Customer Diagnostic Survey Form

VIBRATION

Client Name: ____________________________             Date: ____________________

 

Car Make/Model:____________________________       Licence #: ________________

 

 

IT HAPPENS WHEN…                      DEFINE THE PROBLEM…

__ Light to medium acceleration                      Please check the box that best describes

__ Hard acceleration                      the vibration you feel:

__ Deceleration (coast in gear)                     

__ Deceleration (coast out of gear)                      __ Wobble (side to side)

__ Cruising (constant highway speed)           __Shake (usually caused visual movement)

__ Braking                                                __ Pumping (usually very slow movement)

__ Turning                                                __ Harshness (stiffness, loss of ride quality)

                                                                __ All of the above

SPEED OF VEHICLE

                                                                Please check the box that best describes

Describe the speed at which the                      where you feel the vibration:

Problem occurs _______ km/h                      __ Steering Wheel

Engine Speed                                            __ Seat

__ Idle __ Medium __ High                      __ Floor

                                                                __ All of the above

ROAD CONDITIONS

                                                                If none of the above, please describe where

Describe the road conditions on                      the vibration seems to be coming from:

which the problem occurs:

__ Paved (rough) __ Wet                      ____________________________________

__ Paved (smooth)          

__Going over bumps                      ____________________________________

__ Other______________________

                                                                ____________________________________

THE PROBLEM STARTED…

__Suddenly at ____________(odometer)

__ Gradually at ___________ (odometer)

__ Just started _____________ (odometer)

__ Since the vehicle was new

__ After abnormal occurrences (ie potholes, curb impact)

 

THE PROBLEM OCCURS

__ Rarely  __ Sometimes __ Always

Have the tires been balanced?  __ Yes  __ No

Were any repairs performed prior to the condition occurring? __ Yes __ No                     

 

 

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