This document is presented for informational purposes only and should 

not be relied upon as legal authority. Individuals are urged to seek the 

advice of legal counsel prior to filing any action. 

1

FEDERAL MINE SAFETY & HEALTH REVIEW COMMISSION

: Discrimination Proceeding

[NAME] :

Complainant : Docket No. ______

 :

v. : Mine:

: Mine ID:

:

[OPERATOR’S NAME] :

Respondent :

COMPLAINT OF DISCRIMINATION

[NAME], pursuant to section 105(c)(3) of the Federal Mine Safety and Health Act of 

1977 (the Mine Act), 30 U.S.C. § 815(c)(3), hereby files this Complaint alleging a violation of 

section 105(c)(1) of the Mine Act, 30 U.S.C. § 815(c)(1).

PARTIES

1. Complainant [NAME] was assigned to work as a [POSITION] at the [MINE or MINING 

FACILITY NAME] in [TOWN, STATE]. At all relevant times, [NAME] was a “miner” as 

defined in section 3(g), 30 U.S.C. § 802(g), of the Mine Act. [NAME] resides in [TOWN, 

STATE].

2. At all relevant times, Respondent [OPERATOR’S NAME] operated a [TYPE OF MINE

or MINING FACILITY] and, therefore, was an “operator” as defined in Section 3(d) of the Mine 

Act, 30 U.S.C. § 802(d). The Respondent’s products enter into and affect interstate commerce. 

JURISDICTION

3. Pursuant to section 105(c)(3), 30 U.S.C. § 815(c)(3) of the Mine Act, the Federal Mine 

Safety and Health Review Commission has jurisdiction over the subject matter of this case.
This document is presented for informational purposes only and should 

not be relied upon as legal authority. Individuals are urged to seek the 

advice of legal counsel prior to filing any action. 

2

4. On [DATE], [NAME] filed a discrimination complaint with the U.S. Department of 

Labor’s Mine Safety & Health Administration (“MSHA”). Exhibit A [ATTACH COMPLAINT 

FILED WITH MSHA]

5. On [DATE], [NAME] received a notice from MSHA dated [DATE] stating that MSHA

did not find evidence that the provisions of section 105(c)(1) of the Mine Act, 30 U.S.C. § 

815(c)(1), were violated. Exhibit B [ATTACH NOTICE]

FACTS

6. This is where you describe the basic “story” of what happened. Number each 

paragraph. The “story” does not need to list or describe all the evidence in support of your 

complaint, only a short plan statement of the basic facts you believe to be true. 

7. Include basic facts about your participation in one or more activities that you believe are 

protected by the Mine Act. Protected activities include but are not limited to: making safety 

complaints, identifying hazards, serving as a miners’ representative, refusing to engage in 

unsafe acts, etc. More information about the types of activities protected by the Mine Act can be 

found HERE and in published COMMISSION DECISIONS addressing section 105(c). 

8. Describe the adverse actions you believe were taken by the operator because of your 

participation in protected activities. An “adverse action” may include but is not limited to the 

operator taking or threatening to take any of the following actions: discipline, suspension, 

discharge, and reassignment to unfavorable shifts, positions, or tasks. 

9. Continue facts as necessary. Number each paragraph. 
This document is presented for informational purposes only and should 

not be relied upon as legal authority. Individuals are urged to seek the 

advice of legal counsel prior to filing any action. 

3

10. NOTE: The complaint need not include the names of potential witnesses, which may 

remain confidential until a Commission Judge directs you to disclose their names. You may 

refer to witnesses by number instead of name, e.g., Miner Witness # 1, Miner Witness # 2. 

...

[FINAL NUMBER] Complainant alleges Respondent undertook the above-described adverse

action because Complainant engaged in the above-described protected activity.

REQUESTS FOR RELIEF

WHEREFORE, Complainant respectfully requests the Commission to: State the relief or 

remedy that you believe is appropriate based upon the facts of your complaint. Examples of 

relief or remedies include but are not limited to:

1. A decision finding that the operator unlawfully discriminated against you because of 

your exercise of protected activity in violation of section 105(c) of the Mine Act; 

2. Payment to make you whole including but not limited to lost wages and benefits plus 

interest;

3. Referring the case to the Secretary of Labor so that a civil penalty may be proposed 

for each violation of the Mine Act;

4. Ordering the operator to purge from your personnel file any and all records of 

discipline connected to your protected activity;

5. Ordering the operator to display the Commission’s decision or order in a 

conspicuous place at the mine;

6. Ordering the operator to conduct annual training of miners at the mine regarding 

their rights under section 105(c) of the Mine Act;
This document is presented for informational purposes only and should 

not be relied upon as legal authority. Individuals are urged to seek the 

advice of legal counsel prior to filing any action. 

4

7. Ordering the operator to pay attorney’s fees and other costs you have had in 

connection with this proceeding; 

8. Any other relief to make you whole; And any other relief that the Commission deems 

appropriate. 

Respectfully Submitted,

[NAME]

[ADDRESS]

[PHONE NUMBER]

[E-MAIL ADDRESS]