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E-mail This PageDOL Form 5000-41
| Agency: | MSHA |
| Title: | Health Activity Certification or Hoisting Engineers Qualification Request Form |
| Form Description: | All instructors are required to submit to MSHA the names of persons who have satisfactorily completed required mine foreman and pre-shift examiner or hoisting certification training. The 5000-41 is a combined version of the previous 5000-4 and 5000-7 forms. MSHA uses the form information to issue certification cards to qualified persons. |
| OMB Control Number: | 1219-0127 |
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