Customer Diagnostic Survey Form

ENGINE DRIVEABILITY

 

Client Name: ____________________________             Date: ____________________

 

Car Make/Model:____________________________       Licence #: ________________

 

 

IT HAPPENS WHEN…                                DEFINE THE PROBLEM…

THE PROBLEM OCCURS                                         STARTING

            

                                                                                      Does the engine crank   __yes __no

__ Light to medium acceleration

__ Hard deceleration                                                    Does the engine start?   __ yes __no

__ Deceleration (foot off decelerator)                         If yes, how long does

__ Cruising (constant highway speed)                         it take to start?           _____seconds

__ Braking       slowly ____ suddenly ______

__ Turning

__ Air conditioning on                                                   Does the engine start immediately

__ Air conditioning off                                       after starting? __ yes  __ no                                                                                

__ Hot days                                                                                 

__ Cool/cold days                                               Does vehicle have an alarm system?

__ Humid/rainy days                                                          ___yes   ___no 

__ Other _________________________                   Does the vehicle have a remote

Ambient temperature _______ degrees                     starter system?  __ yes __ no

 

Engine temperature                                               IDLE 

__  Cold  __ Hot                                                Engine idles rough/unsteady __y __n

Outside Temperature                                              Engine idles too fast?    __yes __no

__ Cold __ Hot __ Warm

 

THE PROBLEM STARTED                                     PERFORMANCE

__ Suddenly at _______ (odometer)                      __ Hesitates or stalls on acceleration

__ Gradually at ______ (odometer)                           __ Stalls on deceleration or quick stops

__ After abnormal occurrences  (ie potholes)                      __  Lacks power                                                                                  

Before the condition occurs? ___Mins ___Hrs.                  __ Pings or knocks

Since the vehicle was new ______                                 __ Runs on after key is off          

TYPE OF FUEL USED                                 __ Backfires (popping noise)

                                                                                             __ Speed changes w/o accelerating

__Regular                                                            __Check engine light is on

__Mid-Grade                                                       __ Other – describe

__ Premium                                                        ________________________

__ Alternative Fuel                                               ________________________

__ Brand of fuel                                 ________________________

 

THE PROBLEM OCCURS WHEN…

__Rarely __ Sometimes __ Always

 

 

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