Get Coa-ar Exdes Ancillary Report Form - Nsw Department Of ...

This guide provides step-by-step instructions on how to accurately fill out the COA-AR ExDES Ancillary Report Form for the NSW Department of Trade & Investment. Proper completion of this form is essential for reporting incidents related to explosion-protected diesel engine systems in coal operations.

Follow the steps to successfully complete the online form.

1. Click ‘Get Form’ button to obtain the form, ensuring it opens in an editable format.
2. In the first section, provide information about the coal operation where the incident occurred, including the name of the operation and the date of the incident. If known, include the mine identification number.
3. Next, in the machine identification section, fill out the relevant fields such as MDR1 or MDA1, MIR1, machine manufacturer, model, and owner.
4. For the last inspections section, input the date of the last Code D inspection and the registered service facility number. Additionally, record the date when the failed component was last inspected or tested.
5. In the type of ex failure section, identify and tick only the most likely cause of the incident from options including spark external to the engine, flame external to the engine, or excessive surface temperature.
6. In the location of failure section, specify which component of the diesel engine system failed by ticking the appropriate box, such as exhaust flame trap or engine block.
7. If applicable, go to the failure mode of engine component section to indicate which major component failed and how it failed by selecting from the listed options.
8. If directed, in the control system failure section, indicate the specific control component that failed and describe how the failure occurred.
9. In the recommendations for prevention section, provide details on causal factors and whether a design change could prevent or minimize future failures, adding any necessary comments or additional pages.
10. At the final step, include necessary comments in the provided section and ensure the form is signed by the manager of mechanical engineering. State whether the manufacturer has been informed of the failure, and fill in their name and date signed.
11. Once you have completed the form, save your changes, download a copy, print it for records, or share it as required.

Complete the COA-AR ExDES Ancillary Report Form online to ensure compliance and proper incident documentation.