Customer Diagnostic Survey Form


Client Name: ____________________________             Date: ____________________


Car Make/Model:____________________________       Licence #: ________________



IT HAPPENS WHEN…                                  DEFINE THE PROBLEM…


UNUSUAL NOISES                                               AIR CONDITIONING

Are there any unusual noises?  __Yes __ No        Is there any cooling effect? __Yes __ No 

If yes, please describe the noises and                        If No, how long has the A/C been

Where it seems to be coming from:                   inoperable? _________ months


_____________________________                           If yes,  how long does it take

_____________________________                to cool the vehicle? _________mins/km

_____________________________                           How many days since the air

_____________________________                conditioner was operated? ______ days

Noise increases with engine speed?                      Noise occurs when A/C

__Yes __ No                                                   compressor is on?   __ Yes  __ No


Noise changes when control lever is moved         Outlet temperature fluctuates back

To change outlet?  __ Yes __ No                         and forth? __ Yes  __ No

                                                                                Cooling effectiveness fades?__Yes __ No


Are there any unusual odours? __ Yes __ No

If yes, please describe (ex. Oily, chemical, etc)      HEATING


_______________________________                   Does the heating system work

_______________________________                   properly? __ Yes  __ No

                                                                        Is there any heating effects?__Yes __No

THE PROBLEM STARTED                                   If yes, how long does it take to warm

                                                                        The vehicle? ________ mins/km

__Suddenly at ________ (odometer)

__Gradually at ________ (odometer)                      Ambient temperature outside?

__ Just started  ________ (odometer)                          __________Degrees

__Since the vehicle was new


THE PROBLEM OCCURS                                       AIRFLOW

__Rarely                                                             Can airflow be changed to different

__ Sometimes                                                      outlet?  __ Yes __ No

__ Always                                                           If no, which outlets don’t work?

                                                                          __Center __ Left __ Right

                                                                                    __ Floor  __ Defroster

                                                                                    Does recirculation mode work?

                                                                                     __ Yes   __ No

                                                                                    If no, which does not work?

                                                                                    ___ Fresh

                                                                                    ___ Recirculation




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