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Coal Mine Safety and Health is responsible for enforcing the Mine Act at all coal mines. This includes conducting inspections, including four complete annual inspections of underground coal mines and two complete annual inspections of surface coal mines; investigating fatal and serious nonfatal accidents; issuing citations and orders for any observed violations; and conducting safety and health conferences with mine operators on citations and orders that are issued. For each violation cited, operators may be assessed civil money penalties. Additionally, Coal Mine Safety and Health approves roof control, ventilation, and training plans required to be submitted by mine operators, directs various mine safety and health assistance programs and trains and certifies instructors.

If coal mine inspectors find violations or other conditions that pose an immediate threat to the miners' safety or health, they have the authority to issue a withdrawal order for the affected area, remove the related equipment from service, and have the miners withdrawn until the conditions are corrected.

Coal Mine Safety and Health's organization consists of a small headquarters office located in Arlington, Virginia. Headquarters includes the Office of the Administrator, Health Division and Safety Division. The organization also consists of 12 districts with a total of about 45 field offices located throughout the coal mining regions. Each district is headed by a District Manager who reports to the Administrator for Coal Mine Safety and Health. There are approximately 2,100 coal mines located in 27 states.