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DoL MSHA 5000-23-2026
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- Click ‘Get Form’ to open the DoL MSHA 5000-23 in the editor.
- In Item 1, print the full name of the person trained (first, middle, last). This is essential for record-keeping.
- For Item 2, check the appropriate box indicating the type of approved training received. If 'New Task' is selected, specify the tasks below.
- In Item 3, mark the type of operation and related industry by selecting from options like Surface or Underground and Coal or Metal.
- Complete Item 4 by entering the date training requirements were completed. If not completed, check the box provided.
- If training is partially completed, use Item 5 to check off subjects that have been completed.
- In Item 6, ensure that a responsible person signs to certify that training has been completed.
- 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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dol msha 5000 23
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