FixVault

Worksheet Sample

Question Sheet
Customer name MR/MS Registration number   Manuf. Date  
VIN   Model & Year  
In Service Date Engine   Mileage km / Mile
Symptoms □ Vehicle does not move (□ Any position □ Particular position)
□ No up-shift □ No down-shift
□ Lock-up malfunction
□ Shift point too high □ Shift point too low
□ Shift shock (□ N → D □ N → R □ Lock-up □ R, D, L, Manual position)
□ Slip (□ N → D □ N → R □ Lock-up □ R, D, L, Manual position)
□ Noise □ Vibration
□ No pattern select
□ Others
()
First occurrence □ Recently (Indicate approximate month and year)
Frequency □ All the time □ Under certain conditions □ Sometimes (times a day)
Weather conditions □ Not affected
  Weather □ Fine □ Clouding □ Raining □ Snowing □ Other ()
Temp. □ Hot □ Warm □ Cool □ Cold □ Temp. [Approx. °C (°F)]
Humidity □ High □ Middle □ Low
Transaxle conditions □ Cold □ During warm-up □ After warm-up
□ Engine speed (rpm)
Road conditions □ In town □ In suburbs □ Freeway □ Off road (Up / Down)
Driving conditions □ Not affected
□ At starting □ While idling □ While engine racing □ At racing □ While cruising
□ While accelerating □ While decelerating □ While turning (Right / Left)
□ Vehicle speed [ km/h (MPH)]
Other conditions