Interview Sheet Sample

Interview sheet

Customer name

MR/MS

Registration number

Initial year registration

Vehicle type

VIN

Storage date

Engine/traction Motor

Mileage

km (Mile)

Symptom

□ Does not operate () function

□ Warning lamp turns ON.

□ or □ or □ □

□ Other ()

□ Noise (Location:) □ Vibration (Location:)

□ 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

□ Ordinary road □ Highway □ Mountainous road (uphill or downhill) □ Rough road

Operating condition, etc.

□ Irrelevant

□ When engine/traction motor starts □ During idling

□ During driving □ During acceleration □ At constant speed driving

□ During deceleration

□ Immediately before stop [Vehicle speed: Approx. km/h (MPH)]

□ During cornering (right curve or left curve)

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

Other conditions

VDC OFF switch operation

□ Yes □ No

Use of other functions

(ex. ICC)

□ Yes □ No ()

Presence of non-genuine parts installation

□ Yes □ No ()

Memo