DoL MSHA 5000-23-2026

1. Click ‘Get Form’ to open the DoL MSHA 5000-23 in the editor.
2. In Item 1, print the full name of the person trained (first, middle, last). This is essential for record-keeping.
3. For Item 2, check the appropriate box indicating the type of approved training received. If 'New Task' is selected, specify the tasks below.
4. In Item 3, mark the type of operation and related industry by selecting from options like Surface or Underground and Coal or Metal.
5. Complete Item 4 by entering the date training requirements were completed. If not completed, check the box provided.
6. If training is partially completed, use Item 5 to check off subjects that have been completed.
7. In Item 6, ensure that a responsible person signs to certify that training has been completed.
8. Fill in Item 7 with the mine name, ID, and location of training. Finally, in Item 8, have the trained individual sign and date the form.

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