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REVISED 1/2021DMM72APPROVED BY:PERMIT NO.:APPROVAL DATE: STATE OF WEST VIRGINIA OFFICE OF MINERS HEALTH, SAFETY & TRAINING 7 Players Club Drive, Suite 2 Charleston, West Virginia 253111626 minesafety.wv.govAPPLICATION/WAIVER
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Begin by providing your personal details such as name, address, contact number, and social security number.
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Follow the instructions provided in each section of the form and provide accurate and truthful information.
05
If you are a miner, provide all the relevant details about your health status, previous health issues, and any occupational hazards you have been exposed to.
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Ensure that you provide any supporting documents or medical records that are required as part of the application.
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Submit the completed Chapter 22a Miners Health form to the designated authority or agency as instructed.
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Who needs chapter 22a miners health?

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Chapter 22a Miners Health is needed by miners who are seeking health benefits or compensation for work-related health issues.
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Miners who have been exposed to occupational hazards such as coal dust, asbestos, or other harmful substances may need to fill out this form.
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Miners who have developed health conditions or illnesses as a result of their mining occupation may also need to complete Chapter 22a Miners Health.
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The form is required to determine eligibility for health benefits, compensation, and medical assistance for miners.
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Chapter 22A Miners Health refers to regulations and guidelines established to ensure the health and safety of miners by monitoring various health parameters associated with their work environment.
Employers in the mining industry are required to file Chapter 22A Miners Health for their employees to maintain compliance with health and safety regulations.
To fill out Chapter 22A Miners Health, employers must gather the necessary health data from miners, complete the designated forms accurately, and submit them to the appropriate regulatory agency.
The purpose of Chapter 22A Miners Health is to promote the health and safety of miners by establishing a framework for monitoring and addressing health risks in the mining industry.
Information that must be reported includes the miner's health status, exposure levels to hazardous substances, any incidents of work-related injuries or illnesses, and required medical evaluations.
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