OMB Number 1219-0144, Approval Expires 7/31/2026

Public reporting burden for this collection of information is estimated to average 31 minutes per response. The burden estimate includes the time for reviewing instructions, searching 

existing data sources, gathering and maintaining the data needed, and completing the form. This collection of information is mandatory. You are not required to respond to this 

collection of information unless it displays a valid OMB control number. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden 

to: to DOL/MSHA, Office of Standards Regulations and Variances, 201 12th Street South, Suite 4E401, Arlington, VA 22202-5452, Paperwork Reduction Project (1219-0144), 

NOTE: Do not send your completed form to this address. 

Use of this form is optional. An underground coal mine operator may file a copy of this form with the appropriate District Manager for each of the two designated mine rescue teams, 

that provide coverage for this mine, to certify that each team meets the requirements of 30 CFR Part 49 Subpart B. 

Mine Safety & Health Administration 

Operator's Annual Certification of Mine Rescue Team Qualifications

Page 1 of 2

MSHA Form 2000-224 

(Rev.) September 2023 

Previous editions are obsolete 

MSHA Mine ID No.: Contractor ID No.: Company Name:

Mine Name: 

Team Name:

Team is available at all times when miners are underground

Mine Rescue Team is available within 1 hour ground travel time from the Mine Rescue Station 

address of Mine Rescue Station: Appropriate mine rescue equipment is provided, inspected, tested, 

and maintained

 Member's Name 

1 2 3 4 5 Alternate

Alternate

 Employer's Name

Experience working 

in underground coal 

mine

New member 

training

Physically fit

 Mine Size: Large Small

Type of Team: Mine-Site Composite State-sponsored Contract

Refresher training 

totals 96hrs or more Annual training

8hrs training every 

2 mos; includes 

wearing apparatus 

for 2 hrs 

Jan-Feb

Mar-Apr

May-Jun Nov-Dec

Sep-Oct

Jul-Aug

Initial 20 hrs Initial 20 hrs Initial 20 hrs Initial 20 hrs Initial 20 hrs Initial 20 hrs

Refresher training 

totals 96hrs or more

Refresher training 

totals 96hrs or more

Refresher training 

totals 96hrs or more

Refresher training 

totals 96hrs or more

Refresher training 

totals 96hrs or more

Nov-Dec

Sep-Oct

Jul-Aug

May-Jun

Mar-Apr

Jan-Feb

Nov-Dec

Sep-Oct

Jul-Aug

May-Jun

Mar-Apr

Jan-Feb

Nov-Dec

Sep-Oct

Jul-Aug

May-Jun

Mar-Apr

Jan-Feb

Nov-Dec

Sep-Oct

Jul-Aug

May-Jun

Mar-Apr

Jan-Feb

Nov-Dec

Sep-Oct

Jul-Aug

May-Jun

Mar-Apr

Jan-Feb
 OMB Number 1219-0144 Approval Expires 7/31/2026

Mine Safety & Health Administration 

Operator's Annual Certification of Mine Rescue Team Qualifications

Trains underground Jan-Jun Jan-Jun Jan-Jun Jan-Jun Jan-Jun Jan-Jun

every 6 mos

Wears apparatus in 

smoke annually

Familiar with 

operations of mine

Participates in 2 

local mine rescue 

contests 

(select dates)

Trains at this mine 

(select dates)

Knowledge of 

operations and 

ventilation of mine

 Jul-Dec Jul-Dec Jul-Dec Jul-Dec Jul-Dec Jul-Dec

I certify the information above is true and accurate to the best of my knowledge.

Printed Name:

Signature:

Position held at the mine:

Date:

MSHA Form 2000-224 

(Rev.) September 2023 

Page 2 of 2 Previous editions are obsolete