West Virginia Office of Miners' Health Safety and Training

Permit Applications and Reporting Forms

Underground or Surface Mines

2020 Extension Renewal Forms now available

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.  Available forms are listed in the column to the right. Additional documents will be added as necessary. General descriptions and instructions are listed with the form links.
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Permitting Application Forms - Mining Operations 

2020 WV Permit Extension Renewal Forms (PDF)  - contains the forms necessary to apply for an annual extension of the mine permit.  Applications must be postmarked by January 31, 2019.

DMM-60 Mine Opening Permit Application  (Word format fillable form) The DMM-60 form is the initial WVMHS&T application for all underground and surface mines.  This application is used for the DMM-60, DMM-60S DMM-60B, and the DMM-60SB.

General Information Form (fill-able PDF format)  General Information Form (non fill-able PDF format
   Word format General Information forms must be filed for all new or renewed Certificates of Approval issued by this agency.  Both sides of the form are required to be completed or the permit will not be processed.

Initial Comprehensive Mine Safety Program Application 
Initial Comprehensive Mine Safety Program contains the forms necessary for a new Mine Safety Program.  Must be submitted to the WVMHS&T Regional office for approval.

Components for Comprehensive Mine Safety Program for Underground Mines   Components for Comprehensive Mine Safety Program for Surface Mines

Annual Permit Extension Application ( fillable PDF format)   Annual Permit Extension Application (non fill-able PDF format)   Annual Permit Extension contains the forms necessary to apply for an annual extension of the mine permit.

Minimum Roof Control Plan
Minimum Roof Control Plan contains the forms necessary to apply for an initial plan.

DMM-57 Approved Inactive Application
Approved Inactive Application may be filed when no employees will be present on the mine permit.    

DMM-61 Application
 (Word format) DMM-61 Is a general application for permits for pumps, fan stoppage for maintenance, additional opening, stockpile safety plans, car dropping plans, ect.

DMM-63 Stop the Fan
DMM-63 is an application to stop the ventilation fan.

DMM-65 Use of Propane DMM-65 is an application to use propane in an underground mine.

DMM-62, DMM-64, DMM-66
are applications for shooting in underground mines.
DMM-62 Multiple Shooting in Rock

DMM-64 Solid Shooting

DMM-66 Multiple Shooting in Coal

DMM-67 Surface Mining within 500 ft. of Underground Mines
  (Word format)  DMM-67 Application to surface mine within 500 feet of an active or abandoned underground mine.

Surface Mine Production Termination Application Surface Mine Production Termination Report may be filed once all production has been completed on the surface permit.

DMM-72, DMM-73, DMM-74
are various mine specific waiver applications for communications and ground monitoring.
DMM-72 Communications Waiver   (Word format)

DMM-73&74 Ground Monitor System Waivers with Guidelines (pdf)
  (word format)
Guidelines for Completing DMM-73 & 74 Ground Monitor System Waivers

OG-44, OG-45, OG-59. 
These are applications for permits to mine through or around oil & gas wells.  The mine operator is required to submit three (3) copies of any such application. Note: the OG-45 and the OG-44 are designed for Legal size paper (14in.).  Download the Permitting Procedures Manual for more information.

Permitting Procedures for Operating Near Oil and Gas Wells

OG-45 Underground 200 ft. (requires legal size paper) OG-45 Word Doc
OG-44 Underground 500 ft. (requires legal size paper) OG-44 Word Doc
OG-59 Surface Mining Agreement Within 200 ft.          OG-59  Word Doc

Mine Map Submittal Guides.
These guidelines have been developed to standardize the information required on all submitted mine maps. There is one checklist for initial/semi-annual permit maps and a second checklist for closure/final maps.

Instructions for Mine Maps (revised 2014)
Initial and Semi-Annual Map Checklist (revised 2014)
Closure and Final Map Checklist (revised 2014)

Mine Map Symbols

Reporting Forms

Substance Abuse Reporting Form

Order to Refit Approved Underground Mine Shelters and Forms

Injury/Accident Report (PDF) (WORD FORMAT) The Injury/Accident form is a two sided form and is to be used for reporting all types of mining accidents.  Three copies will need to be filed--follow the instructions on the first page.

Quarterly Production Reporting Form for Tonnage/Employment
The Tonnage/Employment Reporting form must be filed for each reporting mine permit.  Refer to 22A-2-77, 22A-6-4 or Series 3, Section 52.01 for the applicable laws. There are separate forms for Coal and Quarry operations.

Quarry Tonnage Reporting
See above.

Independent Contractor Reporting Form
(PDF) (WORD FORMAT) Independent Contractor Quarterly Reporting form. Title 56 Series 10  Rules Governing Reporting Requirements for Independent Contractors  requires all Independent Contractors to report monthly.

To Make Application for Online Reporting click on one of the links below and "Submit a Request to this Office" and complete the application process or to Log In to Online Reporting click on one of the links below and Log In with your approved username and password.

Online: Quarterly Tonnage Reports for Mines and Quarries
Online: Quarterly Reports for Independent Contractors 

[MHS&T Homepage [ Publications Page]  [ Frequently Asked Questions]
 [Forms Main Page]   [Miner Certification 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.  

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Date this page was last updated:  12/19/2019