Mine Accident, Injury and Illness Report, MSHA Form 7000-1

 Section A - Identification Data Approved For Use Through 2/29/2024 OMB No. 1219-0007

MSHA ID number Contractor ID Report Category 

Metal/Nonmetal Mining Coal Mining 

Check here if report 

pertains to contractor 

Mine name Company Name 

 Section B - Complete for Each Reportable Accident Immediately Reported to MSHA 

1. Accident Code (check applicable code - see instructions) 01 - Death 02 - Serious Injury 03 - Entrapment

04 - Inundation

09 - Outburst

2. Name of investigator

05 - Gas or Dust Ignition 06 - Mine Fire 

10 - Impounding Dam

3. Date investigation started

month day year 

07 - Explosives 08 - Roof Fall

11 - Hoisting 12 - Offsite Injury

4. Steps taken to prevent recurrence of accident

 Section C - Complete for Each Reportable Accident, Injury or Illness 

5. Check the codes which best describe where accident/injury/illness occurred (see instructions)

(a) Surface Location: 02 - Surface at Underground Mine 30 - Mill, Preparation Plant, etc. 03 - Strip/Open Pit Mine 

05 - Culm Bank/Refuse Pile 06 - Dredge Mining 12 - Other Surface Mining 17 - Independent Shops (with own MSHA ID) 

04- Surface Auger Operation 

99 - Office Facilities 

(b) Underground Location: 01 - Vertical Shaft 02 - Slope/Inclined Shaft 03 - Face 04 - Intersection 05 - Underground Shop/Office 

05 - Continuous Mining 07 - Caving 02 - Shortwall (c) Underground Mining Method: 01 - Longwall 03 - Conventional Stoping 06 - Hand

6. Date of accident 7. Time of accident am 8. Time shift started am month day year 

pm pm 

9. Describe fully the conditions contributing to the accident/injury/illness, and quantify the damage or impairment

06 - Other

08 - Other 

7 

8 

______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________

10. Equipment involved Type Manufacturer Model number 10 

Man 

11. Name of witness to accident/injury/illness 12. Number of reportable injuries or illnesses

resulting from this occurrence

male 15. Date of birth 12 13. Name of injured/ill employee 14. Sex

female month day year 

14 

16 

17 

16. Last four digits of 17. Regular job title 18. Check if this injury/ 19. Check if injury/illness resulted 18 

Social Security number illness resulted in death in permanent disability (include 19 

20 amputation, loss of use &

20. What directly inflicted injury or illness? 21. Nature of injury or illness permanent total disability) 21 

22 

24 

22. Part of body injured or affected 23. Occupational illness (check applicable code - see instructions) 21 - Occupational Skin Diseases 

22 - Dust Diseases of the Lungs 23 - Respiratory Conditions (Toxic Agents) 24 - Poisoning (Toxic Materials)

25 - Disorders (Physical Agents) 26 - Disorders (Repeated Trauma) 29 - Other

24. Employee’s work activity Experience 

when injury or illness occurred 25. Experience in this job title

26. Experience at this mine

27. Total mining experience

Years Weeks 

 Section D - Return to Duty Information 

28. Permanently transferred or

terminated (if checked, complete

items 29, 30, and 31)

29. Date returned to

regular job at full 

capacity (or item 28)

Answer 30 & 31 when case is closed 

30. Number of days 31. Number of days

away from work restricted work

(if none enter 0) activity (if none, enter 0) 

month day year 

Person completing form (name) Title 

Date this report prepared (month, day, year) Area code and phone number 

For official use only 

Degree 

Accident Type 

Accident Class 

Scheduled Charge 

Keyword 

MSHA Form 7000-1, February 24 (revised) 
 

MINE ACCIDENT, INJURY, AND ILLNESS REPORT 

MSHA FORM 7000-1 

Section 50.20 of Part 50, Title 30, Code of Federal Regulations, 

requires a report to be prepared and filed with MSHA of each accident, occupational injury, or occupational illness occurring at your 

operation. The requirement includes all accidents, injuries, and illnesses as defined in Part 50 whether your employees or a contractor's employees are involved. A Form 7000-1 shall be completed 

and mailed within ten working days after an accident or occupational injury occurs, or an occupational illness is diagnosed. 

This report is required by law (30 U.S.C. §813; 30 C.F.R. Part 

50). Failure to report can result in the institution of a civil action 

for relief under 30 U.S.C. §818 respecting an operator of a coal 

or other mine, and assessment of a civil penalty against an operator of a coal or other mine under 30 U.S.C. §820(a). An individual who, being subject to the Federal Mine Safety and Health 

Act of 1977 (30 U.S.C. §801 at seq.) knowingly makes a false 

state-ment in any report can be punished by a fine of not more 

than$10,000 or by imprisonment for not more than 5 years, or 

both, under 30 U.S.C. §820.(f). Any individual who knowingly 

and will-fully makes any false, fictitious, or fraudulent statements, 

con-ceals a material fact, or makes a false, fictitious, or 

fraudulent entry, with respect to any matter within the jurisdiction 

of any agency of the United States can be punished by a fine of 

not more than $10,000, or imprisoned for not more than 5 years, 

or both, under 18 U.S.C. §1001. 

REPORTING INSTRUCTIONS 

Form 7000-1 consists of four sheets, an original (page 1) and 

three copies. The original will be mailed to MSHA, Office of Injury 

and Employment Information. The first copy (page 2) will be 

mailed to the appropriate local MSHA District Office. If the 

mailed forms do not show return to duty information on an injured 

employee, complete and mail the second copy (page 3) to 

MSHA, Office of Injury and Employment Information, when the 

employee returns to regular job at full capacity or a final 

disposition is made on the injury or illness. The third copy 

(page 4) is to be retained at the mine for a period of five years. It 

is important to remember that a Form 7000-1 is required on each 

accident as defined in 30 CFR Part 50 whether any person was 

injured or not. A form is required on each individual becoming 

injured or ill, even when several were injured or made ill in a single occurrence. The principal officer in charge of health and safety at the mine or the supervisor of the mine area in which the 

accident, injury, or illness occurred shall complete or review the 

Form 7000-1. Note: First aid cases (those for which no medical 

treatment was received, no time was lost, and no restriction of 

work, motion, or loss of consciousness occurred) need not be 

reported. 

SPECIFIC INSTRUCTIONS 

Detailed instructions for completing Form 7000-1 are contained in 

Part 50. A copy of Part 50 was sent to every active and intermittently active mine and independent mining contractor. If you do 

not have a copy, you may obtain one from your local MSHA Mine 

Safety and Health District or Field Office. 

Section A- IDENTIFICATION DATA 

Check the report category indicating whether your operation is in 

the metal/nonmetal mining industry or the coal mining industry. 

MSHA ID Number is the number assigned to the operation by 

MSHA. If you are unsure of your number assignment, contact the 

nearest MSHA Mine Safety and Health District or Field Office. 

Reports on contractor activities at mines must include an MSHAassigned contractor ID Number as well as the 7-digit operation ID. 

Show mine name and company name. Independent contractors 

should show the contractor name under "company name. " 

Section B- COMPLETE FOR EACH ACCIDENT IMMEDIATELY 

REPORTABLE TO MSHA 

Section B is to be completed only when your operation has an 

accident that must be reported immediately to MSHA. Circle 

code 02 "Serious Injury" only if the injury has a reasonable potential to cause death. For additional detail on those specific kinds of 

accidents see Section 50.10 of Part 50. When it is necessary to 

complete Section B, circle the applicable accident code; give the 

name of the investigator (the mine person heading the 

investigating team on the accident); show the date the 

investigation was started; and describe briefly the steps taken to 

prevent a recurrence of such an accident. 

Section C- COMPLETE FOR EACH REPORTABLE ACCIDENT, 

INJURY, OR ILLNESS 

Section C must be completed on each form submitted to MSHA. 

Item 5. If you are reporting an occurrence at a surface mine or 

other surface activity, circle the code which best describes the accident location in (a). Surface Location; do not mark any codes in (b) 

or (c). If you are reporting an occurrence in an underground mine, 

circle the code which best describes the underground location in (b) 

Underground Location and in (c) Underground Mining Method. 

Items 6, 7, and 8. Show the date and time of the occurrence and 

the time the shift started in (indicate AM/PM) which the accident/ 

incident occurred or was observed. 

Item 9. Describe fully the conditions contributing to the occurrence. Detailed descriptions of the conditions provide the basis 

for accident and injury analyses which are intended to assist the 

mining industry in preventing future occurrences. Please see Part 

50 for detail on what your narrative should include. 

Item 10. If equipment was involved in the occurrence, name the 

type of equipment, the manufacturer, and the model number of 

the equipment. 

Item 11. If there was a witness to the occurrence, give the name 

of the witness. 

Item 12. If the occurrence resulted in one or more injuries, report the 

number. A separate report must be made on each injured person. 

Item 13. Show the name of the injured person. [Note: In these 

instructions, "injured person" means a person either injured or ill.] 

Item 14. Indicate the sex of the injured person. 

Item 15. Show the date of birth of the injured person. 

Item 16. Show the last four digits of the injured person's Social 

Security Number. 

Item 17. Give the regular job title of the injured person at the 

time he was injured. 

Item 18. Check this box if the injury or illness resulted in death. 

Item 19. Check this box if the injury or illness resulted in a permanent disability. A permanent disability is any injury or occupational illness other than death which results in the loss (or complete loss of use) of any member (or part of a member) of the 

body, or a permanent impairment of functions of the body, or 

which permanently and totally incapacitates the injured person 

from following any gainful occupation. 
 

Item 20. Name the object or substance that directly caused the 

injury or illness. 

Item 21. Report the nature of injury or illness by naming the illness; or for injuries, by using common medical terms such as 

puncture wound, third degree burn, fracture, etc. For multiple 

injuries, enter the injury which was the most serious. Avoid general terms such as hurt, sore, sick, etc. 

Item 22. Name the part of body with the most serious injury. 

Item 23. Occupational Illness: Circle the code from the list below 

which most accurately describes the illness. These are typical 

examples and are not to be considered the complete listing of the 

types of illnesses and disorders that should be included under 

each category.

Code 21 - Occupational Skin Diseases or Disorders. 

Examples: Contact dermatitis, eczema, or rash caused by 

primary irritants and sensitizers or poisonous plants; oil 

acne; chrome ulcers; chemical burns or inflammations; etc. 

Code 22 - Dust Diseases of the Lungs (Pneumoconioses). 

Examples: Silicosis, asbestosis, coal worker’s pneumoconiosis and other pneumoconioses.

Code 23 - Respiratory Conditions Due to Toxic Agents. 

Examples: Pneumonitis, pharyngitis, rhinitis, or acute 

congestion due to chemicals, dusts, gases, or fumes; etc. 

Code 24 - Poisoning (Systemic Effects of Toxic Materials). 

Examples: Poisoning by lead, mercury, cadmium, arsenic, or other metals, poisoning by carbon monoxide, hydrogen sulfide, or other gases; poisoning by benzol, carbon tetrachloride, or other organic solvents; poisoning 

by insecticide sprays such as parathion, lead arsenate; 

poisoning by other chemicals such as formaldehyde, 

plastics, and resins; etc. 

Code 25 - Disorders Due to Physical Agents (Other than 

Toxic Materials). Examples: Heatstroke, sunstroke, 

heat exhaustion and other effects of environmental heat; 

freezing, frostbite and effects of exposure to low temperatures; caisson disease; effects of ionizing radiation, 

(non-medical non-therapeutic x-rays, radium); effects of 

nonionizing radiation (welding flash, ultraviolet rays, 

microwaves, sunburn); etc. 

Code 26 - Disorders Associated with Repeated Trauma. 

Examples: Noise-induced hearing loss; synovitis, tenosynovitis, and bursitis; Raynaud's phenomena; and other 

conditions due to repeated motion, vibration, or pressure. 

Code 29 - All Other Occupational Illnesses. Examples: 

Infectious hepatitis, malignant and benign tumors, all 

forms of cancer, kidney diseases, food poisoning, 

histoplasmosis; etc. 

Item 24. Describe what the employee was doing when he or 

she became injured or ill. 

Items 25, 26, and 27. Show the number of weeks (or years and 

weeks) of experience of the injured person at the job title (indicated 

in Item 17), at your operation, and his/her total mining experience. 

Section D - RETURN TO DUTY INFORMATION 

Section D is to be completed in full when all return-to-duty information is available. If the information is not available within ten 

working days after a reportable occurrence, then the first two 

pages are sent to MSHA without Section D being completed; 

PAGE 3 is then mailed to OIEI- with full information when the 

data is available. Until all the items are answered and the 

report is sent to OIEI, the occurrence remains an open case. 

Item 28. If the injured person was transferred or terminated as a 

result of the injury or illness, check the box and answer items 29, 

30, and 31. 

Item 29. Show the date that the injured person returned to his/

her regular job at full capacity or was transferred or terminated. 

This date should indicate when the count of days away from 

work and/or days of restricted work activity have stopped. 

Item 30. Show the number of workdays 1/ the injured person did 

not report to his/her place of employment, i.e., number of days 

away from work. 

Item 31. Show the number of workdays the injured person was 

on restricted work activity; do not include days away from work 

reported in Item 30. 

At the bottom of the form, show the name of the person who 

completed the form; the date the report was prepared; and the 

telephone number where the person who completed the form 

may be reached. 

1/ Note: The number of lost workdays should not include the day 

of injury or onset of illness, or any days on which the employee 

was not previously scheduled to work even though able to work, 

such as holidays or plant closures 

Diagnosis of an "occupational illness or 

disease" under Part 50 does not 

automatically mean a disability or 

impairment for which the miner is 

eligible for compensation, nor does the

Agency intend for an operator's

compliance with Part 50 to be equated 

with an admission of liability for the

reported illness or disease. If a chest xray for a miner with a history of

exposure to silica or other

pneumoconiosis causing dusts is rated at 

1/0 or above, utilizing the International 

Labor Office (ILO) classification system, 

it is MSHA's policy that such a finding is,

for Part 50 reporting, a diagnosis of an

occuaptional illness, in the nature of

silicosis or other pneumoconiosis and, 

consequently, reportable to MSHA.
DEFINITIONS 

(1 ) "Coal or other mine" means (a) an area of land from which 

minerals are extracted in nonliquid form or, if in liquid form, are 

extracted with workers underground, (b) private ways and roads 

appurtenant to such area, and (c) lands, excavations, underground passageways, shafts, slopes, tunnels and workings, 

structures, facilities, equipment, machines, tools, or other property including impoundments, retention dams, and tailings ponds, 

on the surface or underground, used in, or to be used in, or 

resulting from, the work of extracting such minerals from their 

natural deposits in nonliquid form, or if in liquid form, with workers 

underground, or used in, or to be used in, the milling of such minerals, or the work of preparing coal or other minerals, and 

includes custom coal preparation facilities. In making a determination of what constitutes mineral milling for purposes of this Act, 

the Secretary shall give due consideration to the convenience of 

administration resulting from the delegation to one Assistant 

Secretary of all authority with respect to the health and safety of 

miners employed at one physical establishment. 

(2) "Operator" means any owner, lessee, or other person

who operates, controls, or supervises a coal or other mine or any 

designated independent contractor performing services or construction at such mine. 

(3) "Occupational injury" means any injury to a worker

which occurs at a mine for which medical treatment is administered, or which results in death, loss of consciousness, inability to 

perform ail job duties on any day after an injury, or transfer to 

another job. 

(4) "Occupational illness" means an illness or disease of a

worker which may have resulted from work at a mine or for 

which an award of compensation is made. 

(5) "Medical treatment" means treatment, other than first

aid, administered by a physician or by a registered medical professional acting under the orders of a physician. 

DIFFERENCES BETWEEN 

MEDICAL TREATMENT AND FIRST AID 

Medical treatment includes, but is not limited to, the suturing of 

any wound, treatment of fractures, application of a cast or other 

professional means of immobilizing an injured part of the body, 

treatment of infection arising out of an injury, treatment of bruise 

by the drainage of blood, surgical removal of dead or damaged 

skin (debridement), amputation or permanent loss of use of any 

part of the body, treatment of second and third degree burns. 

Procedures which are diagnostic in nature are not considered by 

themselves to constitute medical treatment. Visits to a physician, 

physical examinations, x-ray examinations, and hospitalization 

for observations, where no evidence of injury or illness is found 

and no medical treatment given, do not in themselves con-stitute 

medical treatment. However, if scheduled workdays are lost 

because of hospitalization, the case must be reported. 

Procedures which are preventative in nature also are not considered by themselves to constitute medical treatment. Tetanus and 

flu shots are considered preventative in nature. First aid includes 

any one-time treatment and follow-up visit for the purpose of 

observation of minor scratches, cuts, burns, splinters, etc. 

Ointments, salves, antiseptics, and dressings to minor injuries 

are considered to be first aid. 

(1) Abrasions

(i) First aid treatment is limited to cleaning a wound, soaking,

applying antiseptic and nonprescription medication, and bandages on the first visit and follow-up visits limited to observation 

including changing dressing and bandages. Additional cleaning 

and application of antiseptic constitutes first aid where it is 

required by work duties that soil the bandage. 

(ii) Medical treatment includes examination for removal of

imbedded foreign material, multiple soakings, whirlpool treatment, 

treatment of infection, or other professional treatments and any 

treatment involving more than a minor spot-type injury. Treatment 

of abrasions occurring to greater than full skin depth is considered medical treatment. 

(2) Bruises

(i) First aid treatment is limited to a single soaking or application of cold compresses, and follow-up visits if they are limited 

only to observation. 

(ii) Medical treatment includes multiple soakings, draining of

collected blood, or other treatment beyond observation. 

(3) Burns, Thermal and Chemical (resulting in destruction of

tissue by direct contact). 

(i) First aid treatment is limited to cleaning or flushing the surface, soaking, applying cold compresses, antiseptics or nonprescription medications, and bandaging on the first visit, and followup visits restricted to observation, changing bandages, or additional cleaning. Most first degree burns are amenable to first aid 

treatment. 

(ii) Medical treatment includes a series of treatments including

soaks, whirlpool, skin grafts, and surgical debridement (cutting 

away dead skin). Most second and third degree burns require 

medical treatment. 

(4) Cuts and Lacerations

(i) First aid treatment is the same as for abrasions except the

application of butterfly closures for cosmetic purposes only can 

be considered first aid. 

(ii) Medical treatment includes the application of butterfly closures for noncosmetic purposes, sutures (stitches), surgical 

debridement, treatment of infection, or other professional treatment. 

(5) Eye Injuries

(i) First aid treatment is limited to irrigation, removal of foreign

material not imbedded in eye, and application of nonprescription 

medications. A precautionary visit (special examination) to a 

physician is considered as first aid if treatment is limited to above 

items, and follow-up visits if they are limited to observation only. 

(ii) Medical treatment cases involve removal of imbedded foreign objects, use of prescription medications, or other professional treatment. 

(6) Inhalation of Toxic or Corrosive Gases

(i) First aid treatment is limited to removal of the worker to

fresh air or the one-time administration of oxygen for several minutes. 

(ii) Medical treatment consists of any professional treatment

beyond that mentioned under first aid and all cases involving loss 

of consciousness. 

(7) Splinters and Puncture Wounds

(i) First aid treatment is limited to cleaning the wound, removal

of foreign object(s) by tweezers or other simple techniques, application of antiseptics and nonprescription medications, and bandaging on the first visit. Follow-up visits are limited to observation 

including changing of bandages. Additional cleaning and applications of antiseptic constitute first aid where it is required by work 

duties that soil the bandage. 

(ii) Medical treatment consists of removal of foreign object(s)

by physician due to depth of imbedment, size or shape of 

object(s), or location of wound. Treatment for infection, treatment 

of a reaction to tetanus booster, or other professional treatment, 

is considered medical treatment. 

(8) Sprains and Strains

(i) First aid treatment is limited to soaking, application of cold

compresses, and use of elastic bandages on the first visit. 

Follow-up visits for observation, including re-applying bandage, 

are first aid. 

(ii) Medical treatment includes a series of hot and cold soaks,

use of whirlpools, diathermy treatment, or other professional 

treatment.
 

 

 

 

 

PRIVACY ACT NOTICE FOR 

MINE ACCIDENT, INJURY AND ILLNESS REPORTS 

GENERAL 

This notice is given as required by Public Law 93-579 (Privacy Act of 1974) December 31, 1974, to the operators of 

mines providing personal information on injury and illness reports and accident investigations. 

AUTHORITY 

The authority to collect this information is Section 103 of Public Law 91-173, as amended by Public Law 95-164.

PURPOSE AND USE OF INFORMATION 

The information collected will be used to help determine the cause of accidents, injuries, illnesses, and fatalities 

associated with metal and nonmetallic and coal mining. The information will also be used with the intent to 

prevent and reduce future accidents, injuries, fatalities, and illnesses. MSHA provides a copy of a mine operator's 

or contractor's submitted form to the mine operator or contractor who submitted the form.

EFFECTS OF NON-DISCLOSURE 

You are required to furnish the information. Without it, MSHA may not be able to help prevent miners and other workers 

from becoming similarly hurt or ill in the future. 

INFORMATION REGARDING PERSONAL IDENTIFICATION 

UNDER PUBLIC LAW 93-579 SECTION 7(b) 

MSHA asks for the last 4 digits of the social security number under authority of Section 103 of Public Law 91-173, as 

amended by Public Law 95-164. This personal identification helps MSHA establish the accuracy and usefulness of 

the information from injury and illness records. 

BURDEN STATEMENT 

Public reporting burden for this collection of information is estimated to average 30 minutes per response, including 

the time for reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and 

completing and reviewing the collection of information. Records are retained at the mine office closest to the mine 

for 5 years. This is a mandatory collection of information as required by 30 CFR 50.20. The information is used to 

establish injury, accident or illness files used to measure the levels of injury experience and identify those areas 

most in need of improvement. Send comments regarding this burden estimate or any other aspect of this collection 

of information, including suggestions for reducing this burden, the Office of Program Evaluation and Information 

Resources, Mine Safety and Health Administration, U.S. Department of Labor, 201 12th Street South, Arlington, VA 

22202, and to the Office of Management and Budget, Paperwork Reduction Project (1219-0007), Washington, DC 

20503.

Persons are not required to respond to this collection of information unless it displays a currently valid control number.