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West Virginia Office of Miners' Health Safety and Training
Permit Applications and Reporting Forms
Underground or Surface Mines
2013 Extension Renewal Forms now available
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. Available forms
are listed in the column to the right. Additional documents will be added as
necessary. General descriptions and instructions are listed with the form
links.
Our forms require Acrobat Reader
to view and
download. To download a free version of the current Acrobat Reader, follow the
link above.
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.
Permitting Application Forms - Mining Operations
2013 WV Permit Extension Renewal Forms
- contains the forms
necessary to apply for an annual extension of the mine permit.
Applications must be postmarked by January 31, 2013.
DMM-60 Mine Opening Permit Application (Word format) The DMM-60 form is the initial WVMHS&T application for all underground and surface mines. This application is used for the DMM-60, DMM-60S DMM-60B, and the DMM-60SB.
General Information Form (fill-able PDF format)
General Information Form (non fill-able PDF format)
(Word format) General Information
forms must be filed for all new or renewed Certificates of Approval issued by this
agency. Both sides of the form are required to be completed or the permit will not
be processed.
Initial Comprehensive Mine Safety Program Application
Initial Comprehensive Mine Safety Program
contains the forms necessary for a new
Mine Safety Program. Must be submitted to the WVMHS&T Regional office
for approval. A copy of the company's substance
abuse / drug policy must be included and a copy provided in the company's CMSP.
Revised 05-2013.
Annual Permit Extension Application (
fill-able PDF format) Annual Permit Extension Application
(non fill-able PDF format)
Annual Permit Extension contains the forms
necessary to apply for an annual extension of the mine permit.
Minimum
Roof Control Plan Minimum Roof Control Plan
contains the forms necessary to apply for an initial plan.
DMM-57 Approved Inactive Application
Approved Inactive Application
may be filed when no employees will be present on the mine permit.
DMM-61 Application
(Word
format)
DMM-61 Is a general application for permits for
pumps, fan stoppage for maintenance, additional opening, stockpile safety plans, car
dropping plans, ect.
DMM-63
Stop the Fan
DMM-63 is an application to
stop the ventilation fan.
DMM-65 Use of Propane DMM-65 is an application to use propane in an underground mine.
DMM-62, DMM-64, DMM-66
are applications for shooting in underground mines.
DMM-62
Multiple Shooting in Rock
DMM-64
Solid Shooting
DMM-66
Multiple Shooting in Coal
DMM-67 Surface Mining within 500 ft. of Underground Mines (Word format) DMM-67 Application to surface mine within 500 feet of an active or abandoned underground mine.
Surface Mine Production Termination Application
Surface Mine Production Termination Report may be filed once all production
has been completed on the surface permit.
DMM-72, DMM-73, DMM-74 are
various mine specific waiver applications for communications and ground
monitoring.
DMM-72
Communications Waiver (Word
format)
DMM-73&74
Ground Monitor System Waivers with Guidelines (pdf) (word
format)
Guidelines for Completing DMM-73 & 74 Ground Monitor System Waivers
OG-44, OG-45, OG-59. These are applications for permits
to mine through or around oil & gas wells. The mine operator is required to
submit three (3) copies of any such application. Note: the OG-45 and
the OG-44 are designed for Legal size paper (14in.). Download the
Permitting Procedures Manual for more information.
Permitting Procedures for Operating Near
Oil and Gas Wells
OG-45 Underground 200 ft. (requires legal size paper)
OG-45 Word Doc
OG-44 Underground 500 ft.
(requires legal size paper)
OG-44 Word Doc
OG-59 Surface Mining Agreement Within 200 ft.
OG-59 Word Doc
Mine Map Submittal Guides. These guidelines have been developed to standardize the information required
on all submitted mine maps. There is one checklist for initial and annual permit
maps and a second checklist for final maps.
Checklist for Initial and Annual permit maps.
Checklist for Final Maps.
Reporting Forms
Injury/Accident Report
(PDF) (WORD
FORMAT)
The Injury/Accident
form is a two sided form and is to be used for reporting all types of mining
accidents. Three copies will need to be filed--follow the instructions on the first
page.
Monthly Production Reporting Form for Tonnage/Employment
The Tonnage/Employment
Reporting form must be filed for each reporting mine permit. Refer to 22A-2-77,
22A-6-4 or Series 3, Section 52.01 for the applicable laws. There are separate
forms for Coal and Quarry operations.
Quarry
Tonnage Reporting
See above.
Independent Contractor Reporting Form
(PDF)
(WORD FORMAT)
Independent Contractor
Monthly Reporting form. Title 56 Series 10
To Make Application for Online
Reporting click on one of the links below and "Submit a Request to this Office"
and complete the application process or to Log In to Online Reporting click on
one of the links below and Log In with your approved username and password.
Online:
Monthly Tonnage Reports for
Mines and Quarries
Online: Monthly Reports for Independent
Contractors
[MHS&T
Homepage] [
Publications Page] [ Frequently
Asked Questions]
[Forms Main Page]
[Miner
Certification 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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Office of Miners' Health Safety and Training.
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Date this page was last updated:
05/14/2013