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---□ Other (-------)

Temperature

□ Hot---□ Warm--□ Cool--□ Cold--□ Temp. (Approx.----°C/°F)

Relative humidity

□ High----□ Moderate----□ Low

Transaxle condition

□ In cold-start --□ During warm-up (approx. ----°C/°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