West Virginia Office of Miners' Health Safety and Training

Miner Certification and Training Applications 

The following links are intended to provide the West Virginia Mining industry and the miners of the state with downloadable versions of the common applications and documents required by WVMHS&T.   Additional documents will be added as necessary. General descriptions and instructions are listed with the form links.
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Miner Certification Applications 

Certification applications must be completed in full and mailed to the appropriate office for processing. Many of the documents are two-sided, in those instances, both sides need to be completed in full.  

A directory of WVMHS&T Offices can be found at the following page WVMHST Offices. A schedule of miner certification examinations can be found by jumping to the following page: Exam schedules, and a list of certified instructors/ trainers may be found at: Certified Instructors.

PRIVACY NOTICE.  This privacy notice discloses the privacy practices for the West Virginia Office of Miners’ Health Safety and Training.  This privacy notice applies solely to information collected by this agency.




06, 07 Coal Miner Experience Document       Instructions for Completion of Form
02 Apprentice Electrical Certification Application .doc  or  .pdf    Apprentice High Voltage Log sheet    Apprentice Low Medium Log sheet
26 Electrical Certification Application (revised 8-2009)
08 Shot-firer Application (revised 10-2012)
20 Shaft and Slope Shot-firer Experience Document
18 Gas Testing Application
21 Belt Examiner (revised 9-2019)
03 Coal Truck Driver Certification Application


Safety Sensitive Personnel Document Form

(Applicants must be a resident of or employed in the State of West Virginia)

09 Underground Mine Foreman Application & Assistant Foreman
  Underground Foreman Certification Change Request
  Practice Maps
11 Surface Mine Foreman Application & Assistant Foreman
  Surface Foreman Certification Change Request
15 Surface Construction Supervisor Application
14 Shaft and Slope Examiner (Foreman) Application
16 Clay Mine Foreman Application
35, 36    Raised Bore / Blind Drilling Superintendent Examiner Foreman and Raised Bore / Blind Drilling Examiner Foreman


23, 24 80 and 40 Instructor Application
22 Mine Rescue Instructor Application
28 Qualified Diesel Instructor Application
31 Underground Foreman Continuing Education Instructor Application and Criteria for QualificationQuestions & Answers  Blank Class Roster (.doc)


Letter-in-good-standing - KY Reciprocity Mine Foremen (call Amanda Lucas at 304-369-7823)

Physicians Examination Form - Mine Rescue Team Member

Voluntary Surrender Form - This form must be completed, signed and notarized when an individual wishes to voluntarily surrender a certification.

[MHS&T Homepage [ Publications Page]  [ Frequently Asked Questions
[Forms Main Page]  [Mining Forms]  [Independent Contractor Forms]

Note: The information obtained from these documents is accurate to the best of our knowledge and is not a substitute for current mining laws or regulations.  The state is not liable for any damages resulting from any information that unintentionally may be inaccurate or untimely.

If you don't find the form you need, or if you have accessibility issues with our forms, please contact us by email (see the link below) and we will assist you. We have attempted to make our forms accessible as required by state and federal regulations.  

©2004 West Virginia Office of Miners' Health Safety and Training.  
An official West Virginia State Agency Web site.
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Date this page was last updated:  01/07/2020