office of Standards, Regulations and Variances, 1100 Wilson Boulevard, Arlington, Virginia 22209-3939.

DO NOT SEND THE COMPLETED FORM TO THE OFFICE SHOWN ABOVE

Certificate of Training

U.S. Department of Labor

Mine Safety and Health Administration

Approved OMB Number 1219-0009, Expires July 31, 2014.

This certificate is required under Public Law 91-173 as amended by Public Law

95-164. Failure to comply may result in penalties and other sanctions as provided by sections 108 and 110, Public Law 91-173 as amended by Public Law 95-164.

Issue Certificate Immediately Upon Completion of Training

Serial Number (for operator’s use)

1. Print Full Name of Person Trained (first, middle, last)

2. Check Type of Approved Training Received:

Annual

Experienced Miner

¢ Refresher

Newly Employed

New Task

(specify below)

Inexperienced Miner

Hazard Training

Other (specify)

Date

Task

Initials

Date

Task

Initials

 

Instr

 

 

Instr

 

 

Studt

 

Studt

3. Check Type of Operation and Related Industry:

A. Surface

B. Coal

Construction Metal

Underground

Nonmetal

Shaft & Slope

4. Date Training Requirements Completed

Check if not completed and go to item 5, below.

¦If completed, go to item 6, below.

5. Check Subjects Completed (Use only for partially completed training):

Introduction to Work Environment

Hazard Recognition

Emergency Medical Procedures

H&S Aspects of Tasks Assigned

Statutory Rights of Miners Self-Rescue & Respiratory Devices

Transport & Communications Systems

Roof/Ground Control & Ventilation

Mine Map; Escapeways;

Emergency Evacuation;

Barricading

Cleanup; Rock Dusting

Mandatory Health &

Safety Standards

Authority & Responsibility

of Supervisors & Miners

Representatives

Health

ElectricalHazards

First Aid

Mine Gases

Explosives

Prevention of Accidents

Other (specify)

6.False certification is punishable under section 110 (a) and (f) of the Federal Mine Safety & Health Act (P. L. 91-173 as amended by P. L. 95-164).

I certify that the above training has been completed

(signature of person responsible for training)

7. Mine Name, ID, & Location of Training (if institution, give name & address)

8. Date

I verify that I have completed the above training

 

(signature of person trained)

MSHA Form 5000-23, Jan. 99 (revised)

How to Edit MSHA 5000-23 Form Online for Free

Handling PDF forms online is definitely easy using our PDF tool. Anyone can fill out msha form 5000 23 here effortlessly. Our tool is constantly evolving to provide the best user experience attainable, and that's because of our dedication to constant development and listening closely to feedback from users. Starting is easy! All you need to do is stick to the next basic steps below:

Step 1: Click the orange "Get Form" button above. It will open up our editor so that you can start filling in your form.

Step 2: The editor provides you with the opportunity to customize PDF forms in a variety of ways. Enhance it by adding customized text, adjust existing content, and add a signature - all when you need it!

For you to complete this PDF document, be certain to provide the right details in each blank field:

1. You'll want to complete the msha form 5000 23 correctly, hence be mindful when working with the sections containing all these blanks:

Stage no. 1 of filling in 5000 23 pdf

2. Once this part is complete, you'll want to add the necessary details in Statutory Rights of Miners, SelfRescue Respiratory Devices, Transport Communications Systems, Mandatory Health Safety Standards, Authority Responsibility of, Explosives, Prevention of Accidents, Other specify, False certification is punishable, I certify that the above training, Mine Name ID Location of, Date, I verify that I have completed the, and MSHA Form Jan revised allowing you to progress further.

Transport Communications Systems, I verify that I have completed the, and Statutory Rights of Miners of 5000 23 pdf

In terms of Transport Communications Systems and I verify that I have completed the, make sure you don't make any mistakes in this section. The two of these are the key ones in this page.

Step 3: Prior to moving forward, make sure that all blanks have been filled in the right way. When you think it's all good, click on “Done." Right after registering afree trial account here, it will be possible to download msha form 5000 23 or send it through email at once. The PDF will also be readily accessible through your personal cabinet with your each modification. With FormsPal, you're able to complete documents without having to be concerned about data leaks or data entries getting distributed. Our protected software helps to ensure that your personal data is stored safely.

MSHA 5000-23 Form isn’t the one you’re looking for?

Related Documents