West Virginia Office of Miners' Health Safety and Training

  Reporting Forms


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 WV MHST.  Additional documents will be added as necessary. General descriptions and instructions are listed with the form links.
Our forms require Acrobat Reader  adobe button  to view and download. To download a free version of the current Acrobat Reader, follow the link above.

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.

(we are attempting to update all forms with the new address; the new address was effective January 2012)

CHARLESTON, WV   25311-1626

Substance Abuse Reporting Form

Fill-able version (PDF)   Injury/Accident Report (non fill-able)  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 Report for Mines
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 Quarterly Reporting Form

Independent Contractor Quarterly Reporting Form
Independent Contractor Quarterly Reporting form. Title 56 Series 10  Rules Governing Reporting Requirements for Independent Contractors  requires all Independent Contractors to report.

SCSR INVENTORY SPREADSHEET  (revised 3-2007) must be completed each quarter.

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 

Mine Map Checklists

These guidelines have been developed to standardize the information required on all submitted mine maps. There is one checklist for initial and annual permit maps and a second checklist for final maps.

Checklist for Initial and Annual permit maps.

Checklist for Final Maps.

[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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An official West Virginia State Agency Web site.
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Date this page was last updated:  11/14/2018