Customer Problem Analysis Check

Inspector's Name

Supplemental Restraint System Check Sheet

Customer's Name

Registration No.

Registration Year

Frame No.

Date Vehicle Brought Ir

Odometer Reading

km Miles

Date Problem Occurred

Weather

□ Fine □ Cloudy □ Rainy □ Snowy □ Other

Temperature

Approx.

Vehicle Operation

□ Driving [ □ Constant speed □ Acceleration □ Deceleration

□ Other ]

Road Condition

Details Of Problem

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

Diagnosis System Inspection

SRS Warning Light Inspection

1st Time

□ Remains ON DSometimes Lights Up DDoes Not Light Up

2nd Time

Remains ON Sometimes Lights Up Does Not Light Up

DTC Inspection

1st Time

□ Normal Code □ Malfunction Code [ Code. ]

2nd Time

□ Normal Code □ Malfunction Code [Code. ]

H40I22

H40I22

Supplemental Restraint System Check Sheet

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Do It Yourself Car Diagnosis

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