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