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.

Power steering warning lamp turns on.

The vehicle pulls to one direction.

Steering effort fluctuates (Not smooth Abruptly Increased Decreased)

Noise Vibration

Others

()

First occurrence

Recently Others ()

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. deg.C (deg.F)]

Relative humidity

High Moderate Low

Road conditions

Urban area Suburb area High way

Mounting road (uphill or down hill) Rough road

Steering mode settings

Infiniti drive mode selector (), Steering mode setting ()

Operation conditions, etc.

Irrelevant

When engine starts [Steering wheel angle (deg.), Tilt level (High / Mid /Low)]

During driving At constant speed driving During idling

During acceleration During deceleration

Traveling straight During cornering (right curve or left curve)

During steering [Steering wheel angle (deg.), Steering speed (High / Mid /Low),

Steering effort (Heavy / Light)]

Fully steered right or left (Road condition:)

Other conditions

Memo