West Virginia Office of Miners' Health Safety and Training
Miner Certification and Training Applications
following links are intended to provide the West Virginia Mining industry
and the miners of the state with downloadable versions of the common
applications and documents required by WVMHS&T. Additional documents will be added as
necessary. General descriptions and instructions are listed with the form
Our forms require Acrobat Reader to view and download. To download a free version of the current Acrobat Reader, follow the link above.
Miner Certification Applications Certification applications must be completed in full and mailed to the appropriate office for processing. Many of the documents are two-sided, in those instances, both sides need to be completed in full.
A directory of WVMHS&T Offices can be found at the following page: WVMHST Offices. A schedule of miner certification examinations can be found by jumping to the following page: Exam schedules, and a list of certified instructors/ trainers may be found at: Certified Instructors.
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.
GENERAL CERTIFICATION APPLICATIONS
|06, 07||Coal Miner Experience Document Instructions for Completion of Form|
|02||Apprentice Electrical Certification Application .doc or .pdf Apprentice High Voltage Log sheet Apprentice Low Medium Log sheet|
|26||Electrical Certification Application (revised 8-2009)|
|08||Shot-firer Application (revised 10-2012)|
|20||Shaft and Slope Shot-firer Experience Document|
|18||Gas Testing Application|
|21||Belt Examiner (revised 5-2012)|
|03||Coal Truck Driver Certification Application|
|Safety Sensitive Personnel Document Form|
FOREMAN & SUPERVISORY
(Applicants must be a resident of or employed in the State of West Virginia)
|09||Underground Mine Foreman Application & Assistant Foreman|
|Underground Foreman Certification Change Request|
|11||Surface Mine Foreman Application & Assistant Foreman|
|Surface Foreman Certification Change Request|
|15||Surface Construction Supervisor Application|
|14||Shaft and Slope Examiner (Foreman) Application|
|16||Clay Mine Foreman Application|
CERTIFIED INSTRUCTOR AND MINE RESCUE
|23, 24||80 and 40 Instructor Application|
|22||Mine Rescue Instructor Application|
|28||Qualified Diesel Instructor Application|
|31||Underground Foreman Continuing Education Instructor Application and Criteria for Qualification, Questions & Answers Blank Class Roster (.doc)|
OTHER CERTIFICATION DOCUMENTS
Letter-in-good-standing - KY Reciprocity Mine Foremen (call Judy Moyer at 304-369-7823)
Apprentice Miner Affidavit:
DOC (Word) (to be attached
to 80 and 40 Hr Transmittals).
Physicians Examination Form - Mine Rescue Team Member
Voluntary Surrender Form - This form must be completed, signed and notarized when an individual wishes to voluntarily surrender a certification.
Publications Page] [ Frequently
[Forms Main Page] [Mining 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: 03/09/2016