Interview Sheet Sample

Interview sheet

Customer name

MR/MS

Registration number

Initial year registration

Vehicle type

VIN

Storage date

Engine

Mileage

km (Mile)

Symptom

□ Does not operate (___) function

□ Warning lamp for (___) turns ON.

□ Noise □ Vibration

□ Other

(___)

First occurrence

□ Recently □ Other (___)

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 □ Highway

□ Mountainous road (uphill or downhill) □ Rough road

Operating condition, etc.

□ Irrelevant

□ When engine starts □ During idling

□ During driving □ During acceleration □ At constant speed driving

□ During deceleration

□ During cornering (right curve or left curve)

□ When steering wheel is steered (to right or to left)

Other conditions

Memo