Customer Diagnostic Survey Form

BRAKE SYSTEM EVALUATION

 

Client Name: ____________________________             Date: ____________________

 

Car Make/Model:____________________________       Licence #: ________________

 

 

CONCERN IS OCCURRING                                ARE THE DASH WARNING

__Always __ Sometimes __ Rarely                       LIGHTS ON?

 

 

ARE THE BRAKES MAKING NOISE

__ Squeaking                                                       WHEN THE CONCER OCCURS

__ Squealing                                                        __ Slowing to brake

__ Grinding                                                         __ Hard/sudden braking

__ Rubbing                                                          __ Releasing the brake

__ No noise                                                         __ Tuning & braking

                                                                          __ In the morning/1st drive of the day    

 

How does the brake pedal feel

__ Too soft                                                         OUTSIDE TEMPERATURE

__ Too hard                                                        __ Cold  __ Warm  __ Hot

__ Goes to floor                                              __ Wet              __ Dry

__ Shudders under load

__ Shudders at high speed                                  THE CONCERN STARTED

__ Pulsation                                                        Started on ___________(Date)

 

                                         

 Back to Services Page