All instructors are required to submit to MSHA the names of persons who have satisfactorily completed required electrical training. MSHA uses the form information to issue certification cards to those persons who are qualified.
Form 5000-1, Certificate of Electrical/Noise Training can be filed online or completed online, printed (or printed and filled in manually) and sent to MSHA according to the instructions provided below.
Fill in, print and mail or fax
Change online filing registration information
Questions regarding this form should be directed to MSHA at (877) 778-6055 or email@example.com
30 CFR 75.153(g) and 77.103(g) require that an individual who is a qualified electrical person in accordance with Section 75.153 and 77.103 shall annually certify to the district manager that he has satisfactorily completed a coal mine electrical retraining program approved by the Secretary in order to retain that qualification.
Public reporting burden for this form is estimated to average 25 minutes per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting the form. This collection of information is mandatory. You are not required to respond to this collection of information unless it displays a valid OMB control number. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: to the Mine Safety and Health Administration, U.S. Department of Labor, Office of Standards Regulations and Variances, 201 12th Street South, Suite 401 Arlington, VA 22202-5450, Paperwork Reduction Project (1219-0001). NOTE: Do not send your completed form to this address.