Emergency Mine Evacuation

MSHA - Forms and Online Filings - Form 2000-222 - Self Contained Self Rescuer (SCSR) Inventory and Report

UNITED STATES
DEPARTMENT OF LABOR

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Form number:

MSHA Form 2000-222

Form name:

Self Contained Self Rescuer (SCSR) Inventory and Report

Description:

Mine Operators are required to File a report of inventory of all
Self-Contained Self-Rescuers (SCSRs) at a mine.

OMB Control Number
and
Expiration Date:

OMB # 1219-0141; Expires 8/31/2016

Filing Options:

Form 2000-222, SCSR Inventory and Report can be filed online
electronically, a spreadsheet may be submitted via email, or the
form fill version can be completed, printed (or printed and filled
in manually) and sent to MSHA. For more information on these
options, please refer to these Detailed Instructions.
File online electronically
Attach Spreadsheet in an Email
Print, fill in and mail or fax

This form is for mine operators' use in providing MSHA with
complete SCSR inventories, as well as in reporting problems
with SCSRs. Operators may attach continuation sheets to this
form provided all required SCSR information is included.
Detailed Instructions for completing Form 2000-222 SCSR
Inventory and Report Form, SCSR Inventory Report is a twopart form that also provides for attaching multiple units. The
form asks for date, MSHA-issued mine ID, mine name, company
name, mine address, contact name, telephone number and
manufacturer/model of SCSR, date of manufacture, serial
number, and report date. Purpose: As part of the Mine
Emergency Evactuation Rule (December, 8, 2006), 30 CFR
75.1714-8 authorizes the collection of this information. MSHA
maintains an inventory of all reported SCSR information to
assure the effectiveness of evacuation plans and emergency
evacuations. In addition, such an inventory will assist in
targeting SCSR recalls to specific mines. MSHA may not sponsor
or endorse products. Persons are not required to respond to this
collection of information unless it displays a currently valid OMB
Control Number. The use of this form will facilitate SCSR
inventory information transfer from mine operators to MSHA. If
filing online, copies will be sent electronically to the
appropriate offices.
Original should be sent to:

Mine Safety and Health Administration

Technical Support

Pittsburgh Safety and Health Technology Center

Attn: SCSR Coordinator

Cochrans Mill Road

626 Cochrans Mill Rd

Pittsburgh, Pennsylvania 15236

http://arlweb.msha.gov/forms/ELawsForms/2000-222.htm[6/1/2016 4:12:02 PM]

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MSHA - Forms and Online Filings - Form 2000-222 - Self Contained Self Rescuer (SCSR) Inventory and Report

Fax: (412) 386-5345
Contact Information:

Questions regarding this form should be directed to MSHA at
(877) 778-6055 or [email protected]

Privacy Notice:

Privacy Notice

Burden Statement:

Public reporting burden for this collection of information is
estimated from 3 hours to 19 hours depending on the size of the
mine per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection
information. Persons are not required to respond to this
collection of information unless it displays a currently valid OMB
Control Number. Send comments regarding this burden estimate
or any other aspect of this collection of information, including
suggestions for reducing this burden, to:
Office of Standards, Regulations and Variances

Mine Safety and Health Administration

201 12th Street South

Arlington, VA 22202-5452

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http://arlweb.msha.gov/forms/ELawsForms/2000-222.htm[6/1/2016 4:12:02 PM]