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Form 5000-3 Disclaimer
(Certification of Physical Qualification for Mine Rescue Work)


30 CFR 49 implements the provisions of Section 115(e) of the Federal Mine Safety and Health Act of 1977. Every operator shall assure the availability of mine rescue capability for purposes of emergency rescue and recovery. In accordance with 30 CFR 49.7, each member of a mine rescue team shall be examined annually by a physician who shall certify that he or she is physically fit to perform mine rescue and recovery work. The mine operator is required to keep the completed MSHA Form 5000-3 on file for a period of one year. Any personal information (e-mail or otherwise) submitted is used for contact purposes only. This personal information is not used or distributed to any other agency or used for any other purpose.

Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number.