Worksheet Sample

Question Sheet

Customer name MR/MS

Engine #

Manuf. Date

Incident Date

VIN

Model & Year

In Service Date

Trans.

Mileage

km/Mile

Symptoms

□ Vehicle does not move (□ Any position □ Particular position)

□ No upshift (□ 1GR -> 2GR □ 2GR -> 3GR □ 3GR -> 4GR □ 4GR -> 5GR □ 5GR -> 6GR □ 6GR -> 7GR)

□ No downshift (□ 7GR -> 6GR □ 6GR -> 5GR □ 5GR -> 4GR □ 4GR -> 3GR □ 3GR -> 2GR □ 2GR -> 1GR)

□ Lock-up malfunction

□ Shift point too high or too low

□ Shift shock or slip

□ Noise or vibration

□ No kick down

□ No pattern select

□ Others

Frequency

□ All the time

□ Under certain conditions

□ Sometimes (times a day)

Weather conditions

□ Not affected

□ Weather

□ Fine

□ Clouding

□ Raining

□ Snowing

□ Other ()

Temp.

□ Hot

□ Warm

□ Cool

□ Cold

□ Temp. (Approx. deg.C/ deg.F)

Humidity

□ High

□ Middle

□ Low

Transaxle conditions

□ Not affected

□ Cold

□ During warm-up

□ After warm-up

□ Engine speed (rpm)

Road conditions

□ Not affected

□ In town

□ In suburbs

□ Freeway

□ Off road (Up/Down)

Driving conditions

□ Not affected

□ At starting

□ While idling

□ While engine racing

□ At racing

□ While cruising

□ While accelerating

□ While decelerating

□ While turning (Right/Left)

□ Vehicle speed [ km/h (MPH)]

Other conditions