New Miner Training Record/Certificate Form

This printable "New Miner Training Record/Certificate Form" is a document issued by the U.S. Department of Labor - Mine Safety and Health Administration specifically for United States residents.

Download a PDF of the latest edition of the form down below or find it through the department's forms library.

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NEW MINER TRAINING RECORD/CERTIFICATE
Miner’s Full Name (Print)
Mine or Contractor Name
ID#
Subject
Course
Date
Competent
Location
Miner’s
(Name &
30 CFR Part 46.5
Length
Person
Initials
Address if Institution)
The miner received no less than 4 hours training in the following, before beginning work:
(b) (1) Introduction to work
environment, mine tour, mining
method/operation
(b)(2) Instruction on recognition and
avoidance of electrical and other hazards
(b)(3) Emergency procedures, escape,
and firefighting
(b)(4) Health and safety aspects of tasks
assigned
(b)(5) Instruction on statutory rights of
miners and their representatives
(b)(6) Authority & responsibility of
supervisors and miners’ representatives
(b)(7) Introduction to your rules and
procedures for reporting hazards
No later than 60 days:
(c)(1) Self-rescue, respiratory devices, if
used
(c)(2) First aid
No later than 90 days (balance of 24 hours including the following subjects):
False certification is punishable under section 110 (a) and (f) of the Federal Mine Safety and Health Act
I certify that the above training has been completed
(Signature of person responsible for health and safety training)
(Date)
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NEW MINER TRAINING RECORD/CERTIFICATE
Miner’s Full Name (Print)
Mine or Contractor Name
ID#
Subject
Course
Date
Competent
Location
Miner’s
(Name &
30 CFR Part 46.5
Length
Person
Initials
Address if Institution)
The miner received no less than 4 hours training in the following, before beginning work:
(b) (1) Introduction to work
environment, mine tour, mining
method/operation
(b)(2) Instruction on recognition and
avoidance of electrical and other hazards
(b)(3) Emergency procedures, escape,
and firefighting
(b)(4) Health and safety aspects of tasks
assigned
(b)(5) Instruction on statutory rights of
miners and their representatives
(b)(6) Authority & responsibility of
supervisors and miners’ representatives
(b)(7) Introduction to your rules and
procedures for reporting hazards
No later than 60 days:
(c)(1) Self-rescue, respiratory devices, if
used
(c)(2) First aid
No later than 90 days (balance of 24 hours including the following subjects):
False certification is punishable under section 110 (a) and (f) of the Federal Mine Safety and Health Act
I certify that the above training has been completed
(Signature of person responsible for health and safety training)
(Date)
Clear Page
Print This Form
NEWLY-HIRED EXPERIENCED MINER TRAINING RECORD/CERTIFICATE
Miner’s Full Name (Print)
Mine or Contractor Name
ID#
Subject
Course
Date
Competent
Location
Miner’s
(Name & Address if
30 CFR Part 46.6
Length
Person
Initials
Institution)
The miner has received the following training before beginning work:
(b)(1) Introduction to work
environment, mine tour, mining
method/operation
(b)(2) Instruction on recognition and
avoidance of electrical and other
hazards
(b)(3) Emergency procedures, escape,
and firefighting
(b)(4) Health and safety aspects of
tasks assigned
(b)(5) Instruction on statutory rights of
miners and their representatives
(b)(6) Authority & responsibility of
supervisors and miners’ representatives
(b)(7) Introduction to your rules and
procedures for reporting hazards
No later than 60 days:
(c) Self-rescue, respiratory devices, if
used
False certification is punishable under section 110 (a) and (f) of the Federal Mine Safety and Health Act
I certify that the above training has been completed
(Signature of person responsible for health and safety training)
(Date)
Clear Page
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NEW TASK TRAINING RECORD/CERTIFICATE
Miner’s Full Name (Print)
Mine or Contractor Name
ID#
New Task
Subject
Date
Competent
Location
Miner’s
30 CFR Part 46.7
Length
Person
Initials
(Name & Address of Institution)
The miner received
th
e following training before performing a new task, or a change occurred in an assigned task that affects health and
safety risk:
False certification is punishable under section 110 (a) and (f) of the Federal Mine Safety and Health Act
I certify that the above training has been completed
(Signature of person responsible for health and safety training)
(Date)
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ANNUAL REFRESHER TRAINING RECORD/CERTIFICATE
Miner’s Full Name (Print)
Mine or Contractor Name
ID#
Subject
Subject
Date
Competent
Location
Miner’s
(Name & Address if
30 CFR Part 46.8
Length
Person
Initials
Institution)
The miner received no less than 8 hours of annual refresher training in the following:
Instruction on changes at the
mine that could adversely
affect the miner’s health or
safety
Health and safety subjects
relevant to mining operations
at the mine
(For recommended subjects see 46.8 (c))
xxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxx
xxxxxx
False certification is punishable under section 110 (a) and (f) of the Federal Mine Safety and Health Act
I certify that the above training has been completed
(Signature of person responsible for health and safety training)
(Date)
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SITE-SPECIFIC HAZARD AWARENESS TRAINING
RECORD/CERTIFICATE
Miner’s Full Name (Print)
Mine or Contractor Name
ID#
Location:
Mine Site
Length of Training:
Date Training Provided:
Competent Person Providing
the Training:
Miner’s Initials:
False certification is punishable under section 110 (a) and (f) of the Federal Mine Safety and Health Act
I certify that the above training has been completed
(Signature of person responsible for health and safety training )
(Date)
Clear Page
Print This Form

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