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Interview Sheet Sample

Interview sheet
Customer name MR/MS Registration number   Initial year registration  
Vehicle type   VIN  
Storage date   Engine   Mileage km/Mile
Symptom □ Does not operate (______) function
□ Warning lamp for (______) turns ON
□ Noise□ Vibration
□ Other
(______)
First occurrence □ Recently □ Other (______)
Frequency of occurrence □ Always □ Under a certain conditions of □ Sometimes (time/day)
Climate conditions   □ Irrelevant
  Weather □ Fine □ Cloud □ Rain □ Snow □ Others (______)
  Temperature □ Hot □ Warm □ Cool □ Cold □ Temp. [Approx. °C (°F)]
  Relative humidity □ High □ Moderate □ Low
Road conditions □ Urban area □ Suburb area □ Highway
□ Mountainous road (uphill or downhill) □ Rough road
Operating condition, etc. □ Irrelevant
□ When engine starts □ During idling
□ During driving □ During acceleration □ At constant speed driving
□ During deceleration
□ During cornering (right curve or left curve)
□ When steering wheel is steered (to right or to left)
Memo