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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.

NoiseVibration

Others

()

First occurrence

RecentlyOthers ()

Frequency of occurrence

AlwaysUnder certain conditions Sometimes (time(s)/day)

Climate conditions

Irrelevant

Weather

Fine, Cloud, Rain, Snow, Others ()

Temperature

Hot, Warm, Cool, Cold Temperature [Approx. deg.C (deg.F)]

Relative humidity

High, Moderate, Low

Road conditions

Urban area, Suburb area, Highway

Mountain road (uphill or downhill)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