Certified Mine Safety Professional Certification Board

The
Certified Mine Safety Professional Certification Board

PO Box 690, Veradale, WA 99037-0690; 888-481-1899; fx: 509-922-5509; rhiggins@ismsp.com
CERTIFIED MINE SAFETY PROFESSIONAL (CSMP) Program

Procedures and Requirements
General Criteria: 1. To qualify to sit for the CMSP professional examination you must be actively engaged in a mine safety position, (i.e., manager, coordinator, trainer, inspector, officer, etc.). Membership in The International Society of Mine Safety Professionals is not required to qualify as a CMSP. However, participation in organizations such as ISMSP may assist in keeping your continuing education requirements current as well as offering extensive networking opportunities. 2. CMSP are internationally recognized professional designations. In preparing for the examination you will find it advantageous to have a good understanding of international mining laws, rules, and regulations. 3. Candidates for the CMSP designation must have a minimum of ten (10) years of mining experience, two of which must have been in mine safety per paragraph 1 above. a. A baccalaureate degree in Safety Engineering, Industrial Safety or Industrial Hygiene from a recognized college or university may be substituted for three (3) years of mine safety experience. b. A baccalaureate degree in Mine Engineering, Metallurgy, Geology or other mine related disciplines (approved by the Membership Committee) may be substituted for two (2) years of mining experience or one (1) year of direct safety experience. c. Non-mining related baccalaureate degrees may be substituted for one (1) year of mining experience or one (1) year of safety experience.
Please note: All graduate and undergraduate degrees are given the same level of credit in substitution for actual working safety experience. Peoples lives and company welfare depend upon the decision of the mine safety professional. Our experience has been: there is no substitute for experience.
HOW TO APPLY: 1. Complete the accompanying Application for Certified Mine Safety Professional. The Certified Mine Safety Professional Certification Board will review the application to determine eligibility for examination. Notification will be communicated to you promptly. 2. If a candidate qualifies to sit for the CMSP Examination, the fee will be $500. 3. The examination will take approximately eight hours to complete. It is an objective test consisting of 200 questions. Should you fail the examination, you will have one year under this application to retake it. After one year you must submit a new application. 4. Preparation courses for the CMSP examination are available. Contact the ISMSP office for information on time and location of current courses1.
1 You are not required to enroll in any CMSP Preparation Course as a condition for taking the examination, nor is completion of any such course a guarantee of passing.
Membership in The International Society of Mine Safety Professionals is not a requirement to be a Certified Mine Safety Professional. However, among the many benefits of membership, you can receive credit toward your CMSP recertification fee.
Please continue to examination application
The Certified
Mine Safety Professional Certification Board

PO Box 690, Veradale, WA 99037 1-888-481-1899; fax: 509-922-5509
Certified Mine Safety Professional Examination Application Form

A. APPLICANT PERSONAL DATA Last Name First Name U.S. Address Outside U.S. Home Phone (Area Code/No) Street Address (Home) Street Address (Home) Work Phone (Area Code/No) Apt. Province (if applicable) FAX (Area Code/No) Box No. Middle Name/Initial City Country State (U.S.) BIRTH DATE Zip Code Postal Code
PHONE NUMBERS: For countries outside U.S., please include country and city codes.
EMAIL ADDRESS
Type of Mine: Coal, Metal, Non-Metal, Sand & Gravel
B. COLLEGE EDUCATION (If you are seeking credit toward certification, you must enclose a certified transcript.) Number of Course Dates Attended College or University From Academic of Study Degree Transcript To (Name, City, State, Years or Major Earned (Check One) Mo/Yr Mo/Yr Country) Completed Enclosed School sending Not sending any Enclosed School sending Not sending any C. SUMMARY OF PROFESSIONAL SAFETY EXPERIENCE
(You must complete an Experience Form for each position listed.) POSITION START DATE (Most recent position first) EMPLOYER (Mo/Yr) 1. 2. 3. 4. 5. END DATE (Mo/Yr) MONTHS IN POSITION
D. PROFESSIONAL REFERENCES (List persons who are providing a Reference Form.) PROFESSIONAL REFERENCE TITLE PERIOD RELATIONSHIP NAME COVERED 1. 2. 3. E. CURRENT LICENSE, REGISTRATIONS, & CERTIFICAITONS (Check all that apply. Attach copy for credit.) CIH CHP PE CRSP NEBOSH SISO OHST CHST CSP OTHER ASP
F. PROFESSIONAL SOCIETY MEMBERSHIPS (Check all current memberships.) ISMSP ACGIH ASSE NSMS HPS SSSO SFPE NSC IIE HFS AIHA OTHER
G. PRIMARY SAFETY SPECIALTY (Check the one safety specialty that best describes your overall qualifications.) Mine Safety/Loss Control Transportation Safety Construction Safety Industrial Hygiene Product Safety Environmental Radiation Safety Fire Protection Process Safety General Safety System Safety OTHER
H. VALIDATION (Be sure to sign and date your application, or it cannot be processed. Your signature means you agree with the following statements.) 1. Have you ever been convicted of a criminal offense? (If YES, explain fully on separate sheet.) Yes No
2. 3. Have you ever had a professional registration or certification denied, suspended, or revoked other than for lack of minimum No qualification or failure of examination? (If YES, explain fully on separate sheet.) Yes I certify that the statements above (including any attachments submitted) are accurate to the best of my knowledge. I hereby authorize the Society to verify any information submitted. I understand that any falsification of information in this application (or attachments) may be cause for rejection or withdrawal of certification. I further agree to hold the International Society of Mine Safety Professionals harmless from any and all liability in the event this application is rejected on the basis of information furnished by me or third persons that would, in the judgment of the Society, make me ineligible for certification. Although every effort will be made to keep my application confidential, I understand that the International Society of Mine Safety Professionals is under no obligation to keep confidential any statements, material, information, etc., that I submit. I further agree to adhere to the Societys Code of Professional Conduct and to meet the requirements for Continuance of Certification, if I am certified. Date ______________________________________ Applicant Signature (in ink)
I.
APPLICATION PAYMENT INFORMATION (The application fee is not refundable.)

CREDIT CARD AUTHORIZATION Expiration Date Credit Card Number Amount $ Signature
EXAMINATION FEE PAID BY Check or Money Order Visa MasterCard (U.S. Dollars only) American Express Make checks payable to CMSPCB
Date
PROFESSIONAL SAFETY EXPERIENCE FORM

Applicants for the Certified Mine Safety Professional Examination are required to complete the experience qualification forms for all professional safety experience regardless of previous certifications, licenses or educational status. It is necessary to submit a form for each employer listed in Section C Summary of Professional Safety Experience. Please copy this page as many times as necessary to complete the application. Name:
Last First Middle
Name of Organization: Work Address:

Street Address City State/Province Suite Number Country Zip Code
Dates of Employment:
Start Date End Date
Name of Supervisor: Title of Supervisor: Work Phone: Email: Fax:
Work Description
Provide a concise, full description of your position and how the assigned responsibilities relate to the professional safety experience requirement in Section C of the application. (If additional space is needed, please use the reverse side of this sheet.)
Signature
Date
LETTER OF REFERENCE
Applicants for the Certified Mine Safety Professional Examination are required to have a letter of reference submitted for each reference listed in Section D of the application. Please copy this page as many times as necessary to complete the application. Applicants Name:
Last First Middle
Name of Reference: Work Address:

Street Address City State/Province Suite Number Country Zip Code
How long have you known the applicant?

Years
Relationship to Applicant: Work Phone: Email: Fax:
Reference Description
Provide a concise, full description of why you believe the applicant qualifies to sit for the Certified Mine Safety Professional Examination. (If additional space is needed, please use the reverse side
of this sheet.)
Signature
Date
The
Certified Mine Safety Professional Certification Board
Code of Professional Conduct As a Certified Mine Safety Professional I recognize my work has an impact on the protection of people, property and the environment. Therefore, I shall uphold and advance the integrity, honor and dignity of the mine safety, health and environmental profession by:
Enhancing protection of people, property and the environment through leadership and understanding Providing honest, impartial service to the public, employers and clients Endeavoring to improve my competence and the competence of the mine safety profession Never compromising my profession or what it stands for, and practicing only the highest degree of professional conduct
I shall hold paramount the protection of people, property and the environment; I shall advise employers, clients, employees or appropriate authorities when my professional judgment indicates the protection of people, property or the environment is unacceptably at risk; I shall endeavor to continually improve my abilities as a safety professional; I shall only perform professional services that I am competent to perform; I shall only issue public statements in an objective and truthful manner in accordance with the authority bestowed upon me; I shall act in professional matters as a faithful agent or trustee and avoid conflict of interest; I shall build my professional reputation on merit of service; and I shall assure equal opportunities for individuals under my supervision.
As a member of the International Society of Mine Safety Professionals, I shall comply with this Code of Professional Conduct.
__________________________
Signature
___________________________
Date
Examination Application Checklist

Be sure to check off and enclose each required item. All items must be completely filled out, signed and dated. All required information must be submitted in this package.
___ Code of Conduct (Your signature is required.) ___ Certified Mine Safety Professional Examination Application Form ___ Letters of Reference (one for each reference named in the application) ___ Professional Safety Experience Form (One for each position/employer) ___ Copy of Resume (if appropriate) ___ Check or Credit Card information to CMSPCB (Depending on how you intend to pay for your testing fee (and Preparation Course fee, if applicable).

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The

Certified Mine Safety Professional Certification Board

CERTIFIED MINE SAFETY PROFESSIONAL (CSMP) Program

Please continue to examination application

Mine Safety Professional Certification Board

Certified Mine Safety Professional Examination Application Form

Type of Mine: Coal, Metal, Non-Metal, Sand & Gravel

APPLICATION PAYMENT INFORMATION (The application fee is not refundable.)

PROFESSIONAL SAFETY EXPERIENCE FORM

Name of Organization: Work Address:

Name of Supervisor: Title of Supervisor: Work Phone: Email: Fax:

Name of Reference: Work Address:

How long have you known the applicant?

Relationship to Applicant: Work Phone: Email: Fax:

Certified Mine Safety Professional Certification Board

Examination Application Checklist

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