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PR001 U.S. Department of Labor Preliminary Report of Accident 20-Nov-13 2. Accident Classification 1. Accident Type: Fatal Injury Mine Safety and Health Administration 3. Date/Time of Accident Fall
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How to fill out MSHA - preliminary report:

01
Gather all necessary information: Before starting to fill out the MSHA - preliminary report, it is essential to have all the relevant information at hand. This may include the date of the incident, location, names of individuals involved, witnesses, and any other pertinent details.
02
Identify the incident: Clearly describe the incident that occurred. This could be an accident, near miss, injury, or any other occurrence that requires reporting. Provide a detailed account of what happened, including the sequence of events leading up to the incident.
03
Document the injuries or damages: If there were any injuries or damages resulting from the incident, make sure to document them accurately. Include information about affected body parts, severity of injuries, treatment provided, and any property damage sustained.
04
Interview witnesses: If there were any witnesses to the incident, it is crucial to interview them and record their statements. Include their names, contact information, and a detailed account of what they saw or heard during the incident.
05
Analyze contributing factors: Assess all factors that may have contributed to the incident. This could include equipment issues, safety protocol violations, hazards in the work area, or any other relevant factors. Provide detailed information about these contributing factors in the report.
06
Recommend corrective actions: Based on the analysis of contributing factors, propose corrective actions that can be taken to prevent similar incidents from occurring in the future. These actions may involve training, equipment maintenance, policy changes, or any other necessary measures.
07
Submit the completed report: Once all the required information has been gathered and the report is filled out, make sure to submit it to the appropriate MSHA personnel or department. Follow any specific submission instructions provided by MSHA to ensure that the report is properly received.

Who needs MSHA - preliminary report?

01
Mining companies: Mining companies are required to fill out MSHA - preliminary reports for any incidents that occur at their operations. This helps ensure the safety and well-being of their employees and provides valuable information for regulatory purposes.
02
MSHA inspectors: MSHA inspectors rely on preliminary reports to assess compliance with safety regulations and investigate incidents. By having access to these reports, inspectors can identify trends, areas of concern, and take appropriate action to enforce safety standards.
03
Government agencies: Various government agencies, including the Mine Safety and Health Administration (MSHA), require MSHA - preliminary reports to monitor mining industry safety and compliance. These reports provide vital data that can be used for statistical analysis, policy-making, and enforcement purposes.
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The MSHA - preliminary report is a document required by the Mine Safety and Health Administration (MSHA) that provides an initial account of a mining accident or incident.
Any mine operator or contractor responsible for a mining operation must file the MSHA - preliminary report.
The MSHA - preliminary report can be filled out online through the MSHA's official website or submitted via mail or fax.
The purpose of the MSHA - preliminary report is to ensure accurate and timely reporting of mining accidents or incidents in order to improve safety in the mining industry.
The MSHA - preliminary report must include details such as the date and time of the accident, location, description of the incident, and any injuries or fatalities.
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