The Mine Safety and Health Administration (MSHA) outlines its requirements for training and documentation in several sections of Title 30 Code of Federal Regulations (CFR). MSHA specifically spells out these requirements in Parts 46 and 48 for the training and retraining of miners. One of the ubiquitous forms used for documenting that an individual has completed training is the 5000-23 Certificate of Training. It’s a simple, one-page form that somehow creates a lot of confusion.
So, how do you fill out an MSHA 5000-23 Certificate of Training? Here are some basic steps involved in properly filling out an MSHA 5000-23 Certificate of Training:
- Enter the name of the person trained
- Check the box of the type of training received
- Check the boxes of the location and type of operation
- Enter the date the training was completed
- Check the box(es) of the subject(s) completed
- Certify training was completed with signature of person responsible for training
- Enter location of training
- Enter date and signature of person trained
The 5000-23 isn’t a particularly complicated form. It’s actually a lot easier than filling out your taxes. But it creates a lot of questions in the mining industry about how to fill it out, when to use it, who signs it, etc. And because it’s a federal U.S. form, getting it wrong or falsifying information on it can have very serious consequences. So, it’s extremely important to understand how to use this form and fill it out properly. The following information will help make dealing with your 5000-23 a breeze.
What is an MSHA 5000-23 Form?
The MSHA 5000-23 Certificate of Training form is specified in Parts 46 and 48 as the Record of Training document required to “record and certify” that required training has successfully been completed. It’s a form provided by MSHA for the purpose of standardizing training records for the mining industry.
Trainees are entitled to receive a copy of their 5000-23 certificates and copies must also be maintained at the mine site and available for inspection.
Printed copies of the 5000-23 from MSHA include four copies in different colors with notations at the bottom right specifying each copy’s intended use.
- Copy 1 (white) – Employer’s Personnel Record
- Copy 2 (pink) – Employee’s Record Copy
- Copy 3 (yellow) – Employee’s Separation Copy
- Copy 4 (green) – Record Keeping
You may hear people talk about this form by color. Don’t let that confuse you. These colors are entirely for record keeping convenience. There’s no requirement that colored copies are used. When you download a copy from MSHA, you’ll receive a white version that can be used for all purposes.
When to Use a 5000-23
As MSHA’s official Record of Training form, the 5000-23 is used to record and certify that required training has been completed.
Since training sessions sufficient to meet requirements for New Miner and Annual Refresher may take place at different times, a 5000-23 should be used to document each session. This would allow for In-Process credit, training that’s part of a larger Training Program.
However, MSHA requires that training records are certified upon final completion of a Training Program. For example, a training record must be signed by the person responsible for health and safety training to certify that all 24 hours of compliant Part 46 New Miner Training have been completed.
For Part 48 Underground Miner Training, the 5000-23 must be used in all instances of required training completion.
For Part 46 Surface Miner Training, MSHA allows for use of either the 5000-23 or a form that will be considered compliant if it contains five specified items of information.
The Part 46 alternative form is considered compliant if it contains:
“(1) The printed full name of the person trained;
(2) The type of training, the duration of the training, the date the training was received, the name of the competent person who provided the training:
(3) The name of the mine or independent contractor, MSHA mine identification number or independent contractor identification number, and location of training (if an institution, the name and address of the institution).
(4) The statement, “False certification is punishable under §110(a) and (f) of the Federal Mine Safety and Health Act,” printed in bold letters and in a conspicuous manner; and
(5) A statement signed by the person designated in the MSHA-approved training plan for the mine as responsible for health and safety training, that states “I certify that the above training has been completed.””
It’s important to understand the differences between the five required sets of Record of Training information above and this 5000-23 Certificate of Training. Since the 5000-23 was originally designed for Part 48 Underground Miner Training, it’s not formatted in a way that aligns with MSHA’s requirements for a compliant Part 46 Record of Training, even though both forms are accepted for Part 46. (Content written by Bjorn Ansbro for MSHAU.com)
So, even though there’s no place for it on the 5000-23, MSHA states that when a “5000-23 is used it must list the competent instructor(s) who conducted the training, the duration of the training and that the training is for Part 46.”
Get the Most Recent Version
First, be sure to check the upper left of every 5000-23 for the form’s expiration date. While MSHA allows the use of forms that have passed their expiration dates, it’s wise to use the most recent version.
If the expiration date has already passed, go directly to MSHA’s website and download the latest version. Links to all MSHA forms can be found on our RESOURCES page.
1 – Enter the name of the person trained
Enter the full name (first, middle, last) of the person who received training (trainee). This is the miner or independent mining contractor who will receive credit for the training on this record.
While MSHA technically allows for more than one miner to be listed on a record or certificate of training, I’d recommend that each individual who receives training have their own documentation.
2 – Check the box of the type of training received
These selections refer to the Training Programs on the compliant Training Plan that you would have developed according to MSHA requirements prior to conducting training.
The Training Plan is the document that names the responsible person and competent persons designated by the mine operator or mining contractor, as well as an outline of all the subjects, estimated amounts of training time, teaching methods, and evaluation procedures.
The Training Programs specify which sets of training requirements the trainee will ultimately meet. Individual Training Programs include:
- New Miner
- Newly Hired Experienced Miner
- New Task
- Annual Refresher
- Site Specific Hazard Awareness
The Date/Task/Initials sections below the Training Program selections is only relevant when the New Task Training Program box is checked. This provides space for documenting the new task training in more detail. If you’re not using this form to document New Task training, you can leave this section blank.
3 – Check the boxes of the location and type of operation
This section actually identifies three sets of information:
- Location of mining operation (A) – Surface, Underground (or Both)
- Training intended for (A) – Construction or Shaft and Slope
- Type of commodity being mined (B) – Coal, Metal, or Nonmetal
For example, if you’re completing this form for New Miner training at a sand and gravel open pit surface mine, you’d check the Surface box in Section A and the Nonmetal box in Section B.
4 – Enter the date the training was completed
Understanding this section is extremely important. The difference between the date entered and the designation of “completed” reflects the two primary ways that the 5000-23 can be used. This form can either be used for:
- In-Process Credit – To record and certify a that one or more training subjects were completed, or
- Final Certification – To record and certify that an entire Training Program has been completed.
A Training Program (Part 46 New Miner, for example) is comprised of multiple training subjects.
So, for In-Process Credit, a miner could receive credit for having completed one or more subjects and not yet meet the 24-hour requirement for the entire Training Program. In this case, you would fill in the date of training AND check the box to indicate that Training Program selected in Section 2 was not fully completed yet. You would also check the box(es) of any training subject the trainee is receiving credit for on this form.
For Final Certification, the miner is receiving the 5000-23 for having met all the requirements for the Training Program (having completed all 24 hours of New Miner Training, for example). In this case, only the “Date Training Requirements Completed” should be filled in. This would be the final 5000-23 the trainee receives for a given Training Program.
5 – Check the box(es) of the subject(s) completed
If this 5000-23 is being used for Final Certification of a Training Program, you can skip Section 5.
If the form is being used for In-Process Credit, you’ll check the box(es) of the training subject(s) the trainee is receiving credit for on this form.
These are the subjects within the Training Programs that are specifically outlined in either Part 46 or Part 48.
For Part 46, the name of the competent persons who provided the training on specified subjects are required on this record. The competent persons would have been listed by training subject in the Training Plan.
6 – Certify training was completed with signature of person responsible for training
Upon completion of a Training Program, the 5000-23 must be “certified” via signature of the “person responsible for health and safety training.”
The person signing the form may be the mine operator or a person designated as responsible by the mine operator, like the mine’s safety manager or a contracted trainer. Their name must also appear in the Training Plan.
These same requirements apply to independent mining contractors who must designate a responsible person and name them in their Training Plan.
The responsible person is acting on behalf of the mine operator or mining contractor when signing this form. Since this is a federal document, anyone found falsifying the form is criminally liable.
7 – Enter location of training
Since training can take place virtually anywhere, you must enter the name and location where the training occurred.
If it took place at a mine, enter the mine’s name, MSHA ID, and location.
If it took place at a training facility or at State Grant Program educational institution, provide the facility’s name and address.
8 – Enter date and signature of person trained
The person receiving credit for the training on this form has the option to sign and date the form verifying that they have completed the stated training.
For Part 46, this is not required information for the form to be compliant. And this is not considered the “certifying” signature. The signature required to certify the record is from the responsible person.
Additional Details & Reminders
Serial Number – This field in the upper right of the form isn’t required to be filled in. It’s provided in the event that employee records are tracked using individual identification numbers.
Date, Task, and Initials (Section 2) – This is only relevant if the “New Task” box is checked, indicating that training within the New Task Training Program was received.
Part 46 Competent Persons – For Part 46, the names of the instructors (competent persons) per training subject must be included.
Part46 Note – MSHA requires that when a 5000-23 is used to document Part 46 training, a notation must me included on the form that the training is for Part 46.
Responsible Person – MSHA allows for the responsible person signing and certifying the form to be anyone designated by the mine operator or mining contractor. If a trainer or anyone who isn’t named in the written Training Plan signs to certify this form, your company could be exposed to an MSHA citation.
Inspectors will often ask to review both the Training Plan and all Records of Training (including the 5000-23 Certificates of Training). They will expect to see names of responsible persons correspond with the signatures on the Records of Training. For Part 46, the same goes for competent persons.
