U.S. flag
                An official website of the United States government.
                  Here’s how you know

                Here’s how you know
        Dot gov**The .gov means it’s official.**
                             Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.
                Https**The site is secure.**
                             The **https://** ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.



		United States Department of Labor
					U.S. Department of Labor

        Mine Safety and Health Administration
			Menu
				Search
                    Search
		submenu
    Search
                    Search
            
            SAFETY & HEALTHBack

                                    
                                                                                        

                        Safety & Health
                                    
                                                                                        

                            MSHA Health Locator Tool

                                    

                                                                                                                                                                                                                                                Coronavirus

                                    

                                                                                                                                                                                                                                                Safety & Health Initiatives

                                    

                                                                                                                                                                                                                                                Safety & Health Materials

                                    

                                                                                                                                                                                                                                                Mine Emergency OperationsTRAININGBack

                                    
                                                                                        

                        Training
                                    
                                                                                        

                            Training Programs & Courses

                                    

                                                                                                                                                                                                                                                Develop a Training Plan

                                    

                                                                                                                                                                                                                                                Mine Rescue Training

                                    

                                                                                                                                                                                                                                                Instructor Materials

                                    

                                                                                                                                                                                                                                                Training & Education FAQs

                                    

                                                                                                                                                                                                                                                Quarterly Training Calls & Stakeholder Meetings

                                    

                                                                                                                                                                                                                                                State Grant Participants

                                    

                                                                                                                                                                                                                                                Bookwood-Sago Mine Safety Grants

                                    

                                                                                                                                            COMPLIANCE & ENFORCEMENTBack

                                    
                                                                                        

                        Compliance & Enforcement
                                    
                                                                                        

                            Compliance Assistance

                                    

                                                                                                                                                                                                                                                Mine Inspections

                                    

                                                                                                                                                                                                                                                Forms & Online Filing

                                    

                                                                                                                                                                                                                                                Equipment Approval & Certification

                                    

                                                                                                                                                                                                                                                Pattern of Violations

                                    

                                                                                                                                                                                                                                                Contesting Citations

                                    

                                                                                                                                                                                                                                                Penalty Assessments & Payments

                                    

                                                                                                                                            REGULATIONSBack

                                    
                                                                                        

                        Regulations
                                    
                                                                                        

                            Standards & Regulations

                                    

                                                                                                                                                                                                                                                Laws

                                    

                                                                                                                                                                                                                                                Policy and Procedures

                                    

                                                                                                                                                                                                                                                Rulemaking

                                    

                                                                                                                                            NEWS & UPDATESBack

                                    
                                                                                        

                        News & Updates
                                    
                                                                                        

                            What's New

                                    

                                                                                                                                                                                                                                                News Releases

                                    

                                                                                                                                                                                                                                                Speeches & Testimony

                                    

                                                                                                                                                                                                                                                Events

                                    

                                                                                                                                                                                                                                                Alerts & Hazards

                                    

                                                                                                                                                                                                                                                Media Gallery

                                    

                                                                                                                                                                                                                                                Subscribe to Email Alerts

                                    

                                                                                                                                            DATA & REPORTSBack

                                    
                                                                                        

                        Data & Reports
                                    
                                                                                        

                            Mine Data Retrieval System

                                    

                                                                                                                                                                                                                                                Fatality Reports

                                    

                                                                                                                                                                                                                                                Data Sources & Calculators

                                    

                                                                                                                                                                                                                                                Statistics

                                    

                                                                                                                                                                                                                                                Reports

                                    

                                                                                                                                            ABOUTBack

                                    
                                                                                        

                        About
                                    
                                                                                        

                            Mission

                                    

                                                                                                                                                                                                                                                Miners' Rights and Responsibilities

                                    

                                                                                                                                                                                                                                                Leadership

                                    

                                                                                                                                                                                                                                                Organizational Chart

                                    

                                                                                                                                                                                                                                                Program Areas & Offices

                                    

                                                                                                                                                                                                                                                Careers

                                    

                                                                                                                                                                                                                                                History

                                    

                                                                                                                                                                                                                                                Alliance Program

                                    

                                                                                                                                                                                                                                                Memoranda of Understanding

                                    

                                                                                                                                            CONTACTBack

                                    
                                                                                        

                        Contact
                                    
                                                                                        

                            Emergencies

                                    

                                                                                                                                                                                                                                                General Contacts

                                    

                                                                                                                                                                                                                                                State Mining Agencies

	Breadcrumb
			Home
									Support & Resources

	Record of Individual Exposure to Radon Daughters

		
		Form ID
                    
                4000-9


    Description
                    
                Operators are required to maintain accurate records of employee exposures to potentially toxic materials or harmful physical agents. Data submitted to MSHA on Form 4000-9 establishes a means by which MSHA can: assure compliance with underground radiation standards; form a database for epidemiological studies; and provide information of cumulative radon exposures.


    Control ID
                    
                1219-0003


    Expiration Date
                    
                Sat, 10/31/2026 - 13:15


    Filing Options
                    
                Form 4000-9 can be filled in on line and emailed or printed out and sent to MSHA according to the instructions provided below. Complete and File Form OnlineFill in, print and mail or fax


    Filing Instructions
                    
                The operator shall calculate and record complete individual exposures to concentrations of radon daughters. 30 CFR 57.5040(b) requires the operator to maintain MSHA Form 4000-9, or an equivalent form acceptable to the Administrator of Metal and Nonmetal Mine Safety and Health. Specific information required by the form with respect to each person's time-weighted current and accumulative exposure to concentrations for radon daughters shall be recorded. Each form shall be available for examination by the Secretary or his authorized representative. On or before February 15 of each calendar year, or within 45 days after the shutdown of mining operations for the calendar year, each mine operator shall submit to the Mine Safety and Health Administration a copy of the "Record of Individual Exposure to Radon Daughters" (Form 4000-9), or acceptable equivalent form, showing the data required by the form for all personnel for whom calculation and recording of exposure was required during the previous calendar year. The operator's records of individual exposure to concentrations of radon daughters and copies of "Record of Individual Exposure to Radon Daughters" (Form 4000-9) or acceptable equivalent form or true legible facsimiles thereof (microfilm or other), shall be retained at the mine or nearest mine office for a period as specified in paragraph 9.8, ANSI N13.8-1973, or shall be submitted to the Mine Safety and Health Administration. These records, if retained by the operator, shall be open for inspection by the Secretary of Labor, his authorized representative, and authorized representatives of the official mine inspection agency of the State in which the mine is located.
Chief, Division of HealthMetal and Nonmetal Mine Safety and HealthMine Safety and Health Administration201 12th Street South,Suite 401 Arlington, VA 22202-5450
If questions arise, the nearest MSHA office may be contacted for clarification. Detailed instructions for filing Form 4000-9 are available using this link.
This report is required by law (30 CFR, Part 57). Failure to report can result in assessment of a civil penalty under Section 110 and institution of a civil action for relief under Section 108 of the Federal Mine Safety and Health Act of 1977. Knowingly making a false statement or concealing a material fact can result in criminal prosecution under Section 110 of the Federal Mine Safety and Health Act of 1977 and 18 U.S.C. 1001.


    Contact Information
                    
                Questions regarding this form should be directed to MSHA at (877) 778-6055 or desk.help@dol.gov


    Privacy Notice
                    
                Privacy Notice


    Legal Authority
                    
                30 CFR 57.5040(b)


    Burden Statement
                    
                This form is affected by the Privacy Act of 1974.Public reporting burden for this collection of information is estimated to average 1.5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data need, and completing and reviewing the collection of information. Send comments regarding the collection of information, including suggestions for reducing this burden, to the Mine Safety and Health Administration, U.S. Department of Labor, Office of Standards, Regulations and Variances, 201 12th Street South, Suite 401 Arlington, VA 22202-5450. Persons are not required to respond to this collection of information unless it displays a currently valid OMB Control Number.


    Online Filing
                    
                File OnlineScroll to Top

	Forms
              Fatality Database
              Support & Resources
              Frequently Asked QuestionsU.S. Department of Labor
																Mine Safety and Health Administration201 12th St SSuite 401Arlington, VA 22202-5450www.msha.gov202-693-9400
				Federal Government
        
          

                      White House
              Disaster Recovery Assistance
              USA.gov
              No FEAR Act Data





Labor Department
        
          

                      A to Z Index
              Agencies
              Contact Us
              Emergency Accountability Status Link
              Leadership Team
              Office of Inspector General
              Read The DOL Newsletter
              Subscribe to the DOL Newsletter





About the Site
        
          

                      Freedom of Information Act
              Paperwork Reduction Act
              Records Retention Schedule
              Help Desk
              Privacy & Security
              Accessibility & 508 Compliance
              Disclaimers
              Language Notice
              Español
	
 
Connect With MSHAFacebookTwitterInstagramYouTubeLinkedinGovDelivery Email SignupMiner Safety and Health Application
Site Map Important Website Notices Privacy & Security Statement