1219-0014 Hazards Conditions Complaint MSHA Intro

11/30/22, 11:26 AM

Hazardous Condition Complaint | Mine Safety and Health Administration (MSHA)

Mine Safety and Health Administration (MSHA)
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HAZARDOUS CONDITION COMPLAINT

Hazardous Condition Complaint
Form ID: N/A

Description: 
Use this online form to notify MSHA of a hazardous condition at a mine. Complaints can be filed
anonymously using this system. Disponible en español.
Control ID: 1219-0014
Expiration Date: April 30, 2023
Filing Instructions: 
Hazardous condition complaints may be reported by calling 1- 800-746-1553, or by using the online filing
links below.
Report a Hazardous Condition at a Mine
Reportar una condición peligrosa en una mina
Contact Information: 
Questions regarding this form should be directed to the MSHA Help Desk at (877) 778-6055
or [email protected]
Privacy Notice: 
Privacy Notice
Burden Statement: 
Public reporting burden for this form is estimated to average 12 minutes per response. The burden estimate
includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and submitting the form. This collection of information is voluntary. You are
not required to respond to this collection of information unless it displays a valid OMB control number. Send
comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: to
the Mine Safety and Health Administration, U.S. Department of Labor, Office of Standards Regulations and
Variances, 201 12th Street South, Arlington, VA 22202, Paperwork Reduction Project (1219-0014). NOTE: Do
not send your completed form to this address.
Online Filing: 
Report a Hazardous Condition at a Mine
https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/hazardous-condition-complaint

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