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

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  Article Links: Introduction | Sample Report | One-Time Setup | Produce the Report | Print the Report | File the Report |

 

INTRODUCTION

MSHA Form 7000-1: Mine Accident, Injury and Illness Report shall be completed and mailed within ten working days after an accident or occupational injury occurs, or an occupational illness is diagnosed.  

Generally, an MSHA recordable injury or illness is defined as follows: 

  • 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.
  • 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.
  • 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.

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SAMPLE REPORT

mceclip0.png
The sample report above includes a color key to indicate the record where data is pulling from to complete the report. 

  • Yellow: User Record
  • Salmon: Injuries Tab of the Incident Report
  • Purple: Incident Tab of the Incident Report
  • Bright Pink: Injuries Tab, Body Parts of the Incidents Report
  • Turquoise: Establishments
  • Green: People Tab
  • Grey: Assets Tab
  • Yellow Green: Configuration

Click Sample MSHA Form 7000-1: Mine Accident, Inury and Illness Report to view a completed report with color key.

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ONE-TIME SETUP

Follow these steps to verify the User Record, Assets, Establishments and Confirguation are set up properly so that the form will print all the data collected during the incident. This is a one-time set up.

User Record

Certain optional fields need to be completed for all users in the company BEFORE you submit the incident.

As an alternative to manually updating the fields for all your users; you can complete a spreadsheet with the following fields and return to our support team at support.convergencetraining.com. They will be happy to upload the data to your LMS.

  • Username
  • Email Address
  • Job Title
  • Phone
  • Date of Birth
  • Gender
  • Last 4 Digits of SSN

Follow the steps below to manually update the fields. Red, Italized text denotes where the data appears on the MSHA 7000-1.

  1. Click the Administration tab at the top of the screen.
  2. Click Organization, then Users on the left menu bar.
  3. Search and locate the users that are involved in the incident
  4. Click the Edit button to the left of the user's name
    1. Email Address: Enter the reporting user's email address. Email address appears in Section D; Email Address Field, for the reporting user.
    2. Job Title: Enter the injured and reporting user's job title. Section C; Field 17. Also will appear in Section D; Title for the reporting user.
    3. Phone: Enter the reporting user's phone number. Section D; Area Code and Phone Number.
    4. Date of Birth: Enter the injured user's date of birth. Section C; Field 15.
    5. Gender: Select the injured user's gender. Section C; Field 14
    6. Last 4 Digits of SSN: Type the last 4 digits of the injured user's SSN. Section C; Field 16
    7. Click the Save button.
    8. Click the Close button after receiving the Changes Saved confirmation. You will be returned to the Manage User's screen.

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Assets

If you plan on identifying any assets such as equipment, vechicles or structures in the incident, you will need to set up your company assets in the Asset menu of the Incident Management System.

Please refer to the Assets: Overview article to learn how to create Asset Groups and Assets in the IMS to be used when reporting an incident.

The following fields will appear on the MSHA 7000-1 form. Red, Italized text denotes where the data appears on the MSHA 7000-1.

  • Name: Section C; Field 10 Equipment Involved
  • Manufacturer: Section C; Field 10 Manufacturer
  • Model: Section C: Field 10 Model Number
  • Type: Section C: Field 10 Type

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Establishment Record

Follow the steps below to manually update the MSHA fields in establishment record for all establishments that are an MSHA site. Red, Italized text denotes where the data appears on the MSHA 7000-1.

  1. Click the Administration tab at the top of the screen.
  2. Click Incident Management, then Establishments on the left menu bar.
  3. Search and locate the desired establishment
  4. Click the Edit button to the left of the establishment
    1. Site: Verify the name of the site is populated in the site field. Section A; Mine Name
    2. MSHA ID: Complete the MSHA ID for this establishment. Section A; MSHA ID Number
    3. MSHA Report Category: Select the applicable report category. Section A; Report Category
    4. Click the Save button.
    5. Click the Close button after receiving the Changes Saved confirmation. You will be returned to the Establishment screen.
  5. Repeat Steps 1-4 until all establishments are updated.

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Configuration

The Injuries and Illnesses tab collects the MSHA classification for each injury and illness type.  

Refer to the Injuries and Illnesses: Edit an Injury or Illness article to learn how to update the MSHA classification.

The MSHA Classification will appear in Section C; Field 23.

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PRODUCE THE REPORT

Complete the following fields in the incident to produce the MSHA Form 7000-1.  Red, Italized text denotes where the data appears on the MSHA 7000-1.

  1. Incident Tab: The following entries must be included to complete the form:
    1. Reported by:  Select who reported the incident.  Section D; Person Completing the Form field.
    2. Reported on: Select the date and time the incident was reported.  Section D, Date this Report Prepared.
    3. Incident Type: Select Injury or Illness in addition to any other incident type. 
    4. What Happened During the Incident: Provide a description of how the incident occurred. Section C; Field 9
    5. Occurred On Date and Time: Includes the date and time the accident occurred. Section C; Field 6-7
    6. Third Party/Contractor Incident: Check YES if this incident involved a third-party Contractor. Section A; Check here if report perstains to a contractor checkbox
    7. Investigation Started: Type the date the investigation started. Section C; Field 3
  2. Incident Tab - MSHA Compliance Section: The following entries must be included to complete the form:
    1. Accident Code: Select the accident code from the drop down list. Section B; Field 1
    2. Surface Location: Select the location from the drop down list. Section C; Field 5a
    3. Underground Location (underground mines only): Select the location from the drop down list. Section C; Field 5b
    4. Mining Method (underground mines only): Select the mining method from the drop down list. Section C; Field 5c
    5. Prevention Steps: Type the steps used to prevent the incident. Section B; Field 4
    6. MSHA Contractor ID: Type the Contractor MSHA ID if a third-party contractor was involved in the incident. This field will only appear when the field Third Party/Contractor Incident field is set to YES. Section A; Contractor ID
  3. People Tab: The following entries must be included to complete the form:
    1. Add a User/Contact: Add the person(s) that were injured. Refer to Step 4a Injuries Tab - below.
    2. What Was the Employee Doing Just Before the Incident Occurred: Enter a statement. Section C; Field 24
    3. Add a User/Contact: Add any witness(es). Section C; Field 11
    4. Add Investigator: Add investigator(s). Section B; Field 2
  4. Injuries Tab: The following entries must be included to complete the form.
    1. Injured Person: Add the injured person(s). Section C; Field 13. The total injured persons will aggregate and display in Section C; Field 12. A separate report will print for each person with an illness or is injured.
    2. Severity: The following selections will result in the following entries on the form:
      • Fatality: Complete the date of death. Section C; Field 18 will be checked.
      • Lost Workdays: Complete the Timeline fields. Refer to Step 5 Injuries Tab - Timeline below.
      • Restricted Workdays: Complete the Timeline fields. Refer to Step 5 Injuries Tab - Timeline.
    3. Time Work Began: Complete the time shift started. Section C; Field 8
    4. What Object or Substance Directly Harmed the Employee: Describe what action or substance harmed the employee. Section C; Field 20.
  5. Injuries Tab - Timeline. This section appears when Lost Workdays and Restricted Workdays and Transfer is selected as Severity. The following entries must be included to complete the form.
    1. Days Away From Work: Appears with Lost Workdays is checked as a severity. Enter the total days away from work. Section D; Field 30
    2. Days Restricted: Appears when Restricted Workdays and Transfer is selected as a Severity. Section D; Field 31
    3. Date Returned: Appears when either Lost Workdays or Restricted Workdays and Transfer is selected as a Severity. Enter the date returned to regular job at full capacity. Section D; Field 29.
  6. Injuries Tab - Body Parts Injured: The following entries must be included to complete the form.
    1. Type: Select the type of injury from the drop down list that occurred. Section C; Field 21.
    2. Body Part: Select the body part affected. Section C; Field 22.
  7. Injuries Tab - MSHA Compliance: the following entries must be included to complete the form.
    1. Job Title Experience: Enter the total job title experience in years/weeks of the injured person. Section C; Field 25.
    2. Facility Experience: Enter the total facility experience in years/weeks of the injured person. Section C; Field 26.
    3. Total Experience: Enter the total mining experience in years/weeks of the injured person. Section C; Field 27.
  8. Save the incident.

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PRINT THE REPORT

Follow these steps to print the report

  1. Click the Forms button and select MSHA Form 7000-1 to run the form.
  2. Click the OK button on the MSHA Form 7000-1 Instructions screen.  It provides the steps to distribute and retain copies of the report. 
  3. When MSHA Form 7000-1 screen appears: 
    1. Select the desired user from the drop down list.
    2. Click the View Form button.
    3. The form will appear on the screen.
  4. If data on the form is missing or incomplete:
    1. Use the color key above to identify which record(s) to edit.
    2. Edit the record(s) to correct data or add missing data.
    3. Follow Steps 1-3 to run the form again
  5. Click the Print Icon at the top of the screen and follow the on screen prompts to print the form.
  6. Email Report - One Time: Refer to the Reports: Run, Print, Export and Email article to learn how to email the form one-time.
  7. Email Report - Recurring: Refer to the Reports: Run, Print, Export and Email article to learn how to email the form on a recurring basis.

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FILE THE REPORT

There is no requirement to electronically file or publicly post MSHA Form 7000-1. Print 3 copies of the form and distribute as follows:

  • Mail first copy to MSHA, Denver Safety and Health Technology Center within 10 days of the recordable incident
  • Mail second copy to the appropriate local MSHA District or Subdistrict office within 10 days of the recordable incident
  • Retain the third copy at the mine for a period of five years

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

  • Update the incident when the employee returns to regular job at full capacity or a final disposition is made on the injury and illness
  • Print two copies
  • Mail the first to MSHA, Denver Safety and Health Technology Center 
  • Retain the second copy at the mine for a period of five years

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