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West Virginia Office of Miners' Health Safety and Training

Miner Certification and Training Applications 

The 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 links.
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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.

General Certification Applications

Miner Experience Document

Electrical Certification Application

Shot-firer Application

Shaft and Slope Shot-firer Experience Document

Gas Testing Application

Belt Examiner

Truck Driver Certification Application

Foreman  & Supervisory Applications: 
(Applicants must be a resident of or employed in the State of West Virginia)

Underground Mine Foreman Application
(This form has recently been revised - please follow the instructional sheet included in the packet)

Surface Mine Foreman Application

Surface Foreman Certification Change Request

Underground Foreman Certification Change Request

Surface Construction Supervisor Application

Shaft and Slope Examiner (Foreman) Application

Clay Mine Foreman Application

Other Certification Documents (Instructor and Mine Rescue):

Underground Foreman Continuing Education Inst. Application and Criteria for QualificationQuestions & Answers  Blank Class Roster (.doc)

80 and 40 Instructor Application

Physicians Examination Form - Mine Rescue Team Member

Mine Rescue Instructor Application

Qualified Diesel Instructor Application


[MHS&T Homepage [ Publications Page]  [ Frequently Asked Questions
[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.  

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Date this page was last updated:  04/16/2008