Customer Name: ____________________________________________
Date: _______________
Service Rep: _______________________________________________
Repair Order #:___________
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Starting Problems |
Cranks, But Won't Start Will Not Crank Starts, but Takes a Long
Time |
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Engine Quits/
Running Problems |
QUITS: Right after Starting While Idling When Parking
During Steady Speed Driving Right after Vehicle Comes to a
Stop
When Put in
Gear During Acceleration |
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Poor Idling Conditions |
Idle Speed: Is Too Slow at All
Times Is too Slow With A/C On
Is Rough or Uneven Is Too Fast
Fluctuates Up and Down |
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Poor Running
Condition |
Runs Rough Lacks Power
Back-Fires Bucks and Jerks
Fuel, Gas, or Sulfur Smell Engine Light on Sometimes Engine
Light Always On
Misfires or Cuts Out Poor Fuel Economy Engine
Knocks, Pings, Rattles
Dieseling or Run-On Surges and/or Chuggles Hesitates or Stumbles on
Acceleration |
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Auto-Transmission Problems |
Improper Shifting (Early / Late) Changes Gears
Randomly On It's Own
Vehicle Does Not Move When in Gear |
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Poor Handling |
Pulls to One Side Hard Steering Vehicle Shakes and /
or Vibrates While Moving |
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Noise Problems |
Explain: |
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Odor Problems |
Explain: |
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Problem Frequency |
Always Often
Occasionally |
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Usually Occurs |
Morning Afternoon
Evening |
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Engine Temperature |
Cold Warm
Hot |
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Vehicle Speed |
Low Cruising
High |
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Driving Conditions During Occurence |
Short- Less Than 2 Miles Less Than 10 Miles Long
-More Than 10 Miles
Stop and Go Mile Turning While Braking
At Gear Engagement With A/C Operating
With Headlights On
During Acceleration During Deceleration
Rough Road
Mostly Uphill Mostly Downhill Mostly Level
Mostly Curvy |
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Driving Habits |
Drive Hard Before Engine is Warmed Allow Engine to Warm
Mostly
City
Driving Highway Park Vehicle Inside
Outside
Drive Per Day: Less Than 10 Miles 10-50 Miles More
Than 50 Miles
Fuel Octane: 87 89 91 Brand:
Do You Maintain Your Vehicle Regularly?
If Yes When was the Last Maintenance Performed? |
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Outside Weather |
Cold Warm Hot Wet/Rainy Fog Snow/Hail
Dust/Dirt
Dry Humid |
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Additional Notes/Comments: |
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