Forms and Online Filings
Form number: |
MSHA Form 7000-1 |
Form name: |
Mine Accident, Injury and Illness Report |
Description: |
If an accident, injury or illness occurs at or in conjunction
with activity at a mine, mine operators are required to report the
circumstances of the incident to MSHA using Form 7000-1. |
OMB Control Number and Expiration Date: |
1219-0007; 12/31/2004 |
Filing Options: |
Form 7000-1, Mine Accident, Injury and Illness Report can be filed
online or completed online, printed (or printed and filled in manually)
and sent to MSHA according to the instructions provided below.
File online
Fill in online,
print and mail or fax (or print and fill in manually) |
Filing Instructions: |
Detailed
Instructions for completing Form 7000-1, Mine Accident, Injury and Illness
Report
Definitions of
terms used in Form 7000-1, Mine Accident, Injury and Illness Report
If filing by mail or fax, Form 7000-1, Mine Accident, Injury and Illness Report is a
four-part, color-coded form; however, the online version is not. Therefore,
four copies of the completed form must be made. Handling procedures for the
four color-coded pages are as follows:
Two copies should be sent to:
MSHA Office of Injury and Employment Information P.O. Box
25367 Denver, Colorado 80225
Toll-free fax: (888) 231-5515 (If sending via fax, please use
black ink and do not send a copy of the same form via regular mail unless
requested to do so.)
Note: Please write Pink at the top of one of the
copies
One copy should be sent to your local MSHA District
office.
District
office contact information for coal mines
District
office contact information for metal/nonmetal mines
(If sending via fax, please use black ink and do not send a copy
of the same form via regular mail unless requested to do so.)
Note: Please write Yellow at the top of this
copy
One copy should be retained at the mine (or nearest mine
office) for five years. |
Contact Information: |
Questions regarding this form should be directed to MSHA at
(877) 778-6055 or
zzMSHA-PEIRHelpDesk@dol.gov |
Privacy Notice: |
Privacy Notice |
Legal Authority: |
30 CFR Part 50.20 |
Burden Statement: |
Public reporting burden for this collection of information is
estimated to average 30 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of information. This
is a mandatory collection of information as required by 30 CFR 50.20. The
information is used to establish injury, accident or illness files used to
measure the levels of injury experience and identify those areas most in need
of improvement. Send comments regarding this burden estimate or any other aspect
of this collection of information, including suggestions for reducing this burden,
to the Office of Information Management, Department of Labor, Room N-1301, 200
Constitution Avenue, N.W., Washington, D.C. 20210; and to the Office of Management
and Budget, Paperwork Reduction Project (1219-0007), Washington, D.C. 20503. Persons
are not required to respond to this collection of information unless it displays a
currently valid OMB control number. |
Complete and File Form Online
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