Worksheet Sample

Question Sheet

Customer name MR/MS

Engine #

Manuf. Date

Incident Date

VIN

Model & Year

In Service Date

Trans.

Mileage

km/Mile

Symptoms

Vehicle does not move (Any position Particular position)

No upshift (1GR -> 2GR 2GR -> 3GR 3GR -> 4GR)

No downshift (4GR -> 3GR 3GR -> 2GR 2GR -> 1GR)

Lock-up malfunction

Shift point too high or too low

Shift shock or slip

Noise or vibration

No kick down

No pattern select

Others

Frequency

All the time

Under certain conditions

Sometimes (times a day)

Weather conditions

Not affected

Weather

Fine

Cloud

Rain

Snow

Other ()

Temp.

Hot

Warm

Cool

Cold

Temp. (Approx. deg.C/ deg.F)

Humidity

High

Middle

Low

Transmission conditions

Not affected

Cold

During warm-up

After warm-up

Engine speed (rpm)

Road conditions

Not affected

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