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.

□Warning lamp turns on.

□Noise □Vibration

□Others

(____)

First occurrence

□Recently □Others (____)

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 □Highway

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

Operation conditions, etc.

Irrelevant

□When engine starts □During idling

□During driving □During acceleration □At constant speed driving

□During deceleration □During cornering (right curve or left curve)

□During steering

Other conditions

Memo