West Virginia Office of Miners' Health Safety and Training

Certification Applications, Permit Applications, Forms and Documents

Which WV MHST form do you need? 

Select from the links below. For example, if you need a surface foreman application click on the Miner Certification link, if you need a General Information form for an underground mine, click on the Mine Permit Applications link.

OUR WELCH OFFICE ADDRESS HAS CHANGED PLEASE NOTE THE NEW ADDRESS:  830 Virginia Avenue, Welch, WV  25901
(we are attempting to update all forms with the new address; the new address was effective DECEMBER, 2017)

WV OFFICE OF MHST
NUMBER 7 PLAYERS CLUB DR. - SUITE 2
CHARLESTON, WV   25311-1626

1. Miner Certification  - All Certification Types Including Foreman

2. Safety Sensitive Personnel List Form

3. Safety Sensitive Personnel Document Form

4. Certified Instructors
          80 and 40 Hour Instructor Application and Update Form  WORD  (PDF)
          Continuing Education of Underground Mine Foreman Instructor and Update Form (word)
    

5. Inspector and Instructor Applications
    

6. Inspector and Instructor Job Description and Qualifications
    

7. Underground Mine and Surface Mine Permit Applications
    

8. Independent Contractor Certificate of Approval and Renewal Applications
    

9. Reporting Forms Page      Click on links below to go directly to PDF forms for:

• Substance Abuse Reporting Form (PDF) 

• Injury/Accident  (PDF) (PDF FILLABLE FORM) (WORD FORMAT)

• Quarterly Production Reporting for Mines (PDF) (WORD FORMAT)

• Quarterly Reporting for Quarry  (PDF)  (WORD FORMAT)

• Quarterly Independent Contractor Reporting   (PDF) * (WORD FORMAT) 
  Title 56 - Series 10  Regulation Governing Reporting Requirements for Independent Contractors

• Independent Contractor Approved Inactive Status

*SOME VERSIONS OF ADOBE ACROBAT WILL HAVE THE OPTION FOR YOU TO SAVE FILLABLE PDF FORMS.  IF YOU DON'T HAVE THE VERSION THAT ALLOWS YOU TO SAVE; YOU CAN STILL USE THE FORMS.  SIMPLY COMPLETE THE FORM AND PRINT IT.

    10.  Agency Administration Forms

    11.  REVISED Diesel Forms and Plans

    12.  EMT-M and EMT-M Instructor  Class Roster and Application
           EMT-M Instructors PLEASE SEE PUBLICATIONS

    13.  Metatarsal Boot Waiver application 

PRIVACY NOTICE
This privacy notice discloses the privacy practices for the West Virginia Office of Miners’ Health Safety and Training.
This privacy notice applies solely to information collected by this agency.

Our forms require Acrobat Reader    to view and download. To download a free version of the current Acrobat Reader, follow the link above.

MHS&T Homepage     Publications Page     Frequently Asked Questions      Miner Certification Forms     Mine Forms     Independent Contractor Forms

Note: The information obtained from these documents is accurate to the best of our knowledge and is not a substitute for current mining laws or regulations.  The state is not liable for any damages resulting from any information that unintentionally may be inaccurate or untimely.

If you don't find the form you need, or if you have accessibility issues with our forms, please contact us by email (see the link below) and we will assist you. We have attempted to make our forms accessible as required by state and federal regulations.  

©2004 West Virginia Office of Miners' Health Safety and Training.  
An official West Virginia State Agency Web site.
Read our Privacy Notice Summary.   Contact us.
Date this page was last updated:  03/29/2019