Monthly Production Report Form - West Virginia
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1’
,
OFFICE OF MINERS
HEALTH
SAFETY AND TRAINING
MONTHLY PRODUCTION REPORT
04/2012
(CHECK WHICH TYPE OF MINE)
SURFACE
UNDERGROUND
MONTH: ___________________YEAR:___________ WV PERMIT NO.:______________ COUNTY: _________________________
COMPANY NAME: _____________________________________________________ MINE: ________________________________
ADDRESS: __________________________________________ LOCATION OF MINE: _____________________________________
COAL SEAM / MINERAL MINED: _______________________TYPE OF MINE :(
,
,
)_______________________
SHAFT
SLOPE
OPEN PIT
EMPLOYMENT
AVERAGE NUMBER OF EMPLOYEES AT WORK EACH DAY
-
________
_______ TOTAL
_________
_______
_________
UNDERGROUND
INSIDE
OUTSIDE
NON
SUPERVISORY
SUPERVISORY
EMPLOYEES
(ONLY)
____________________________
_________________________________
NUMBER OF DAYS MINE OPERATED
TOTAL MAN HOURS
PRODUCTION
DISTRIBUTION
THIS MONTH
YEAR TO DATE
THIS MONTH
YEAR TO DATE
CONTINUOUS MINER
RAIL
LONGWALL
RIVER
AUGER
TRUCK
SURFACE MINE
USED LOCALLY
QUARRY
TOTAL TONNAGE
TOTAL TONNAGE
:
_________________________________________
MAIL COMPLETED REPORT TO
SIGNATURE
’
,
&
___________________________________
OFFICE OF MINERS
HEALTH
SAFETY
TRAINING
PRINTED NAME
– S
#7 P
C
D
2
______________________________________________
TITLE
LAYERS
LUB
RIVE
UITE
C
, WV 25311-1626
______________________________________________
DATE
HARLESTON
# 304-558-1425
___________________________________
PHONE
TELEPHONE NUMBER
FAX # 304-558-1282
.
.
______________________________________________
EMAIL
WWW
WVMINESAFETY
ORG
Applicable laws and general instructional information:
1. The operator of every mine shall, on or before the end of each month, file with the director of the West Virginia Office of Miners’ Health,
Safety & Training a report covering the preceding calendar month on the form(s) furnished by the director. Such reports shal l state the
number of accidents (Form 3333) which have occurred, the number of persons employed, the days worked and the actual tonnage mined, on
each permit issued by the Office of M.H.S. & T. (West Virginia Code Sections: 22A-2-77, 22A-6-4, and Administrative Regulations Series 3,
Section 52.01).
2. All mines and all “excess tonnage” prospecting operations (over 250 tons) are required to file these reports. If the min e is idle, tonnage
reports are required until such mine is permanently closed or bonding has been released. Failure to submit production reports will result in
the issuance of a notice of violation, and a resultant penalty.
3. General instructions: Print or type all information required.
a. The report requests tonnage, employment, distribution, etc. After completing this report, mail to the Office of M.H.S. & T., at the
address listed above.
Should you have any questions concerning the completion of this form, call or write our office (address and phone number shown above.).
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