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Wvminesafety. org Phone 304 558-1425 Rev. 04/2012 Fax 304 558-1282 Section A-Identification Data WV PERMIT NUMBER MSHA ID NUMBER WV CONTRACTOR ID NUMBER CHECK HERE IF REPORT PERTAINS TO CONTRACTOR COMPANY NAME IINJURED S EMPLOYER MINE NAME COUNTY MINE LOCATION 1. WEST VIRGINIA OFFICE OF MINERS HEALTH SAFETY TRAINING CHARLESTON AND REGIONAL OFFICE ADDRESSES CHARLESTON OFFICE 7 PLAYERS CLUB DRIVE - SUITE 2 CHARLESTON WV 25311-1626 PHONE 304 558-1425 FAX WESTOVER OFFICE - REGION I 14 COMMERCE...
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