Roster Letter to Miners

P01 – Roster Letter. Sent to miner stating that they can get a medical examination as part of the CWHSP.

Per 42 CFR Part 37.3 Chest radiographs required for miners and 37.92 Spirometry testing required for miners

NOTE: Items in brackets {} are filled in from the database. If there is a slash (/) within the brackets, there are two options for the text. The first two {/} items are for a shared roster between more than one mine and the third {/} item is if there are more than 4 radiographic facilities listed on the Mine Plan.

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Miner Name

Miner Address

Dear Miner Name:

The National Institute for Occupational Safety and Health’s (NIOSH) Coal Workers' Health Surveillance Program (CWHSP) invites you to participate in a free confidential medical screening that includes:

• A health questionnaire

• Blood pressure screening

• A chest x-ray

• A breathing test (spirometry)

These screenings are only offered once every 5 years for a period of 6 months. NIOSH recommends that you receive chest x-rays every 5 years for the first 15 years of coal mining and every 3 years after if you continue to work in coal mining. More frequent chest radiographs are not recommended if screening results remain normal.

Screenings are free because NIOSH has approved a Plan filed by your employer, {OPERATOR_NAME} / {MINE_NAME} ({MINE_CODE}), to offer you this service at your employer's expense. This Plan and screening information should be posted by your employer on bulletin boards in highly visible areas or you should be notified directly. A copy of the Plan should also be made available for your review upon request.

WHEN: Between {MINE_PLANS_PLAN_DATE} and {MINE_PLANS_END_OF_OPEN}

HOW: If you are employed by the above company/mine{:/ or}

{/one of the additional mines listed on the enclosed Mine List:}

Complete the enclosed MINER IDENTIFICATION DOCUMENT. For your convenience, some of the information has already been entered. This form is required:

• Complete both sides

• Provide a complete work history on page 2

• Sign the second page Take it to one of the listed facilities

Once NIOSH receives your information, you should receive your results within 60 days. If there is an urgent problem identified, we will call you as soon as possible. Your results are not shared with your employer.

We hope you participate! If you have any questions or concerns, please contact us:

• Email - CWHSP@cdc.gov

• Phone - 1-888-480-4042

• Mail - NIOSH Respiratory Health Division

1000 Frederick Lane, Morgantown, WV 26508

Sincerely,

Jason Hinkle

Health Assessment Specialist

Coal Workers' Health Surveillance Program

Surveillance Branch

Respiratory Health Division

Enclosure(s)

Mine Contact Information List

MSHA ID Contact Information

XXXXXXX OPERATOR_NAME xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

MINE_NAME xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

CITY, STATE ZIP_CODE xxxxxxxxxxxxxxxxxxxxxxxxxxxxx

XXXXXXX OPERATOR_NAME xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

MINE_NAME xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

STREET xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

CITY, STATE ZIP_CODE xxxxxxxxxxxxxxxxxxxxxxxxxxxxx

XXXXXXX OPERATOR_NAME xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

MINE_NAME xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

STREET xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

CITY, STATE ZIP_CODE xxxxxxxxxxxxxxxxxxxxxxxxxxxxx

Facility List

State Contract Information Available Exams

XX xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Chest X-ray and

Xxxxxxxxxxxxxxxxxx, xx Breathing Test

(xxx) xxx-xxxx

Xx xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Chest X-ray Only

Xxxxxxxxxxxxxxxxxx, xx

(xxx) xxx-xxxx

Xx xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Breathing Test Only

Xxxxxxxxxxxxxxxxxx, xx

(xxx) xxx-xxxx

Xx xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Chest X-Ray and

Xxxxxxxxxxxxxxxxxx, xx Breathing Test

(xxx) xxx-xxxx