Check List for Interview: Check
Inspect the following items regarding the vehicle's state.
| Writer/Inspector | Writer's name | |||
| Inspector's Name | ||||
| Vehicle information | Car accessory equipment condition | Car accessory is installed to the windshield glass. | No/Yes (Position:) | |
| Other | No/Yes (Accessory's name:) | |||
| Is there any modification for the following items? | Suspension? | Not changed/Changed (Specifically:) | ||
| Headlight? | Not changed/Changed (Specifically:) | |||
| Tire size? | Not changed/Changed (Specifically:) | |||
| Front wiper? | Not changed/Changed (Specifically:) | |||
| How is the condition around camera? | Is there any scratch or damage on the windshield glass? | No/Yes (Specifically:) | ||
| Are antennas, etc. attached on the prohibited area? | No/Yes (Specifically:) | |||
| Is wide mirror or accessory attached? | No/Yes (Specifically:) | |||
| How is the surface condition of the windshield glass? | Presence of oil film, fogging, dirt and/or glass coating | No/Yes (Specifically:) | ||
| How is the condition of the dashboard? | Is there anything that can be easily reflected against the windshield glass on the dashboard? | No/Yes (Specifically:) | ||
| How is the deterioration of the wiper? | Does any streak or uneven wiping area remain in front of the camera? | No/Yes (Specifically:) | ||
| How is the condition of the tire? | Is there any wear? Is there any excessive wear difference? | No/Yes (Specifically:) | ||
| Is the air pressure proper? | Proper/Improper (Specifically:) | |||
| How is the condition of the camera lens filter? | Is there finger print adhesion or cracks on the lens filter? | No/Yes (Specifically:) | ||
| Description of malfunction | What kind of malfunction has been detected? | Failure/temporary stop/faulty operation of adaptive cruise control/faulty operation of pre-collision brake/other faulty operations | ||
| What kind of DTC and/or cancel code is displayed? | ||||
| How is the meter display? | EyeSight warning light | Off/On/Blink | ||
| Pre-collision brake OFF indicator light | Off/On | |||
| Lane departure warning OFF indicator light | Off/On | |||
| Multi information display |
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| Occurrence conditions | Occurrence date | Occurrence location | ||
| Vehicle speed at occurrence | Approx. km/h (MPH) | Occurrence timing | During driving/during stopping/continues after engine has started | |
| Road type | Express way/limited highway/main highway/general road | Weather | Fine/cloudy/rainy/snowy/other | |
| Road condition (1) | Dry/slippery (Rainy compacted snow icy road) | Ambient temperature | Approx. ° C | |
| Road condition (2) | Asphalt/gravel/earth and sand/other | Position of solar radiation | Described in the detailed chart when the weather is fine. | |
| Road shape | Uphill/downhill/bank/roll/uneven surface | Time elapsed after engine start | Immediately after engine start/within 5 minutes after engine start/more than 5 minutes after engine start | |
| Wiper operation status | OFF/INT/LO/HI/AUTO | Light on status | Off/LO On/HI On | |
| Vehicle weight | Number of passengers: (), Did the vehicle carry heavy load? (No/Yes (Approx. kg)) | |||
| Detailed chart (Refer to the example of description.) | ||||
In case of malfunction caused by temporary stop or faulty operation, draw a chart so that the following conditions can be recognized referring to the example of description. (Images taken by digital camera can be used.)
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