MSHA Form 5000-1 Certificate of Electrical Training

Certificate of Electrical/Noise Training | Mine Safety and Health Administration (MSHA)

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UNITED STATES
DEPARTMENT OF LABOR
Mine Safety and Health Administration (MSHA)
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Form ID: 5000-1

Equipment Approval and
Certification

Description: 

Alliances and MOUs
State Mining Agencies

CERTIFICATE OF ELECTRICAL/NOISE

Certificate of Electrical/Noise
Training

Forms and Online Filing

Resources and Tools

COMPLIANCE & ENFORCEMENT

SUPPORT & RESOURCES

SUPPORT & RESOURCES

Support &
Resources

REGULATIONS

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All instructors are required to submit to MSHA the names of persons who have
satisfactorily completed required electrical training. MSHA uses the form
information to issue certification cards to those persons who are qualified.
Control ID: 1219-0001
Expiration Date: November 30, 2019
Filing Options: 
Form 5000-1, Certificate of Electrical/Noise Training 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, print and mail or fax
Change online filing registration information
Filing Instructions: 
Detailed Instructions for completing Form 5000-1, Certificate of Electrical/Noise
Training are available in HTML or PDF.

https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-electricalnoise-training[10/16/2019 12:12:14 PM]

Certificate of Electrical/Noise Training | Mine Safety and Health Administration (MSHA)

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 desk.help@dol.gov
Privacy Notice: 
Privacy Notice
Legal Authority: 
30 CFR 75.153(g) and 77.103(g) require that an individual who is a qualified
electrical person in accordance with Section 75.153 and 77.103 shall annually
certify to the district manager that he has satisfactorily completed a coal mine
electrical retraining program approved by the Secretary in order to retain that
qualification.
Burden Statement: 
Public reporting burden for this form is estimated to average 25 minutes per
response. The burden estimate includes the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed,
and completing and submitting the form. This collection of information is
mandatory. You are not required to respond to this collection of information
unless it displays a valid OMB control number. Send comments regarding the
accuracy of the burden estimate and any suggestions for reducing the burden
to: 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, Paperwork Reduction Project (12190001). NOTE: Do not send your completed form to this address.
Online Filing: 
File Online

UNITED STATES
DEPARTMENT OF
LABOR

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Certificate of Electrical/Noise Training | Mine Safety and Health Administration (MSHA)

Mine Safety and Health

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