Fillable Form 50: Southern Regional th (Mine Safety and Health Administration)

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Form 50: Southern Regional th (Mine Safety and Health Administration)

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50
th
Southern Regional
Mine Rescue Classic
First 50
th
Metal/Non-
Metal Contest in
America
New Iberia, LA
April 27-30, 2020
50
th
SOUTHERN REGIONAL:
MINE RESCUE CLASSIC
NEW IBERIA, LOUISIANA
April 27
th
-30
th
,2020
ENTRY FEE:
$550 per Team
AWARDS DINNER:
$30.00 per Individual
TROPHIES:
1
st
FIELD CONTEST: – 5th
1
st
TEAM TECHNICIAN CONTEST: - 3rd
1
st
FIRST-AID CONTEST:
– 3rd
OVERALL CHAMPION TEAM
: 1
st
Only
(Overall winner is determined by the combined scores from the Field, Team
Technician, and First-Aid)
DEADLINE FOR ENTRY: APRIL 15, 2020
GENERAL INFORMATION
1.
The Captain's meeting will be at the South Louisiana Community College on
Monday, April 27
th
at 4:30 PM. Team positions will be drawn at this time.
Address: 609 Ember Dr., New Iberia La. 70560
2.
All written tests will be administered on Monday at 5:00 PM, immediately following
the Captain's meeting.
3.
The field problems will be held at the Sugarena, on Tuesday, April 28th and
Wednesday April 29
st
Address: 713 NW Bypass Hwy, New Iberia, LA 70560
4.
The First-Aid and Team Technician Contests will be held on Thursday, April 30
th
(additional information will be provided later, see Team Tech contest rules).
Address: 1688 Smede Highway, St. Martinville, La. 70582
5.
The Awards Ceremony and Dinner will be held at the Cade Community Center on
Thursday, April 30
th
at 6:00 PM (menu to consist of boiled crawfish and
jambalaya for those that will not participate in the boiled crawfish).
Address: 1688 Smede Highway, St. Martinville, La. 70582
6.
Special Note
: During the working of the field problem, the Fresh Air Base Attendant
is required to map the team's progress and findings. Comparison of the team's two
maps will not be allowed. The FAB attendant may communicate with the team at all
times, but will not be allowed to compare his or her map with that of the team.
7.
NEW
: Subject: Carbon Dioxide Scrubber- Due to the serious injuries that can ensue, the
Southern Mine Rescue Regional Association has decided, any team member who shows
up to the field without the carbon dioxide scrubber in any of the S.C.B.A.’s will be
assessed 500 discounts for the entire team for that day of the contest. The team will be
allowed to continue in the remainder of the contest.
8.
All entry and dinner fees should be sent to:
Southern Mine Rescue Regional Association
Scott Fountain
Compass Minerals
P.O. Box 10 Lydia LA.
70569
9.
T-Shirts will not be sold at the contest. You may purchase by order with your
entry. T-Shirts are $15.00/Short Sleeve and $20.00/LongSleeve.
10.
The written test for teams will be delivered from the Mine Rescue modules,
MSHA 3027, formerly IG6.
11.
First Aid- Emergency Medical Responder 10
th
Edition.
WE LOOK FORWARD TO SEEING YOU!!
REGISTRATION FORM
Southern Mine Rescue Regional Association, P. 0. Box 10, Lydia, Louisiana
Company Name: __________________________________ Contact Person: __________________________
Address: ________________________ City: _____________________ State: _________ Zip: __________
Phone #: ________________________ Fax: ______________________ Email: _______________________
Team Name: ________________________________________________ No. of Team Members: _________
Field Competition
Team Members:
1. Captain:
2. Team Member:
3. Team Member
4. Team Member:
5. Tail Captain:
6. Fresh Air Base:
7. Fresh Air Base:
8. Alternate:
Trainer/Trainers:
_____________________________________________________________________
Official in Charge at Contest: ____________________________________________________________
First Aid Competition
First Aid Team:
1. ____________________________________________________
2. ____________________________________________________
3. ____________________________________________________
Emergency Medical Response (10
th
Edition)
Team Technician Competition
Team Technician:
1.
__________________________________________________
2. __________________________________________________
Type of Apparatus
BG4 ___________ BioMarine 240 Revolution ______________ BioMarine 240 _____________
*Note
:
All radios must be preprogrammed
with
correct frequency channel according to rule book.
Award Dinner Tickets
A
ward
Dinner
Ticket Amount
Entry Fee
T-Shirt Order ($15/Short Sleeve)
($20/Long Sleeve)
Sizes
Total Amount
$ ______________________
$ _
$ ________________
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Completed 25 September 2021

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