Interview sheet sample

Interview sheet

Customer name

MR/MS

Registration number

Initial year registration

Vehicle type

VIN

Storage date

Engine

Mileage

km (Mile)

Symptom

□ The steering wheel position (center) is in the wrong position.

□ Power steering warning lamp turns on.

□ The vehicle pulls to one direction.

□ Steering effort fluctuates (□ Not smooth □ Abruptly □ Increased □ Decreased)

□ Noise □ Vibration

□ Others

()

First occurrence

RecentlyOthers ()

Frequency of occurrence

□ Always □ Under a certain conditions of □ Sometimes (time(s)/day)

Climate conditions

□ Irrelevant

Weather

□ Fine □ Cloud □ Rain □ Snow □ Others ()

Temperature

□ Hot □ Warm □ Cool □ Cold □ Temperature [Approx. deg.C(deg.F)]

Relative humidity

□ High □ Moderate □ Low

Road conditions

□ Urban area □ Suburb area □ High way

□ Mounting road (uphill or down hill) □ Rough road

Steering mode settings

Infiniti drive mode selector (), Steering mode setting ()

Operation conditions, etc.

□ Irrelevant

□ When engine starts [Steering wheel angle (deg.), Tilt level (□ High / □ Mid / □ Low)]

□ During driving □ At constant speed driving □ During idling

□ During acceleration □ During deceleration

□ Traveling straight □ During cornering (right curve or left curve)

□ During steering [Steering wheel angle (deg.), Steering speed (□ High / □ Mid / □ Low),

Steering effort (□ Heavy / □ Light)]

□ Fully steered right or left (Road condition:)

Other conditions

Memo