Reporting Instructions and Specific Instructions
Definitions
Privacy Statement
Please Note:
The form is a four-part form. The electronic version provided here is not. You will need to make four copies of the form. Handling procedures for the four color-coded pages are different; please note the following:
Page 1 MAIL THIS PAGE TO THE OFFICE OF INJURY AND EMPLOYMENT
INFORMATION, P.O. BOX
25367, DENVER, COLORADO 80225. |
Page 2 FIRST, WRITE "YELLOW" ON THE TOP OF THE
COPY.
SECOND EITHER MAIL IT TO YOUR LOCAL MSHA DISTRICT
OFFICE OR
SUBMIT A FACSIMILE TO YOUR LOCAL MSHA DISTRICT
OFFICE .
(Please prepare fax copies with black ink and
do not send a copy of the same form
in the mail unless
requested to do so.) |
Page 3 FIRST, WRITE " PINK " ON THE TOP OF THE
COPY.
SECOND, EITHER MAIL IT TO THE OFFICE OF INJURY AND
EMPLOYMENT
INFORMATION, P.O. BOX 25367, DENVER, COLORADO
80225 or
SUBMIT A FACSIMILE TO THE TOLL FREE NUMBER 1
888 231-5515.
(Please prepare fax copies with black ink
and do not send a copy of the same form
in the mail
unless requested to do so.) |
| Page
4 RETAIN THIS COPY AT THE MINE
(OR NEAREST MINE OFFICE) FOR 5
YEARS. |
Form 7000-1 |
