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November 4, 2008    DOL Home > Find It! By Form > DOL Form   

DOL Form 5000-3

View MSHA's Form 1219-0078 Online htm
Agency: MSHA
Title: Certification of Physical Qualification for Mine Rescue Work
Form Description: 30 CFR 49 implements the provisions of Section 115(e) of the Federal Mine Safety and Health Act of 1977. Every operator shall assure the availability of mine rescue capability for purposes of emergency rescue and recovery. In accordance with 30 CFR 49.7 , each member of a mine rescue team shall be examined annually by a physician who shall certify that he or she is physically fit to perform mine rescue and recovery work. The mine operator is required to keep the completed MSHA Form 5000-3 on file for a period of one year.
OMB Control Number: 1219-0078
OMB Expiration Date: Wednesday, January 31, 2007




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