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Mine Safety and Health
Administration - MSHA
- Protecting Miners' Safety
and Health Since 1978

Form
5000-3 Disclaimer
(Certification of Physical
Qualification for Mine Rescue Work)

30 CFR 49 implements the
provisions of Section 115(e) of the Federal Mine Safety and Health Act of
1977. Every operator shall assure the availability of mine rescue
capability for purposes of emergency rescue and recovery. In accordance
with 30 CFR 49.7, each
member of a mine rescue team shall be examined annually by a physician who
shall certify that he or she is physically fit to perform mine rescue and
recovery work. The mine operator is required to keep the completed MSHA
Form 5000-3 on file for a period of one year. Any personal information
(e-mail or otherwise) submitted is used for contact purposes only. This
personal information is not used or distributed to any other agency or
used for any other purpose.

See MSHA's Site Privacy
Policy

See DOL's
Privacy Policy

Persons are not required to
respond to this collection of information unless it displays a currently
valid OMB control number.

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U.S. Department of Labor | Mine Safety and Health
Administration (MSHA) | 1100 Wilson Boulevard, 21st
Floor | Arlington, VA 22209-3939
http://www.msha.gov/ | Telephone:
(202) 693-9400 | Fax-on-demand: (202) 693-9401