|
Form number: |
MSHA Form 5000-41 |
| Form name: |
Safety and Health Activity Certification or Hoisting Engineers Qualification Request Form |
| Description: |
All instructors are required to submit to MSHA the names of
persons who have satisfactorily completed required mine foreman and
pre-shift examiner or hoisting certification training. The 5000-41
is a combined version of the previous 5000-4 and 5000-7 forms. MSHA
uses the form information to issue certification cards to qualified
persons. |
OMB Control Number and
Expiration Date: |
1219-0127; 7/31/2011 |
| Filing Options: |
Form 5000-41, Health Activity Certification or Hoisting Engineers
Qualification Request Form can be either filed online or printed,
filled in and sent to MSHA according to the instructions below.
File
online
Form fill, print and mail or fax
Change online filing registration information |
| Filing Instructions: |
Detailed instructions for filing Form 5000-41, Health Activity
Certification or Hoisting Engineers Qualification Request Form are
available in HTML or PDF.
If filing by mail or fax, completed printed forms should be sent
to:
MSHA Qualification and Certification
P.O. Box 25367
Denver,
Colorado 80225-0367
Fax: (303) 231-5474 |
| Contact Information: |
Questions regarding this form should be directed to MSHA at
(877) 778-6055 or MSHAhelpdesk@dol.gov |
| Privacy Notice: |
Privacy Notice |
| Legal Authority: |
30 CFR 75.100, 30
CFR 77.100
(Health and Safety Certification) establish the procedures under
which miners are certified to make certain tests and examinations
which are required by MSHA regulations to be performed by certified
persons. For mines located in states that do not have provisions for
certifying miners, 30 CFR 75.100 (c)
(1) and 30
CFR 77.100 (b) (2) require mine operators to make application to
MSHA to obtain certification for miners who meet certain minimum
experience requirements. A certified person is one who has been
certified as a Foreman, Assistant Foreman (UG only), or Pre-shift
Examiner (UG only).
30 CFR
75.155 and 30 CFR 77.105
(Hoisting Engineers Qualification) establish the procedures
under which miners are qualified to operate hoists (Steam
Driven/Electrical-UG; Slope & Shaft Sinking Operation-Sur). For
mines located in states that do not have provisions for qualifying
hoist operators, 30 CFR 75.155/77.105 requires mine operators to
apply to MSHA to obtain qualification for miners who meet certain
minimum experience requirements. |
| Burden Statement: |
Public reporting burden for this collection of information is
estimated to average 10 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 information. Persons are not required to respond to this
collection of information unless it displays a currently valid OMB
Control Number. 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 (1219-0069),
Washington, D.C. 20503. Persons are not required to respond to this
collection of information unless it displays a currently valid OMB
control number. |
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