"Mining Qualifications - Application for a certificate of"
Health and Safety Executive Management and Administration of Safety and Health at Mines Regulations 1993 Click for guidance Mining Qualifications Click for printable version Application for a Certificate of Qualification for Coal Mines • The completed application form should be sent to: Mining Qualifications, The Health and Safety Executive, 3rd Floor Edgar Allen House, 241 Glossop Road, Sheffield, S10 2GW. Telephone: 0114 291 2390 Part I Surname Forenames Date of birth Private address I apply for a: (please tick appropriate box) First Class Certificate of Qualification Second Class Certificate of Qualification Electrical Engineer’s Certificate Class I Electrician’s Certificate Class II Electrician’s Certificate Mechanical Engineer’s Certificate Class I Mechanic’s Certificate Class II Mechanic’s Certificate Mine Surveyor’s Certificate of Qualification Deputy’s Certificate I enclose: Birth Certificate Proof of academic qualification For First and Second Class Certificates: Gas Testing and Hearing Certificate valid on the date of this application Examination in mining health and safety law pass letter For Electical and Mechanical Engineers Certificates: Examination in mining health and safety law pass letter For Mine Surveyor’s Certificate: Practical examination in mine surveying pass letter For a Deputy's Certificate: Proof of a pass in the practical underground test at a mine Signature Date Part II - Manager’s Declaration of statement of practical experience (not required for practical experience under approved schemes) I, being the manager of Coal Mine, certify that of Coal Mine, has completed the practical experience detailed. For Mine Surveyor’s Certificate only: The particulars of practical experience given by in columns (i) - (vi) overleaf are correct and that they were in my employment from to during which period they have been regularly engaged in surveying and levelling underground and that they have executed responsible work under my supervision. Signature Date Mining Qualifications (08.06) Part II (cont’d) 1. If you already hold any Mining Qualification Certificate please give details below: Name of Certificate Certificate Number Date of Issue Office of Issue 2. If you have completed a management training scheme or an apprenticeship scheme approved by the HSE for the qualification applied for, you should enclose the certificate(s). 3. Statement of Practical Experience (this need not be completed if 2 above applies) Workshop, Mine or Period Months Years Name of posts held other place at which Full particulars of (in date order) practical experience practical experience Date From Date To obtained (i) (ii) (iii) (iv) (v) (vi) (vii) Total period Continue this table overleaf if required 3. Statement of Practical Experience (cont’d) Workshop, Mine or Period Months Years Name of posts held other place at which Full particulars of (in date order) practical experience practical experience Date From Date To obtained (i) (ii) (iii) (iv) (v) (vi) (vii) Total Period c/f Total Period 4. Summary - For Electrical and Mechanical Engineering Certificates, Class 1 and II Electrician’s and Mechanic’s Certificate only The practical experience stated in Columns (i) - (vii) of Part II (3) includes the following: (a) Workshop experience Years Months (b) Plant maintenance etc, including supervision Years Months Supervision (if any): Number of Persons Period Occupation Supervised (c) Time spent at a Coal Mine Years Months (d) 200 days spent below ground Yes No Guidance Notes for completion of Mining Qualifications Forms Back to Page 1 1. The granting of statutory certificates of qualification is governed by the Management and Administration of Safety and Health at Mines Regulations 1993. 2. The academic and practical requirements for certificates of qualification are contained in the document entitled “HSE Criteria for Qualification for Coal Mines”. Copies of the document can be obtained from the HSE at the address on the form or from the Internet at http://www.hse.gov.uk/mining/coalqual/index.htm. 3. Where it is required to complete the Statement of Practical Experience, and the applicant has been employed at more than one coal mine, the statement should be confirmed by the manager completing the Manager’s Declaration in Part II. 4. The qualifications and practical experience normally relate to those obtained in the United Kingdom. There are statutory requirements for the mutual recognition of qualifications obtained in member states of the European Union. HSE will consider such qualifications in accordance with these requirements. Relevant qualifications and practical experience from countries outside the European Union may also be considered. Individuals claiming mining experience outside of the UK should contact the HSE at the address on the form. 5. Photocopies of certificates can be sent in place of the originals. The applicant’s Mine Manager should properly certify any photocopies. Uncertified copies will not be accepted. WARNING: A person knowingly or recklessly making a false statement for the purpose of obtaining a Certificate under the Management and Administration of Safety and Health at Mines Regulations 1993, is liable on conviction, to a fine (Health and Safety at Work etc Act, 1974, s33(1)(k),(3)). Back to Page 1