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Mine Safety Training
Adobe PDF Collection

Category: Forms, Checklists, and Training Certificates

Accident Prevention

59 Kb
Spill Prevention and Control Plan Checklist and Certification
All applicants for permits to discharge any wastewater must complete and submit this Spill Prevention and Control Plan Checklist and Certification.  All applicants for permits to discharge process wastewater must also submit the actual Spill Prevention and Control Plan with this Plan Checklist and Certification.

Active Shooter

174 Kb
Active Shooter Planning Checklist
Healthcare organizations are increasingly vulnerable as events involving armed individuals and guns are on the rise.  Incidents of a violent nature can never be entirely prevented; the challenge is to plan and protect the occupants in a healthcare facility from a threat with potential for significant consequences.

58 Kb
Active Shooter Drill Checklist
Provides key points to address in active shooter situations.

Accident Prevention
Stop the Drop Campaign
A dropped object is: ďAny object, with the potential to cause death, injury or equipment/environmental damage, that falls from its previous static position under its own weight.Ē

Certificate Templates
Sample Training Certificates
Hereís a list of sample training certificates in PowerPoint format that you can distribute following your presentations.  Donít be turned off by the titles.  Most, if not all, of these can be easily edited to suit your needs.

Construction

776 Kb
OSHA Checklist for the Construction Industry
This checklist has been compiled to aid those employers and employees who seek to comply with the Rules and Regulations of the Occupational Safety and Health Act.

Emergency Response
Red Cross Resources
The American Red Cross has created this Disaster and Safety Library to assist you in preparing your home, school and workplace in the event of a disaster or emergency.  Here you will find fact sheets, preparedness checklists, recovery guides and other helpful information to keep you informed and safe.

Hand and Power Tools

42 Kb
Pre-Operation Checklist for Drill
Equipment checklist for drills.

795 Kb
Pre-Operation Checklist for Drill
Equipment checklist for drills.

Heat Stress

273 Kb
Heat Wave Safety Checklist
In recent years, excessive heat has caused more deaths than all other weather events, including floods.  A heat wave is a prolonged period of excessive heat, often combined with excessive humidity. Generally, temperatures are 10 degrees or more above the average high temperature for the region during summer months, last for a long period of time and occur with high humidity as well.

206 Kb
Heat Stress Checklist
This check list is only to be used when conducting a heat stress risk assessment.  It should not be used for the purposes of a thermal comfort risk assessment.

Hot Work
Sample Hot Work Permits
Here are several samples of hot work permits in PDF and Word format listed in no particular order.

Machinery

2.1 Mb
A Guide to Machine Safeguarding
This guide examines dozens of possible ways to safeguard machinery.  There is even a machine safety checklist in the back of the book so the reader can see how his or her own workplace rates.  A Guide to Machine Safeguarding also explains many issues related to making workplaces safer.

Mine Rescue

1.1 Mb
Underground Coal Mine Fire Preparedness and Response Checklist
NIOSH paper from the fire and explosion group.

334 Kb
Operatorís Annual Certification of Mine Rescue Team Qualifications
Form required by the 2008 Mine Rescue Final Rule.  This form is interactive - download only for use.

277 Kb
Operator's Annual Certification of Mine Rescue Team Qualifications
A generic form to satisfy the annual certification of qualifications of mine rescue team members.

32 Kb
MSHA Form 5000-3 - Physical Exam
Physical exam form 5000-3 for mine rescue team members.

334 Kb
Operatorís Annual Certification of Mine Rescue Team Qualifications
Form required by the 2008 Mine Rescue Final Rule.  This form is interactive - download only for use.

413 Kb
BioPak 240R Facepiece Donning Checklist
This document, provided for trained 240R users, goes through the steps to successfully donning the apparatus facepiece.

Mobile and Heavy Equipment

114 Kb
Light Vehicle Inspection Forms I
Pre-shift inspection forms for pickup trucks and other light duty vehicles.

30 Kb
Light Vehicle Inspection Forms II
Pre-shift inspection forms for pickup trucks and other light duty vehicles.

66 Kb
Light Vehicle Inspection Forms V
Pre-shift inspection forms for pickup trucks and other light duty vehicles.

24 Kb
Vehicle Pre-Operation Checklist
Pre-shift inspection forms for pickup trucks and other light duty vehicles.

27 Kb
Equipment Inspection
Equipment checklist for light-duty vehicles.

18 Kb
Front-End Loader Certification Form
Self explanatory sample certification form for front-end loader operators.

119 Kb
Front End Loader Pre-use Inspection Checklist
Sample pre-use inspection checklist from the Ives Training Group.

4.0 Mb
Checklist and Sample Specifications for Front End Loaders
Attached is a checklist and sample specifications for purchasing front end loaders for use in the maintenance of Indiana's local roads and streets.

31 Kb
Forklift Operatorís Daily Checklist By Week
Self explanatory.

776 Kb
OSHA Checklist for the Construction Industry
This checklist has been compiled to aid those employers and employees who seek to comply with the Rules and Regulations of the Occupational Safety and Health Act.

49 Kb
Examination and/or test of hydraulic mobile cranes
Form for this from All Crane Training USA.

MSHA Forms and Online Filing
MSHA Forms and Online Filing
These are the most frequently requested MSHA forms.  You can complete some forms online, while you can download and print all others.

MSHA Inspections

130 Kb
Self-Inspection Checklist
This may interest many because it goes beyond MSHA to office spaces and things covered more by OSHA than MSHA, including training for office persons.

33 Kb
Frequently Inspected or Most often Cited
If an MSHA inspector comes to your property for an inspection, the following is a list of regulations commonly covered.  Remember, all mine operators are required to be in compliance with ALL regulations that apply to their mine.  However, the following is a good starting checklist for you.  You can use this list as a guide for self-inspections of your property.

50 Kb
Contractors Truck Inspection
Sample checklist citing specific Part 77 rules pertaining to contractor trucks.

Part 46 and 48 Training
Hazard Recognition Training Forms
All visitors entering these premises may encounter various hazards.  By law, you must be informed of their possible existence and how to avoid them.  This list identifies many of those hazards and the safe procedures to avoid personal injury and/or property damage.

1.1 Mb
Fillable Form 5000-23
Form 5000-23 may be completed while on your PC screen and printed (or printed and filled in manually).  MSHA does not receive or maintain copies of the 5000-23.  DO NOT FILE THIS FORM WITH MSHA.

15 Kb
Form 5000-23 Instructions
This file provides a description of how to complete each item of the 5000-23.

278 Kb
5000-23 Form Exercise - Scenarios and Blank Forms (I)
From MSHA's Train the Trainer, Instructor Training Workshop.  Includes 5000-23 Form Exercise - Scenarios and Blank Forms.

509 Kb
5000-23 Form Exercise - Scenarios and Blank Forms (II)
From MSHA's Train the Trainer, Instructor Training Workshop.  Includes 5000-23 Form Exercise - Scenarios and Blank Forms.

22 Kb
New Task Training Record and Certificate
This is an interactive and fillable form to assist in compliance with Part 46.27.

Substance Abuse

515 Kb
Drug Test Consent Form
Consent for pre-employment, random or reasonable suspicion drug test and release covenant not to sue and indemnity agreement.

127 Kb
Reasonable Suspicion Testing Consent Form
Sample reasonable suspicion consent form used by Ohio State University.

27 Kb
Reasonable Suspicion Checklist
When there is reasonable suspicion that an employee at work is unfit for duty, the supervisor or manager observing the behavior as well as another supervisor/manager as witness, if possible, must complete the checklist included here.

13 Kb
Reasonable Suspicion Checklist
Less detail than the form above, this document also allows the supervisor or manager observing the behavior to record same.

Weather and Driving Safety

57 Kb
Checklist and Tips for Safe Winter Driving
No one wants to break down in any season, but especially not in cold or snowy winter weather.  Start the season off right by ensuring your vehicle is in optimal condition.
Red Cross Resources
The American Red Cross has created this Disaster and Safety Library to assist you in preparing your home, school and workplace in the event of a disaster or emergency. Here you will find fact sheets, preparedness checklists, recovery guides and other helpful information to keep you informed and safe.

Workplace Examination

60 Kb
Pre-Op Checklist for Drill - page 1
Self explanatory.

57 Kb
Pre-Op Checklist for Drill - page 2
Self explanatory.

266 Kb
Hazard Identification Checklist
Sample list including a variety of hazards workers may have to deal with.
Caterpillar Safety and Maintenance Checklists
SAFETY.CAT.COMô provides safety and maintenance checklists for various machine types, along with detailed start-up and shut-down procedures for many of those same machine types.

132 Kb
Workplace Examination Checklists
Contains checklists for the following: General Safety, S&H Management, AEDs, Vehicle, Fleet Safety and Garage, and Elevator.

18 Kb
Manlift Checklist
Checklist for manlift devices.



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