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.____°C (°F)]

Relative humidity

□High □Moderate □Low

Road conditions

□Urban area □Suburb area □High way

□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