Customer Problem Analysis Check Sheet

SRS AIRBAG System Check Sheet

Inspector's.

Wanne

Inspector's.

Wanne

Customer's N^nne

Registration No.

RegittraHon Year

/ /

Frame No.

□ete Vehicle Brought In

□donne;ter Reeding

Miles

Date of Problem Occurrence

/ /

Conditions et Time of Problam Occurrence

Weather

□ Fina □ Cloudy □ Rainy □ Snowy □ Various/Other

Outdoor Temperature

□ Hoi □ Warm □ Cool L"J Cold (Appro*. "C {'FJJ

Vehicle Operetion

□ Driving [□ Constant speed □ Acceleration □ Gecel&rat'on

□ OtllCr f } J

Condition of reed

□ tteilE of Prob la m

Vehicle Inspection, Repair History Prior to Occurrence of Malfunction (Including AirbSg System)

{Diagnosis System Inspection}

Airbag Warning Light Inspection

1st Time

□ Remains On □ Soimeli/nes Lights Up 12 Does Not Light Up

2nd Trme

□ Remains On □ Sometimes Lights Up □ Does Not Light Up

Diagnostic Code Inspection

1st Time

□ Normal Code □ Malfunction Code [Code. ]

2nd Time

U Normal Code □ Malfunction Code [Code

Code 11 art 31

T.5 OtS

Repeal

Aaatin

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