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 □ DS position □ M 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, DS and M position)

□ Slip (□ N→D□ Lock-up □ R, D, DS and M 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