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PR001 U.S. Department of Labor Preliminary Report of Accident 12-Nov-13 2. Accident Classification 1. Accident Type: Fatal only)l Mine Safety and Health Administration 3. Date!time of Accident Powered

How to fill out msha - preliminary report

How to Fill Out MSHA - Preliminary Report:

1. Obtain the necessary forms: The MSHA - Preliminary Report form can usually be downloaded from the MSHA website or obtained from your employer. Make sure you have the correct version of the form before proceeding.
2. Gather essential information: Before starting to fill out the report, ensure you have all the relevant details. This may include the mine name, operator's name, date of the incident, location, description of the event, and names of the individuals involved.
3. Provide incident details: Begin completing the MSHA - Preliminary Report by accurately describing the incident or accident that occurred. Include information such as the type of accident (e.g., fall, machinery malfunction), the time and date it occurred, specific location within the mine, and any factors that may have contributed to the incident (e.g., poor lighting, improper training).
4. Document injured individuals: Include the names and job titles of any employees who were injured during the incident. Provide details about their injuries and whether they received medical treatment.
5. Identify witnesses: If there were any witnesses to the incident, list their names, job titles, and contact information. This may be crucial for conducting further investigations or gathering additional information.
6. Submit additional forms: In some cases, you may need to fill out supplementary forms along with the MSHA - Preliminary Report. This could include forms related to specific types of accidents, such as those involving powered haulage or electrical accidents. Make sure to check if any additional forms are necessary and complete and submit them accordingly.

Who Needs MSHA - Preliminary Report:

1. Mine operators: It is typically the responsibility of mine operators to ensure that all necessary reports are completed, including the MSHA - Preliminary Report. They must promptly file this report with the Mine Safety and Health Administration (MSHA) within the required timeframe.
2. MSHA inspectors: MSHA inspectors rely on the MSHA - Preliminary Report to gather information about accidents or incidents in the mine. This report helps them assess the situation, determine any potential violations, and take appropriate actions to prevent future accidents.
3. Government agencies: MSHA - Preliminary Reports play a vital role in monitoring mine safety and ensuring compliance with relevant regulations. Government agencies, such as the MSHA, use these reports to track trends, identify common hazards, and implement changes to improve overall mine safety.

In summary, filling out the MSHA - Preliminary Report involves obtaining the necessary forms, gathering accurate incident details, documenting injuries and witnesses, and submitting any additional forms as required. This report is essential for mine operators, MSHA inspectors, and government agencies involved in monitoring and improving mine safety.

For pdfFiller’s FAQs

What is msha - preliminary report?

The MSHA - Preliminary Report is a form required by the Mine Safety and Health Administration (MSHA) to report preliminary information regarding accidents, injuries, and illnesses at mining sites.

Who is required to file msha - preliminary report?

All mine operators are required to file the MSHA - Preliminary Report in the event of an accident, injury, or illness at a mining site.

How to fill out msha - preliminary report?

The MSHA - Preliminary Report can be filled out online through the MSHA website or submitted via mail. It requires providing details about the incident, individuals involved, and any initial actions taken.

What is the purpose of msha - preliminary report?

The purpose of the MSHA - Preliminary Report is to ensure the prompt reporting of accidents, injuries, and illnesses at mining sites to enable MSHA to investigate and take necessary actions to improve safety.

What information must be reported on msha - preliminary report?

The MSHA - Preliminary Report requires information such as the date, time, and location of the incident, details about the individuals involved, and a brief description of the event.

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