Customer Problem Analysis Check

Inspector's Name

Supplemental Restraint System Check Sheet

Customer's Name

Registration No.

Registration Year

/ /

Frame No.

Date Vehicle Brought In

/ /

Odometer Reading

km Miles

Date Problem Dist Occurred

/ /

Weather

Fine Cloudy Rainy Snowy Other

Temperature

Approx.

Vehicle Operation

□ Driving [□ Constant speed □ Acceleration □ Deceleration

□ Other ]

Road Conditions

Details Of Problem

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

Diagnosis System Inspection

SRS Warning Light

1st Time

Remains ON

Sometimes Light Up Does Not Light Up

Inspection

2nd Time

Remains ON

□ Sometimes Light Up □ Does Not Light Up

1st Time

Normal Code

□ Malfunction Code [Code. ]

DTC Inspection

2nd Time

Normal Code

Malfunction Code [ Code. ]

Do It Yourself Car Diagnosis

Do It Yourself Car Diagnosis

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