Training Plan Regulations and Certificate of Training

MSHA: Instructions for Completing MSHA Training Form 5000-23

UNITED STATES
DEPARTMENT OF LABOR

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Mine Safety and Health Administration - MSHA                                              
     - Protecting Miners' Safety and Health Since 1978

Instructions for Completing a Mine Safety and Health Administration
Certificate of Training Form (5000-23)

All part 48 training must be properly recorded on a Mine Safety and Health Administration (MSHA) Form 5000-23
(training certificate), or on an MSHA approved alternate form. For additional policy information on the 5000-23
form, you may refer to the MSHA Program Policy Manual. To review the applicable policy please use this link.
The current MSHA Form 5000-23 has an expiration date of July 31, 2014, however, previously issued forms with
an earlier expiration date may still be used. The printed version comes with four copies. Listed below are notations,
which appear on the bottom right-hand side of the form, showing the intended use of each copy:
Copy
Copy
Copy
Copy

1
2
3
4

(white)  - Employer's Personnel Record
(pink)    - Employee's Record Copy
(yellow) - Employee's Separation Copy
(green) - Record Keeping

The following is a description of how to complete each item of the 5000-23.
DESCRIPTION .

ITEM

Serial Number
(for operator's use)

Item 1. Print Full Name of
Person Trained

This is an optional field which may
be used to help track employees
by an identification number. There
is no Federal requirement to use
this field.
Enter the person's name who has
received the training.

(first, middle, last)

Item 2. Check Type of
Approved Training Received

There are five boxes for the five
types of training required. Check
the appropriate box(es) to
indicate what training was given.
When New Task is checked,
additional space is provided to
record 1-8 task training events.
This space is used to identify each
task and to allow for the initials of
the instructor(s) and the student
(miner), as needed.

Item 3. Check Type of
Operation and Related
Industry

SEARCH

(1) Mark the box for the
appropriate commodity: coal,
metal or nonmetal. (2) Mark the
box for the appropriate location:
surface or underground. (3) Mark
the appropriate box if the training
is for construction or shaft and
slope work. When completed the
box should identify the type of

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MSHA: Instructions for Completing MSHA Training Form 5000-23

mining, location and if
construction or shaft and slope
activities are involved.
Item 4. Date Training
Requirements Completed

Depending on whether the
training is complete or partial will
determine how this item is
completed. Only entering a date
indicates that the training marked
in item 2 is completed.
Placing a check in the box to the
right of the date entry, indicates
that the training for the
program(s) marked in item 2 is
not complete. The appropriate
boxes in item 5 must then be
checked to indicate what subjects
were completed.
The following are some examples
of partially completed training:
(1) training for new miners given
away from the mine site (which
will then require site specific
training at the mine site); (2)
utilizing the 8 and 16 hours in 60day provision for newly employed
inexperienced surface miners; and
(3) providing partially completed
annual refresher training.

Item 5. Check Subjects
Completed
(use only for partially completed
training)

Item 6. Signature of person
responsible for training

This is generally used for
conducting annual refresher
training in increments throughout
an annual refresher cycle; or for
newly employed inexperienced
miner training which does not
cover mine specific courses that
are required to be covered at the
mine site.
Upon completion of an MSHA
approved training program, such
as experienced miner, task, or
annual refresher training, you
must record and certify on the
5000-23 form that the miner has
received the specified training.
The person signing the form in
item 6 is representing that the
miner has received the indicated
training. Anyone falsifying the
5000-23 form is criminally liable
under section 110(a) and (f) of
the Federal Mine Safety and
Health Act.
Generally, the person signing the
form is the mine operator or a
person acting on behalf of the

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MSHA: Instructions for Completing MSHA Training Form 5000-23

operator. For example, a
company safety official, a trainer
employed or contracted by the
operator, or a cooperative
instructor (such as, a state
grantee).
Item 7. Mine Name, ID, &
Location of Training
(if institution, give name &
address)

Item 8. Date and (signature
of person trained)

List the mine name, mine ID and
location where training was
conducted. If the training was
conducted by a cooperative
instructor or state grantee and a
class participant is not employed
at a particular mine, fill in the
cooperative instructor's name or
state name and address.
The person trained has the option
of signing and dating the form,
acknowledging that the training
indicated on the form was
received.
A copy of the 5000-23 form must
be given to the miner upon
completion of each MSHA
approved training program, such
as experienced miner, task, or
annual refresher training.

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