Worksheet Sample

WARNING: This page is about a different car, the 2018 Nissan NV3500 HD and 2018 Nissan NV2500 HD. However, it is still accessible from the selected car via links, so may be relevant.

Question Sheet
Customer name MR/MS		Engine #	Manuf. Date
Incident Date			VIN
Model & Year	In Service Date
Trans.	Mileage		km/Mile
Symptoms		□ Vehicle does not move (□ Any position □ Particular position)
		□ No upshift (□ 1GR → 2GR □ 2GR → 3GR □ 3GR → 4GR □ 4GR → 5GR □ 5GR → 6GR □ 6GR → 7GR)
		□ No downshift (□ 7GR → 6GR □ 6GR → 5GR □ 5GR → 4GR □ 4GR → 3GR □ 3GR → 2GR □ 2GR → 1GR)
		□ Lock-up malfunction
		□ Shift point too high or too low
		□ Shift shock or slip
		□ Noise or vibration
		□ No kick down
		□ No pattern select
		□ Others

Frequency		□ All the time	□ Under certain conditions		□ Sometimes (times a day)
Weather conditions	□ Not affected
Weather		□ Fine	□ Cloudy	□ Raining	□ Snowing	□ Other (_____)
Temp.		□ Hot	□ Warm	□ Cool	□ Cold	□ Temp. Approx. °C/°F
Humidity		□ High	□ Middle	□ Low
Transmission conditions		□ Not affected
		□ Cold	□ During warm-up		□ After warm-up
		□ Engine speed (RPM)
Road conditions		□ Not affected
		□ In town	□ In suburbs	□ Freeway	□ Off road (Up/Down)
Driving conditions		□ Not affected
		□ At starting	□ While idling	□ While engine racing		□ At racing	□ While cruising
		□ While accelerating		□ While decelerating		□ While turning (Right/Left)
		□ Vehicle speed [ km/h (MPH)]
Other conditions