30 CFR § 50.20-6 Criteria--MSHA Form 7000-1, Section C.
(a) Complete items 5 through 12 for each accident, occupational
injury, or occupational illness.
(1) Item 5. Location and mining method. Circle the
appropriate location code that was nearest to the location of the accident
injury or illness. If the accident injury or illness occurred at the surface,
circle only the surface location code in column (a). If the accident injury
or illness occurred underground, circle only the underground location code in
column (b). Where applicable, circle the underground mining method code in
column (c). Applicable codes for columns (a), (b), and (c) are as
(a)(1)(i) Column (a)--Surface location codes. If the accident
injury or illness occurred at the surface of a mine, circle one of the
following codes which best describes where the accident injury or illness
occurred and ignore columns (b) and (c):
Code 02--Surface shop, yard, etc., at an underground mine;
Code 30--Mill operation, preparation plant, or breaker, including associated
shops and yards;
Code 03--Surface strip or open pit mine, including shop and yard;
Code 04--Surface auger coal operation on a coal mine, including shop and
Code 05--Surface culm bank or refuse pile at a coal mine, including shop and
Code 06--Dredge mining, including shop and yard;
Code 12--Other surface mining;
Code 17--Independent shops;
Code 99--Office facilities.
(a)(1)(ii) Column (b)--Underground location codes. If the
accident injury or illness occurred underground, circle the one code which
best describes where the accident injury or illness occurred:
Code 01--Vertical shaft;
Code 02--Slope/Inclined shaft;
Code 05--Underground Shop/Office;
(a)(1)(iii) Column (c)--Underground mining method. If the
underground accident injury or illness occurred on a working section or
working place, enter the code for the mining method at that working section
or working place:
Code 05--Continuous Miners;
Code 06--Hand Loading;
(2) Item 6. Date of accident injury or illness. Enter
the date the accident injury or illness occurred.
(3) Item 9. Describe fully the conditions contributing to
the accident injury or illness and quantify the damage or impairment.
Describe what happened and the reasons therefor, identify the factors which
led or contributed to the accident, injury or illness and identify any damage
or impairment to the mining operation. The narrative shall clearly specify
the actual cause or causes of the accident injury or illness and shall
include the following:
(a)(3)(i) Whether the accident injury or illness involved any
aspect of compliance with rules and regulations;
(a)(3)(ii) Whether the accident injury or illness involved
mine equipment or the mining system;
(a)(3)(iii) Whether the accident injury or illness involved
job skills and miner proficiency, training and attitude; and
(a)(3)(iv) Whether the accident injury or illness involved
protective items relating to clothing, or protective devices on
(4) Item 10. If equipment was involved in the accident,
injury or illness specify type (loader, shuttle car, dozer, etc.), name of
manufacturer, and equipment model number.
(5) Item 11. Name of witness to accident injury or
illness. If any miner witnessed the accident injury or illness, enter the
(b) Complete items 13-27 for each occupational injury, or occupational
(1) Item 13. Name of injured/ill miner. Enter the miner's
name (first, middle initial, and last).
(2) Item 17. Regular job title. Enter the miner's regular
job title. For example: "shuttle car operator".
(3) Item 19. Check if this injury/illness resulted in
permanent total or partial disability.
(b)(3)(i) "Permanent total disability." The classification for
any injury or illness other than death which permanently and totally
incapacitates an employee from following any gainful occupation or which
results in the loss, or the complete loss of use, of any of the following in
one accident injury or illness:
(b)(3)(i)(A) Both eyes;
(b)(3)(i)(B) One eye and one hand, or arm, or leg, or
(b)(3)(i)(C) Any two of the following not on the same limb:
hand, arm, foot, or leg.
(b)(3)(ii) "Permanent partial disability." The
classification for any injury or illness other than death or permanent total
disability which results in the loss, or complete loss of use, of any member
or part of a member of the body, or any permanent impairment of functions of
the body or part thereof, regardless of any preexisting disability of the
affected member or impaired body function.
(4) Item 20. What directly inflicted injury or illness.
Name the object or substance which directly affected the miner. For example:
the machine or thing struck against or which struck the miner; the vapor or
poison inhaled or swallowed; the chemical or non-ionizing radiation which
irritated the skin; or in cases of strains or hernias, the thing lifted or
(5) Item 21. Nature of injury or illness. For injuries,
use commonly used medical terms to answer this question such as puncture
wound, third degree burn, fracture, dislocation, amputation. For multiple
injuries, enter the injury which was the most serious. For illness, name the
illness, such as pneumoconiosis, silicosis. Avoid general terms such as
"hurt", "sore", "sick".
(6) Item 22. Part of body injured or affected. Name the
part of the body with the most serious injury. For example, if an injured
employee has a bruised finger and a broken ankle, write "ankle". If
amputation, enter part of the body lost.
(7) Item 23. Occupational Illness. Circle the code from
the list below which most accurately describes the illness. These are typical
examples and are not to be considered the complete listing of the types of
illnesses and disorders that should be included under each category. In cases
where the time of onset of illness is in doubt, the day of diagnosis of
illness will be considered as the first day of illness.
(b)(7)(i) Code 21--Occupational Skin Diseases or
Disorders. Examples: Contact dermatitis, eczema, or rash caused by
primary irritants and sensitizers or poisonous plants; oil acne; chrome
ulcers; chemical burns or inflammations.
(b)(7)(ii) Code 22--Dust Diseases of the Lungs
(Pneumoconioses). Examples: Silicosis, asbestosis, coal worker's
pneumoconiosis, and other pneumoconioses.
(b)(7)(iii) Code 23--Respiratory Conditions due to Toxic
Agents. Examples: Pneumonitis, pharyngitis, rhinitis, or acute congestion
due to chemicals, dusts, gases, or fumes.
(b)(7)(iv) Code 24--Poisoning (Systemic Effects of Toxic
Materials). Examples: Poisoning by lead, mercury, cadmium, arsenic, or
other metals, poisoning by carbon monoxide, hydrogen sulfide or other gases;
poisoning by benzol, carbon tetrachloride, or other organic solvents;
poisoning by insecticide sprays such as parathion, lead arsenate; poisoning
by other chemicals such as formaldehyde, plastics and resins.
(b)(7)(v) Code 25--Disorders Due to Physical Agents
(Other than Toxic Materials). Examples: Heatstroke, sunstroke, heat
exhaustion and other effects of environmental heat; freezing, frostbite and
effects of exposure to low temperatures; caisson disease; effects of ionizing
radiation (radon daughters, non-medical, non-therapeutic X-rays, radium);
effects of nonionizing radiation (welding flash, ultra-violet rays,
(b)(7)(vi) Code 26--Disorders Associated with Repeated
Trauma. Examples: Noise-induced hearing loss; synovitis, tenosynovitis,
and bursitis; Raynaud's phenomena; and other conditions due to repeated
motion, vibration or pressure.
(b)(7)(vii) Code 29--All Other Occupational
Illnesses. Examples: Infectious hepatitis, malignant and benign tumors,
any form of cancer, kidney diseases, food poisoning, histoplasmosis.
(8) Item 24. Miner's work activity when injury or
illness occurred. Describe exactly the activity of the injured miner when the
occupational injury or occupational illness occurred. For example: "Setting
temporary support prior to drilling holes for roof bolts."
(Secs. 103(a) and (h), and 508, Pub. L. 91-173, as amended by Pub. L. 95-164, 91
Stat. 1297, 1299, 83 Stat. 803 (30 U.S.C. 801, 813, 957))