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? _______________________________________