Refuge alternatives are airtight, reinforced shelters that underground coal miners can enter during a mine emergency. Although different states and different mines refer to refuge alternatives by different names, this publication will refer to refuge alternatives that are close to the working face as refuge chambers, whether inflatable from a skid or constructed from steel. Other common terms for refuge chambers are rescue chambers, rescue shelters, and refuge shelters. Refuge alternatives that are outby of the face area, whether a prefabricated refuge chamber or one built into a crosscut, will be referred to as outby refuges because of their location in the mine. Outby refuges can be permanent, semipermanent, or portable and are usually located at every other self-contained self-rescuer (SCSR) cache. Outby refuges are sometimes called hardened rooms, outby shelters, or in-place shelters. Refuge chambers are safe havens that provide breathable air, food, water, and a safe environment for up to 96 hours. They are typically made of steel or have tents that inflate from a steel skid. In 2008, the U.S. Department of Labor's Mine Safety and Health Administration (MSHA) mandated that all underground coal mines provide refuge alternatives at each working face and at additional locations outby the faces 73 Fed. Reg. 80698 (2008)]. Refuge chambers are usually portable so that they can be moved as mining advances. It should be noted that entering a refuge chamber is a last resort for miners in an emergency situation. Although this option is considered a last resort, as refuge chambers are added to underground coal mines, mine trainers and refuge chamber manufacturers are faced with the task of training miners how to operate them. The regulation 73 Fed. Reg. 80698 (2008)] states that in addition to an introductory training session, each quarterly evacuation drill must include a review of the procedures for use of refuge alternatives. In addition, annual expectations training must include deployment and operation of refuge alternatives similar to those in use at the mine. As part of a larger project titled "Refuge Chamber Training," NIOSH researchers observed four introductory refuge chamber training sessions and created this document to summarize their findings and make recommendations for future training sessions. This publication is intended to provide recommendations for training miners in how to operate a refuge chamber and may also be used to train miners on the operation of other types of refuge alternatives.