Generally, the person signing the form is the mine operator or a person acting on behalf of the operator.
Item 6: the person signing the form in item 6 is representing that the miner has received the indicated training.
False certification: punishable under section 110(a) and (f) of the Mine Act.
Item 4: only entering a date indicates that the training marked in item 2 is completed.
Item 5: use only for partially completed training.
Miner's copy: a copy of the form must be given to the miner upon completion of each MSHA approved training program.
| Question | Answer |
|---|---|
| Form Name | MSHA Form 5000-23 |
| Form Length | 4 pages |
| Fillable? | Yes |
| Fillable fields | 81 |
| Avg. time to fill out | 14 min |
| Other names | 5000-23, 5000/23, 5000 23, MSHA 5000-23, MSHA Form 5000-23, Certificate of Training |
| Edition | Rev February 2025 |
| Issuing agency | Mine Safety & Health Administration |
| Previous editions | Previous editions are obsolete |
| Matches the agency's file | Yes, checked October 3, 2026 |
| Official source | MSHA Form 5000-23 (Rev February 2025), Mine Safety & Health Administration |
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