What to know
There are many forms needed for participating in the NIOSH Coal Workers' Health Surveillance Program (CWHSP). Forms listed on this page are for B readers, coal miners, mine operators and contractors, spirometry facilities, and radiograph facilities.
B Readers
Complete this form if you are a physician interested in taking the NIOSH B Reader exam. Email the completed form and a copy of your current medical license to cwhsp@cdc.gov. You will receive a confirmation email with your exam date and additional information.
- Chest Radiograph Classification Form (For official government use only.)
This form must be completed by B Readers that interpret chest radiographs for the CWHSP. Email completed forms to cwhsp@cdc.gov.
This is a general classification form intended to be used by certified B Readers. It is not an official government form.
Coal miners
Miners must fully complete, sign, and provide this form to their health facility during screening appointments. Print/Copy as a double-sided form. The completed form, along with the miner's chest x-ray, will then be submitted to the CWHSP.
Miners wishing to receive copies of their CWHSP chest x-rays and related files must fully complete, sign, and email the form to cwhsp@cdc.gov. The form can also be mailed or faxed using the address and fax listed on the form.
Mine operators and contractors
Coal mine operators should use this form when submitting plans for their miners to receive chest x-rays at designated x-ray facilities. Plans and Part 48 trained employee rosters must be submitted to the CWHSP that include names and home addresses:
No later than 60 days after opening a new mine
OR
Within 30 days when mine ownership is transferred.
Email completed forms to cwhsp@cdc.gov. If unable to email, send by mail using the address listed on the form.
Contractors should use this form when submitting a mine plan for their employees to receive chest x-rays at designated x-ray facilities. Plans and Part 48 trained employee rosters must be submitted to the CWHSP that include names and home addresses:
No later than 60 days after opening a new mine
OR
Within 30 days when mine ownership is transferred.
Email completed forms to cwhsp@cdc.gov. If unable to email, send by mail using the address listed on the form.
Spirometry facilities
Complete this request form to become a NIOSH-approved spirometry facility. Email completed forms to cwhsp@cdc.gov. If unable to email, send the form by mail using the address listed on the form.
This form must be completed by NIOSH-approved spirometry facilities prior to each spirometry test session and emailed to cwhsp@cdc.gov. The form should be used to identify possible contraindications to testing or factors that might affect testing results.
NIOSH-approved spirometry facilities must complete this form during initial spirometry tests and at each subsequent test. Email completed forms to cwhsp@cdc.gov.
Radiograph facilities
Complete this form to become a NIOSH-approved radiograph facility. Email completed forms to cwhsp@cdc.gov. If unable to email, send the form by mail using the address listed on the form.