Worksheet Sample

Question Sheet

Customer's Name

MR/MS

Registration Number

Initial Year Registration

Year Month

day

Vehicle type

Chassis No.

Storage Date

Year Month

Day

Engine

Mileage

km/mile

Symptom

Vehicle does not start. (R position D position L position)

Upshifting does not occur. Downshifting does not occur.

Lock-up malfunction

Shift point is too high. Shift point is too low.

Shift shock (N → D Lock-up R, D, and L position)

Slip (N → D Lock-up R, D, and L position)

Noise Vibration

When selector lever position is shifted, shift pattern does not change.

Other

(_____)

First occurrence

Recently (as from month of year)

Frequency of occurrence

Always Under certain conditions Sometimes (time(s)/day)

Climate conditions

Irrelevant

Weather

Clear Cloud Rain Snow Others)

Temperature

Hot Warm Cool Cold Temperature (Approx. deg. C/ deg. F)

Relative humidity

High Moderate Low

Transaxle condition

In cold-start During warm-up (approx. deg. C/ deg. F) After warm-up

Engine speed: RPM

Road conditions

Urban area Suburb area Highway

Mountainous road (uphill or downhill)

Operating condition, etc.

Irrelevant

When engine starts During idling During driving

During acceleration At constant speed driving During deceleration

During cornering (RH curve or LH curve)

Other conditions