Mine Health and Safety in South Africa: A Guide for EMS Providers
Mines sit outside the Occupational Health and Safety Act. They run under the Mine Health and Safety Act, with their own inspectorate, their own regulations for emergency response and accident reporting, and a medical surveillance system that keeps records for 40 years. This guide covers what that regime requires and where EMS crews working on mines fit into it.
How mine health and safety is regulated
The Mine Health and Safety Act 29 of 1996 (MHSA) governs health and safety at every mine in South Africa. It is administered by the Department of Mineral and Petroleum Resources through the Mine Health and Safety Inspectorate, headed by the Chief Inspector of Mines. The detail sits in the Mine Health and Safety Regulations and in the mandatory codes of practice each mine must write for itself.
The Mine Health and Safety Act, No. 29 of 1996
The MHSA puts the primary duty on the employer at each mine: the mine must be designed, operated and maintained so that people can work without endangering themselves or others, as far as reasonably practicable. Health and safety at the mine is the employer's responsibility, and that covers contractors' staff working there, including EMS crews on a mine contract.
The Act sets up a tripartite structure. The Mine Health and Safety Council brings together the state, employers and organised labour to advise the Minister on regulations, research and standards. Health and safety representatives and committees give employees a formal role at each mine.
General workplaces follow a different Act. The Occupational Health and Safety Act 85 of 1993 excludes mines. For first aid, incident reporting and medical surveillance outside mining, see the Occupational Health and Safety guide.
Where the industry stands
Mining in South Africa has become much safer over three decades. Fatalities fell from 615 in 1993 to 41 in 2025, the lowest on record, and injuries fell from 8,515 to 1,871 over the same period. The 2024 total of 42 deaths was the first year with no disaster-type accident, meaning a single event that kills five or more people.
The trend has not held in 2026. By 14 September 2026 the industry had already recorded 49 fatalities, more than in the whole of 2025. Falls of ground remain a persistent cause: 15 of the 2025 deaths, six of them linked to seismic activity.
Occupational disease is the slower problem. Mines reported 1,723 occupational disease cases in their 2024 annual medical reports, mostly noise-induced hearing loss and pulmonary tuberculosis, with 136 cases of silicosis.
| Indicator | Figure | Period |
|---|---|---|
| Mining fatalities | 42 | 2024 (record low at the time) |
| Mining fatalities | 41 | 2025 (current record low) |
| Mining fatalities | 49 | 1 January to 14 September 2026 |
| Reported mine injuries | 1,871 | 2025 |
| Occupational disease cases in annual medical reports | 1,723 | 2024 |
Sources: Department of Mineral and Petroleum Resources statistics and parliamentary replies, the Mine Health and Safety Inspectorate Annual Report 2024/25, and the Minister's address to the Mine Health and Safety Summit on 17 September 2026.
Employer and employee duties under the MHSA
Chapter 2 of the Act sets the employer's core obligations. Most of them turn into paperwork an inspector can ask for: a policy, a risk assessment, a code of practice, a training record. EMS providers on a mine contract work inside that system and are expected to follow the mine's procedures while they are on site.
A safe mine and a healthy workplace
The employer must ensure, as far as reasonably practicable, that the mine is designed, operated, maintained and decommissioned so that employees can work without endangering their health and safety, and that the working environment is safe and without risk to health.
CEO responsibility
The chief executive officer is responsible for health and safety at the mine. Delegating functions to managers does not relieve the CEO of that responsibility.
Staffing, policy and training
The mine must be staffed with due regard to health and safety, have a written health and safety policy, prepare and implement the codes of practice the Chief Inspector requires, and train employees to work safely.
Risk assessment and investigation
The employer must identify hazards, assess the risks, and put controls in place, recording the significant ones. It must also investigate every accident, serious illness and health-threatening occurrence to find the cause and prevent a repeat.
Employee duties and the right to withdraw
Employees must take reasonable care for their own safety and that of others and cooperate with the employer's measures. Section 23 gives every employee the right to leave a working place where circumstances pose a serious danger to their health or safety.
Representatives and committees
A mine with 20 or more employees must have a health and safety representative for each shift at each designated working place. A mine with 100 or more employees must have one or more health and safety committees.
Inspections, stoppages and fines
The Mine Health and Safety Inspectorate has stronger tools than its general-workplace counterpart. An inspector can halt operations on the spot, and the Principal Inspector can impose administrative fines without going to court.
Section 54 instructions
If an inspector has reason to believe that an occurrence, practice or condition at a mine endangers anyone's health or safety, they can issue an instruction under section 54. The instruction can stop work at a working place, a section or the whole mine until the danger is dealt with. Courts have held that the instruction must be based on objective grounds and go no further than needed to address the danger.
Section 54 stoppages are common after serious accidents. For an EMS provider on site, a stoppage does not end the need for cover: crews may be needed for the investigation, for rescue work, or for the teams making the area safe.
Administrative fines
Under sections 55A and 55B, an inspector can recommend an administrative fine where an employer has failed to comply with specified provisions of the Act. The Principal Inspector of Mines decides whether to impose it, refer the matter for prosecution instead, or drop it.
Up to R1 million per contravention. An administrative fine may not exceed R1,000,000, and each contravention can attract its own fine. Fines are payable within 30 days, and criminal prosecution under the Act remains available for serious failures.
Mandatory codes of practice
Section 9 of the MHSA lets the Chief Inspector of Mines issue guidelines that require every mine to prepare its own mandatory code of practice on a given topic. The guideline sets the minimum content. The mine's code, written for its own risks, is what an inspector audits. Several of these codes shape how medical and emergency services work on a mine.
Ask for the codes before the contract starts. A mine's emergency preparedness code and fitness-to-work code will set expectations for your crews: response roles, equipment, induction, medical fitness and communication. Reading them before you price the contract avoids committing to a response standard you cannot staff.
Emergency preparedness, rescue and medical response
Chapter 16 of the Mine Health and Safety Regulations covers rescue, first aid and emergency preparedness and response. The whole chapter was replaced by new regulations published in Government Gazette 52388 on 28 March 2025, and they took effect on that date. For EMS providers it is the most relevant part of the mining regulations.
What the substituted Chapter 16 requires
Mine rescue and where EMS fits
Underground rescue is specialist work. Mines Rescue Services, a non-profit established in 1924 and funded by member mines, trains mine-employee rescue teams and provides rescue services under contract. Rescue team members go through regular medical examinations and pre-deployment fitness checks, which is itself a surveillance workload.
EMS providers work alongside that system rather than inside it. Mines contract EMS for site-based paramedics and medics, standby ambulances, first-aid stations and clinics, and transport from the mine to hospital. The competent-person report on emergency medical care is where that service gets judged: whether the mine has the right people, equipment and response capability for the risks it has assessed.
That report depends on evidence. Response times, crew qualifications per shift, equipment checks and patient outcomes are all things your records can show, or fail to show.
Your crews' fitness counts too. Paramedics who go underground or into hot or confined areas fall under the mine's fitness-to-work standards and must complete the mine's induction and self-rescuer training. Expired medical fitness or induction for a single crew member can take that crew off shift.
Reporting accidents and dangerous occurrences
Chapter 23 of the Mine Health and Safety Regulations sets out which accidents and dangerous occurrences the employer must report to the Principal Inspector of Mines, and on which forms. The system is called SAMRASS, the South African Mines Reportable Accidents Statistical System, and its forms are prescribed in Chapter 21.
Reportable accidents under regulation 23.1
Follow-up reporting
SAMRASS 1 for the accident or occurrence
The main accident and dangerous occurrence report, with supporting forms attached depending on the type of event.
SAMRASS 3 within 14 days for fall-of-ground deaths
Where a death is related to a rockburst or fall of ground, the SAMRASS 3 form goes to the Principal Inspector within 14 days of the death.
Report immediately if the patient deteriorates
If a reported injury later results in death, if a minor injury that was not reportable leads to death, or if sepsis or tetanus develops, the employer must report it immediately and submit an amended SAMRASS 1.
SAMRASS 9 monthly until return to work
A SAMRASS 9 is submitted monthly for every injured person who has not returned to work.
The clinical timeline feeds the statutory one. Whether an injury is reportable often depends on clinical facts your crew records first: loss of consciousness, heat illness, gas inhalation, or a mechanism likely to cause a serious injury. So does the follow-up duty when a patient deteriorates after handover. A complete, timestamped patient report form gives the mine what it needs to classify and report the accident correctly. The Digital Patient Records guide covers what that record should contain.
The regulations also require the place of a reportable accident to be left undisturbed until an inspector releases it, with exceptions for rescue and for making the area safe. Record what your crew moved during treatment and extrication, and why.
Occupational health and medical surveillance
Sections 11 to 20 of the MHSA set up a medical surveillance system that runs from an employee's first exposure to after they leave the mine. The scale is large: annual medical reports submitted for 2024 covered 549,878 employees under medical surveillance.
Hygiene measurements linked to each employee (section 12)
The employer must keep a record of occupational hygiene measurements that can be linked to each employee's record of medical surveillance, so exposure and health outcomes can be read together.
A surveillance system run by an occupational medical practitioner (section 13)
The employer must establish a system of medical surveillance for employees exposed to health hazards, engage an occupational medical practitioner, give them the means to do the work, and keep a record of medical surveillance for each exposed employee.
A record of hazardous work (section 14)
The employer keeps a service record of employees doing work that requires surveillance, and delivers the relevant part to the Medical Inspector when an employee leaves the mine or when the Chief Inspector asks for it.
Confidential records kept for 40 years (section 15)
Each employee's record of medical surveillance is confidential and may only be disclosed in line with the ethics of medical practice, where the law requires it, or with the employee's written consent. It must be stored safely and not destroyed for 40 years from the employee's last surveillance.
An annual medical report (section 16)
Every occupational medical practitioner at a mine compiles an annual report analysing employees' health from the surveillance records, without naming anyone. Copies go to the owner, the health and safety committees or representatives, and the Medical Inspector.
An exit certificate (section 17)
When an employee who was subject to surveillance leaves the mine for any reason, the employer must arrange an exit examination. The occupational medical practitioner issues an exit certificate showing the results of all surveillance and whether any occupational disease is present.
What paramedics can and cannot do
Under the MHSA, medical surveillance is the occupational medical practitioner's responsibility. Site paramedics can support it: taking blood pressure and other measurements, capturing monitoring data, and following up employees on a schedule the practitioner sets. They work within their HPCSA scope of practice, and the clinical findings, fitness decisions and certificates stay with the practitioner.
The records need to show that division clearly. Who captured each measurement, under whose instruction, and who made the decision.
Costs and disputes
Section 18 places the cost of the examinations the Act requires on the employer. Under section 20, an employee found unfit to perform a particular kind of work can dispute that finding, which makes a clear, complete medical record important for everyone involved.
Because surveillance records outlive most contracts, agreements between mines and medical service providers should state where records are held, who can access them, and how they are handed over when the contract ends.
Compensation: COIDA and ODMWA
Mineworkers can fall under two separate compensation systems, depending on what harmed them. Injuries and most occupational diseases go through the Compensation for Occupational Injuries and Diseases Act. Occupational lung diseases at mines go through the Occupational Diseases in Mines and Works Act. The two are run by different departments, with different funds and different processes.
Injuries on duty and other occupational diseases
Accidents at mines, and diseases such as noise-induced hearing loss, are compensated under COIDA. Most mining employers are covered through Rand Mutual Assurance (RMA), a licensed mutual association, rather than the state Compensation Fund. The 2026 COIDA amendments apply in full, including administrative penalties for late accident reporting. The OHS guide covers those changes.
Occupational lung disease
Lung diseases such as silicosis, pneumoconiosis and tuberculosis linked to work at controlled mines and works are compensated under ODMWA. The Medical Bureau for Occupational Diseases assesses claimants, and the Compensation Commissioner for Occupational Diseases, under the Department of Health, pays from the Mines and Works Compensation Fund. Former mineworkers can have benefit medical examinations to check for compensable disease.
The silicosis and TB settlement
The Tshiamiso Trust administers the settlement between six gold mining companies and mineworkers with silicosis or work-related tuberculosis. By February 2026 it had paid out R2.5 billion to eligible claimants and their families across South Africa and neighbouring countries. It runs alongside ODMWA rather than replacing it.
Bill the right fund for the right condition. An injury-on-duty account for a mineworker usually goes to RMA, not the Compensation Fund. An occupational lung disease claim follows the ODMWA route. Confirm the employer's insurer and the claim route when you capture the patient, and record it on the patient record.
Records EMS providers generate on a mine
On a mine contract, your records become part of the mine's statutory evidence. They feed accident classification, SAMRASS reports, investigations under section 11, the competent-person report on emergency medical care and, in some cases, medical surveillance. Retention runs from three years on an incident record to 40 years on a surveillance record, so plan for the longest period that applies.
| Record | What it supports | Retention |
|---|---|---|
| Patient report forms for incidents on the mine | Accident classification, SAMRASS reporting, section 11 investigations, COIDA claims | At least 6 years (HPCSA guidance), longer while claims or investigations are open |
| Monitoring data captured for the occupational medical practitioner | The employee's record of medical surveillance | 40 years from the employee's last surveillance (MHSA section 15) |
| Shift rosters, crew qualifications and response times | The competent-person report on emergency medical care, contract compliance | For the contract term, and as long as the evidence may be needed |
| Crew fitness certificates, inductions and self-rescuer training | Proof that crews were permitted to work where they were deployed | Current at all times, with history kept for the contract term |
| Equipment and vehicle checks | Emergency preparedness audits and incident investigations | For the contract term, and as long as the evidence may be needed |
Where mine contracts go wrong
What a defensible contract looks like
Sources and reference documents
The legislation and bodies referenced in this guide. Mining regulations change regularly, so check for amendments before relying on any specific requirement.
The consolidated Act on SAFLII, including employer duties, codes of practice, medical surveillance, section 54 instructions and administrative fines.
The Council's library of promulgated regulations, including the substituted Chapter 16 on rescue, first aid and emergency preparedness and response.
The department responsible for the Mine Health and Safety Inspectorate. Publishes the Chief Inspector's guidelines for mandatory codes of practice and annual mine safety statistics.
The non-profit mine rescue service provider that trains rescue teams and supports member mines during underground emergencies.
Information on eligibility and claims under the silicosis and tuberculosis settlement for gold mineworkers.