Online Submittals and Forms - Kentucky Energy and Environment Cabinet

Kentucky Energy and Environment Cabinet

These are forms used by the Division of Mine Safety. Some of the forms are fillable, while others will require to be completed after printing a hard copy.

Drug Test Reporting Form (DTR-1)Certification form of a drug or alcohol violation.Notification of an Occupational Injury (EB-83)Accident/injury report form.Staff Training RequestTraining request form.Mine License Application (EB-4)Application for a mine license.Application for Miner Certification (EG-47)Application for miner certification.MET Application for Initial Certification of Training (EF-18)Application for the 40-hour initial training course or challenge for renewal.Application for MET Certification (EF-17)Application for persons who are certified EMTs or certified EMT instructors that are exempted from challenging the MET examination.MET Recertification of Training (EF-16)Recertification of training for an MET.Certificate of Training (MSHA Form 5000-23)Certificate of training form as required by the U.S. Department of Labor, Mine Safety and Health Administration.Mine Foreman, Asst. Foreman, Instructor, and Inspector Application (EA-37)Application for surface and underground mine foreman and instructor, assistant foreman, and mine inspector.Hoisting Engineer for Electrically Driven Hoist ApplicationApplication for hoisting engineer for electrically driven hoist.Blaster Affidavit for Underground MinesAffidavit for conventional, solid blasting, or drill operator.Electrical Worker CertificationCertification requirements and forms for an electrical worker. Includes the required qualifications, experience, documentation, and affidavit.Notification of Training (EF-13)Training notification conducted by private and contract instructors.Class Enrollment Form (EF-6A)Class enrollment form for private and contract instructors.