Noise(s) Customer Diagnostic Survey Form
* Required
Customer Name
*
Your answer
Date
*
MM
/
DD
/
YYYY
License Plate #
Your answer
VIN
Your answer
Type of sound(s)
Clicking
Grinding
Scraping
Rattle
Thump
Tinging
Buzz
Squeek
Wind Noise
Other:
If other, please explain
Your answer
Location of sound(s)
Interior
Exterior
Front
Rear
Driver Side
Passenger Side
Other:
Description of noise location
Your answer
Concern is Occurring...
Always
Sometimes
Rarely
Clear selection
When does the concern occur?
Light to medium acceleration
Hard acceleration
Deceleration (foot off accelerator)
Cruising (constant highway speed)
Braking (see Brake Diagnosis form)
Turning
In reverse
First thing in the morning
Going over bumps
Normal road
Rough road
Wet road
With vehicle occupants
With the window down
At idle
While moving
On level ground
On an incline
Moving forward
Moving rearward
When wet
When hot
Freezing conditions
Vehicle speed (km/hr)
Your answer
Engine speed (RPM)
Your answer
Engine temp
Cold
Warm
Hot
Clear selection
What accessories are on when noise occurs?
A/C
Stereo
Heater
Does any action stop / change the noise?
Your answer
When did the noise start?
MM
/
DD
/
YYYY
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