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Pool 16-Aug-13 U.S. Department of Labor Preliminary Report of Accident Fatal Injury 4. Dateline of Death 3. Dateline of Accident 2. Accident Classification 1. Accident Type: Mine Safety and Health

How to fill out msha - preliminary report

How to fill out MSHA - Preliminary Report:

1. Start by gathering all relevant information: Before filling out the MSHA - Preliminary Report, make sure you have all the necessary details regarding the incident or accident that occurred at your mine site. This includes the date, time, location, names of individuals involved, and a description of what happened.
2. Identify the type of incident: The MSHA - Preliminary Report has different sections depending on the type of incident. Determine if it falls under one of the categories provided, such as machinery accidents, roof falls, electrical accidents, or others.
3. Provide a brief summary of the incident: In the designated section of the report, provide a concise overview of what happened. Be sure to include any immediate actions taken to address the situation, such as administering first aid or evacuating personnel.
4. Document witness statements: If there were witnesses to the incident, document their statements accurately and thoroughly. Include their names, job titles, and contact information if possible. Their statements can provide valuable insights and additional details about the incident.
5. Describe the conditions at the time of the incident: In this section, describe the general conditions at the mine site when the incident occurred. Include information about weather conditions, lighting, visibility, equipment status, and any other relevant factors that may have contributed to the incident.
6. Outline any potential causes: Analyze the situation to identify potential causes of the incident. Consider factors such as unsafe working conditions, lack of training, equipment failure, or human error. Provide an objective assessment of what you believe may have contributed to the incident.
7. Suggest corrective actions: Based on your analysis, propose specific corrective actions to prevent similar incidents from occurring in the future. These may include additional training, equipment maintenance, changes in work procedures, or any other measures that can mitigate the risk of similar occurrences.

Who needs MSHA - Preliminary Report:

1. Mine Owners/Operators: It is the responsibility of mine owners or operators to ensure that a MSHA - Preliminary Report is filled out for any incidents or accidents that happen at their mine site. This report helps them document and address any safety concerns or hazards promptly.
2. Mine Safety and Health Administration (MSHA): The MSHA requires mine operators to submit the Preliminary Report for certain types of incidents. This information helps them track safety trends, enforce safety regulations, and improve safety standards in the mining industry.
3. Insurers and Legal Authorities: Insurance companies and legal authorities may request the Preliminary Report as part of their investigation into an incident or accident at a mine site. This report helps them gather essential information to determine liability, assess damages, or provide compensation.

In summary, filling out the MSHA - Preliminary Report requires gathering relevant information, accurately describing the incident, documenting witness statements, analyzing potential causes, and suggesting corrective actions. This report is necessary for mine owners/operators, the MSHA, insurers, and legal authorities to ensure safety compliance, track trends, and address any safety concerns in the mining industry.

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