Worksheet Sample
WARNING: This page is about a different car, the 2016 Infiniti QX50. However, it is still accessible from the selected car via links, so may be relevant.
| 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 up-shift (□ 1GR → 2GR□ 2GR → 3GR□ 3GR → 4GR□ 4GR → 5GR□ 5GR → 6GR□ 6GR → 7GR) | |||||||
| □ No down-shift (□ 7GR → 6GR□ 6GR → 5GR□ 5GR → 4GR□ 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 | □ Clouding | □ Raining | □ Snowing | □ Other () | ||
| Temp. | □ Hot | □ Warm | □ Cool | □ Cold | □ Temp. [Approx. °C (°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 | |||||||