ENGINE DRIVEABILITY

Customer Diagnostic Survey Form

Customer Name__________________________________ Date________________

Repair Order #___________________________________ License#_____________

Service Advisor__________________________________ Vin__________________

______________________________________________________________________

IT HAPPENS WHEN…

WHEN THE PROBLEM OCCURS

Light to medium acceleration

Hard Acceleration

Decelerating (foot off accelerator)

Cruising (constant highway speed)

Braking slowly________ Suddenly_______

Turning

Air conditioning on

Air conditioning off

Hot days

Cool / cold days

Humid / rainy days

Other______________________________

Ambient Temperature___________degree

Engine Temperature____________degree

Cold Hot Warm

Outside Temperature

Cold Hot Warm

THE PROBLEM STARTED…

Suddenly at___________ (odometer)

Gradually at___________ (odometer)

Just Started (odometer)

Since the vehicle was new

TYPE OF FUEL USED

Regular

Mid-Grade

Premium

Alternative fuel

Brand of fuel

Customer Signature__________________

DEFINE THE PROBLEM…

STARTING

Does the engine “crank”? Yes No

Does the engine start? Yes No

If yes, how long does it take the

engine to start? _______seconds

Does the engine stop

immediately after starting? Yes No

Is the vehicle equipped with an

alarm system? Yes No

Is the vehicle equipped with a

remote control system? Yes No

IDLE

Engine idles rough / steady? Yes No

Engine idles too fast? Yes No

PERFORMANCE

Describe the vehicle’s engine performance problem(s).

Check all that apply.

Hesitates or stalls on acceleration

Stalls on deceleration or quick stops

Lacks power

Misses under load

“Pings” or “knocks”

Runs on after key is turned off

Backfires (popping noise)

Speed changes without touching accelerator

Check engine light on

Other (describe)

________________________________________________

THE PROBLEM OCCURS…

Rarely Sometimes Always