West Virginia Office of Miners' Health Safety and Training
Reporting Forms
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.
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.
Reporting Forms
NOTE:
OUR CHARLESTON OFFICE ADDRESS HAS CHANGED, THE NEW ADDRESS IS:
WEST VIRGINIA OFFICE OF MINERS' HEALTH SAFETY & TRAINING
NUMBER 7 PLAYERS CLUB DR. SUITE 2
CHARLESTON WV, 25311
Fill-able version (PDF)
Injury/Accident Report (non fill-able)
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 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.
Contractor Reporting Form
Independent Contractor
Monthly Reporting form. Title 56 Series 10
SCSR INVENTORY SPREADSHEET (revised 3-2007) must be completed each quarter.
Note:
Monthly Reports may now be filed electronically. For more information or
to apply for this service use the following links:
Monthly Tonnage Reports (Mines and Quarries)
Monthly Reports for Independent
Contractors
Mine Map Checklists
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.
[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.
©2004 West Virginia
Office of Miners' Health Safety and Training.
An official West Virginia State Agency Web site.
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Date this page was last updated:
01/19/2012