Mine Accident, Injury and Illness Report _ Mine Safety and Health Administration (MSHA)

9/18/23, 8:36 AM

Mine Accident, Injury and Illness Report | Mine Safety and Health Administration (MSHA)

U.S. DEPARTMENT OF LABOR

Mine Safety and Health Administration

Mine Accident, Injury and Illness
Report
Form ID: 7000-1
Description
If an accident, injury or illness occurs at or in conjunction with activity at a mine, mine operators

are required to report the circumstances of the incident to MSHA using 
Form 7000-1.
Control ID: 1219-0007
Expiration Date: Wed, 01/31/2024 - 00:00
Filing Options
Form 7000-1, Mine Accident, Injury and Illness Report can be filed online electronically or the

form fill version can be completed, printed (or printed and filled in manually) and sent to MSHA
according to the instructions provided below.
File online electronically
Form fill, print and mail or fax
Change online filing registration information
Filing Instructions

Detailed Instructions for completing Form 7000-1, Mine Accident, Injury and Illness Report
Definitions of terms used in Form 7000-1, Mine Accident, Injury and Illness Report 
Form 7000-1, Mine Accident, Injury and Illness Report is a four-part, color-coded form. If filing
online, copies will be sent electronically to the appropriate offices. 
If you are using the form fill option, make four copies of the completed form and mail or fax as
follows: 
Copy 1: Original (White) should be sent to: 
https://www.msha.gov/support-resources/forms-online-filing/2015/04/14/mine-accident-injury-and-illness-report

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Mine Accident, Injury and Illness Report | Mine Safety and Health Administration (MSHA)

MSHA PEIR-Office of Injury and Employment Information 
P.O. Box 25367
Denver, Colorado 80225-0367 
OFFICE: 1-303-231-5453
FAX: 1-888-231-5515
Copy 2: Return to Duty Report (Pink) should be sent to above address only after the employee
has returned to full duty or been transferred or terminated. Please write Pink at the top and
complete Section D - Return to Duty Information. 
Note: It is not necessary to send in the Pink copy if Section D is completed on the original 70001. 
Copy 3: should be sent to your Local MSHA District Office (Yellow)
District office contact information for Enforcement
(If sending via fax, please use black ink and do not send a copy of the same form via regular mail
unless requested to do so.)
Note: Please write "Yellow" at the top of this copy
Copy 4: should be retained at the mine (or nearest mine office) for five years.
Contact Information
Questions regarding this form should be directed to MSHA at

(877) 778-6055 or [email protected]
Privacy Notice

Public reporting burden for this collection of information is estimated to average 30 minutes per
response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of
information. This is a mandatory collection of information as required by 30 CFR 50.20. The
information is used to establish injury, accident or illness files used to measure the levels of
injury experience and identify those areas most in need of improvement. Send comments
regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to the Office of Program Evaluation and Information
Resources, Mine Safety and Health Administration, U.S. Department of Labor, Room 2301, 201
12th Street South, Suite 401 Arlington, VA 22202-5450, and to the Office of Management and
Budget, Paperwork Reduction Project (1219-0007), Washington, D.C. 20503. 
https://www.msha.gov/support-resources/forms-online-filing/2015/04/14/mine-accident-injury-and-illness-report

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Mine Accident, Injury and Illness Report | Mine Safety and Health Administration (MSHA)

Persons are not required to respond to this collection of information unless it displays a
currently valid control number. 
Privacy Policy
Legal Authority
30 CFR 50.20
Burden Statement
Public reporting burden for this collection of information is estimated to average 30 minutes per

response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of
information. This is a mandatory collection of information as required by 30 CFR 50.20. The
information is used to establish injury, accident or illness files used to measure the levels of
injury experience and identify those areas most in need of improvement. Send comments
regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to the Mine Safety and Health Administration, U.S.
Department of Labor, Office of Standards, Regulations and Variances, 201 12th Street South,
Suite 401 Arlington, VA 22202-5450. Persons are not required to respond to this collection of
information unless it displays a currently valid OMB control number.
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U.S. DEPARTMENT OF LABOR
Mine Safety and Health Administration
201 12th St S
https://www.msha.gov/support-resources/forms-online-filing/2015/04/14/mine-accident-injury-and-illness-report

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Mine Accident, Injury and Illness Report | Mine Safety and Health Administration (MSHA)

Suite 401
Arlington, VA 22202-5450
www.msha.gov
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Mine Accident, Injury and Illness Report | Mine Safety and Health Administration (MSHA)

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