West Virginia State Seal
West Virginia
Office of Miners' Health Safety &Training

Independent Contractor Reporting - User Entry Record
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Use this form to enter your contact information, the password you will be using to login to the site, and the company or companies for which you wish to submit contractor reports. You must enter values for the fields designated by an "*" in the middle column. If you fail to enter required information an alert box will popup to let you know that the information is required. When you have entered all the information and selected your company name(s), Click on the "Submit Request" button to save the information and have the request processed.
Your request will be reviewed and you should receive an e-mail in a few days that will tell you the results and give you further instructions.
If you change your mind and decide not to submit a request, simply click on the "CANCEL Submission" button.

Click on the twistie above or the "Exit Help" button below to close this help window.


Inactive hide details for How to Navigate this FormHow to Navigate this Form



This is a web Form. There are places in the Form in which you will enter information. When the Form is first opened your cursor will be positioned at the place at the top of the Form which requests your Firstname. If you press the "Tab" key you will be taken to the next place in the sequence which is vertically below your current location. If you do not wish to follow this sequence, you may use your mouse to move directly to a place in which to enter or edit information.
Once you have entered information into a place, you may use the arrow keys to move around within the information that you have entered. You will still use the "Tab" key or the Mouse to move among places.

Click on the twistie above or the "Exit Help" button below to close this help window.


Please Note: This Contact Information is ONLY associated with On Line processing.
To change the official information associated with a company, contact the Charleston office of MHST

*
[indicates required entry
First Name:
*
Middle Initial:
Last Name:
*
Signature:
*used as a report default
Title:
*used as a report default
Contact Company Name:
your primary company where you should be contacted
*
Address 1:
*
Address 2:
Address 3:
City:
*
State/Province/Region:
*
Select from list:
Or enter value:
Zip/Postal Code:
*

Email Address:
*used as a report default
*
Phone number:
*used as a report default
*
Comment:
Select Companies:
*

Company/Permit Selected:


Choose the Independent Contractor(s) for whom you wish to submit monthly reports. Highlight a contractor company by clicking on the Company name/WV Permint # in one of the 3 boxes below. Once highlighted, click on the "Add Company .." button next to the "Company List ..." title to develop your list. Repeat if needed to select multiple companies. Click on any "Remove All" button to erase everything and start again. Do Not enter anything other than an item from the list. You will not be able to create reports for an item not in this list.



Company Listing (3 tables)
Company List A - G
Company List H - S
Company List T - Z
Comment:
Username:
*
(accept or enter your own)
Password:
*
(minimum of 6 characters)
Confirm Password:
*


Last Modified:04/19/2025 04:40 AM
Created:04/19/2025 04:40 AM