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MSHA-Forms and Online Filings

Form number: MSHA Form 2000-222
Form name: Self Contained Self Rescuer (SCSR) Inventory and Report
Description: Mine Operators are required to File a report of inventory of all Self-Contained Self-Rescuers (SCSRs) at a mine.
OMB Control Number and
Expiration Date:
OMB # 1219-0141; Expires 8/31/2016
Filing Options: Form 2000-222, SCSR Inventory and Report can be filed online electronically, a spreadsheet may be submitted via email, or the form fill version can be completed, printed (or printed and filled in manually) and sent to MSHA. For more information on these options, please refer to these Detailed Instructions.

File online electronically
Attach Spreadsheet in an Email
Print, fill in and mail or fax
Filing Instructions: This form is for mine operators' use in providing MSHA with complete SCSR inventories, as well as in reporting problems with SCSRs. Operators may attach continuation sheets to this form provided all required SCSR information is included. Detailed Instructions for completing Form 2000-222 SCSR Inventory and Report Form, SCSR Inventory Report is a two-part form that also provides for attaching multiple units. The form asks for date, MSHA-issued mine ID, mine name, company name, mine address, contact name, telephone number and manufacturer/model of SCSR, date of manufacture, serial number, and report date. Purpose: As part of the Mine Emergency Evactuation Rule (December, 8, 2006), 30 CFR 75.1714-8 authorizes the collection of this information. MSHA maintains an inventory of all reported SCSR information to assure the effectiveness of evacuation plans and emergency evacuations. In addition, such an inventory will assist in targeting SCSR recalls to specific mines. MSHA may not sponsor or endorse products. Persons are not required to respond to this collection of information unless it displays a currently valid OMB Control Number. The use of this form will facilitate SCSR inventory information transfer from mine operators to MSHA. If filing online, copies will be sent electronically to the appropriate offices.

Original should be sent to:
Mine Safety and Health Administration
Technical Support
Pittsburgh Safety and Health Technology Center
Attn: SCSR Coordinator
Cochrans Mill Road
P.O. Box 18233
Pittsburgh, Pennsylvania 15236
Fax: (412) 386-5345
Contact Information: Questions regarding this form should be directed to MSHA at
(877) 778-6055 or MSHAhelpdesk@dol.gov
Privacy Notice: Privacy Notice
Burden Statement: Public reporting burden for this collection of information is estimated from 3 hours to 19 hours depending on the size of the mine per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection information. Persons are not required to respond to this collection of information unless it displays a currently valid OMB Control Number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to:
Office of Standards, Regulations and Variances
Mine Safety and Health Administration
1100 Wilson Boulevard
Arlington, VA 22209-3939

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