Customer Diagnostic Survey Form

NOISE AND WATER LEAKS

Client Name: ____________________________             Date: ____________________

 

Car Make/Model:____________________________       Licence #: ________________

 

DEFINE THE PROBLEM…                  IT OCCURS AS FOLLOWS…

__ Noise                                                   WHEN THE PROBLEM OCCURS

__ Water Leak                                              __ Light to medium acceleration

(check both if applicable)                            __ Hard acceleration

                                                                __ Deceleration (foot off accelerator)

TYPE OF SOUND                                         __ Cruising (constant highway speed)

                                                                __ Braking

Clicking __ Yes __ No                            __ Turning

Rattle     __ Yes __ No                            __ In reverse

Thump   __ Yes __ No                            __ First thing in morning

Tinging  __ Yes __ No                            __ Going over bumps

Buzz       __ Yes __ No                            __ Normal Road

Squeak   __ Yes __ No                            __ Rough Road

Wind Noise __ Yes __ No                       __ Wet Road

Other       __ Yes __ No                            __With vehicle occupants

 

LOCATION OF SOUND                         WHEN THE WATER LEAK OCCURS

                                                                __ On level ground

                                                                __ On an incline

Interior  __ Yes __ No                            __ Forward

Exterior __ Yes __ No                            __ Rearward

Front     __ Yes __ No                                      __ Light Rain

Rear      __ Yes __ No                                      __ Medium Rain

Driver Side __ Yes __ No                            __ Heavy Rain

Passenger Side __ Yes __ No                       __ Winter Conditions

                                                                __Automatic Car Wash

WATER LEAK                                  __ Power Wand Wash

Please describe the leaks and where             __ Hand Wash

They seem to be coming from:

______________________________           SPEED OF VEHICLE

                                                                Describe the speed at which the problem

______________________________                    occurs ______________km/h

                                                                Engine speed ___________ (RPM)

THE PROBLEM OCCURS…              __ Idle  __ Medium __High

__ Rarely __Sometimes __ Always                 Engine Temperature

                                                                __Cold __Warm __ Hot

Which accessories are on when

Noise occurs?

__A/C __Stereo __Heater

Does any action stop/Change the noise? _______________________________________

 

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