Mine Accident, Injury & Illness Report and Quarterly Mine Employment and Coal Production Report

Mine Accident, Injury and Illness Report | Mine Safety and Health Administration (MSHA)

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Form ID: 7000-1

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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.
Control ID: 1219-0007
Expiration Date: January 31, 2021
Filing Options: 
Form 7000-1, Mine Accident, Injury and Illness Report can be filed online
electronically or the form fill version can be completed, printed (or printed and
filled in manually) and sent to MSHA according to the instructions provided
below.
File online electronically
Form fill, print and mail or fax
Change online filing registration information
Filing Instructions: 

https://www.msha.gov/support-resources/forms-online-filing/2015/04/14/mine-accident-injury-and-illness-report[11/16/2020 11:32:18 AM]

Mine Accident, Injury and Illness Report | Mine Safety and Health Administration (MSHA)

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 
Form 7000-1, Mine Accident, Injury and Illness Report is a four-part, colorcoded form. If filing online, copies will be sent electronically to the
appropriate offices. 
If you are using the form fill option, make four copies of the completed form and
mail or fax as follows: 
Copy 1: Original (White) should be sent to: 
MSHA PEIR-Office of Injury and Employment Information 
P.O. Box 25367
Denver, Colorado 80225-0367 
OFFICE: 1-303-231-5453
FAX: 1-888-231-5515
Copy 2: Return to Duty Report (Pink) should be sent to above address only
after the employee has returned to full duty or been transferred or terminated.
Please write Pink at the top and complete Section D - Return to Duty
Information. 
Note: It is not necessary to send in the Pink copy if Section D is completed on
the original 7000-1. 
Copy 3: should be sent to your Local MSHA District Office (Yellow)
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
Copy 4: 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
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Mine Accident, Injury and Illness Report | Mine Safety and Health Administration (MSHA)

(877) 778-6055 or desk.help@dol.gov
Privacy Notice: 
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
Program Evaluation and Information Resources, Mine Safety and Health
Administration, U.S. Department of Labor, Room 2301, 201 12th Street South,
Suite 401 Arlington, VA 22202-5450, 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 control number. 
See MSHA's Site Privacy Policy
See DOL's Privacy Policy
Legal Authority: 
30 CFR 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 Mine
Safety and Health Administration, U.S. Department of Labor, Office of
Standards, Regulations and Variances, 201 12th Street South, Suite 401
Arlington, VA 22202-5450. Persons are not required to respond to this
collection of information unless it displays a currently valid OMB control
number.

https://www.msha.gov/support-resources/forms-online-filing/2015/04/14/mine-accident-injury-and-illness-report[11/16/2020 11:32:18 AM]

Mine Accident, Injury and Illness Report | Mine Safety and Health Administration (MSHA)

Online Filing: 
File Online

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