survey for placitus CPM
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survey for placitus CPM
SURVEY:
(1) CAR ... Describe your car:
Make _______
Model ______
Year ___02____
Engine type ____1.8t___
Auto/Manual ___m____
FWD/AWD ___awd____
(2) _____ NUMBER OF FAILURES ... Is this survey for your:
A ... 1st. Coil failure
B ..x. 2nd. Coil failure
C ... 3rd. Coil failure
D ... 4th. Coil failure
SYMPTOMS ... Check all symptoms that occurred for each failure:
A ... 1st__x___2nd__x___3rd_____4th_____Shaking
B ... 1st___x__2nd__x___3rd_____4th_____ Vibration
C ... 1st__x___2nd___x__3rd_____4th_____Rough Idle
D ... 1st__x___2nd___x__3rd_____4th_____Flashing Engine Warning Light
E ... 1st_____2nd_____3rd_____4th_____Steady Engine Warning Light
F ... 1st_____2nd_____3rd_____4th_____Minor loss of power while driving
G ... 1st_____2nd_____3rd_____4th_____Moderate loss of power whild driving
H ... 1st___x__2nd__x___3rd_____4th_____Major loss of power while driving
I ... 1st_____2nd_____3rd_____4th_____Total loss of power while driving
J ... 1st_____2nd_____3rd_____4th_____Got progressively worse with time.
K ... 1st_____2nd_____3rd_____4th_____Could not keep the engine running
L ... 1st_____2nd_____3rd_____4th_____Didn't try to drive it
3a .. Do you have any other comments regarding the symptoms you experienced:
_______________________________
(4) 1st __c___ 2nd _c____ 3rd _____ 4th _____ WHEN FIRST NOTICED ... Did you first notice the problem:
A ... Upon starting your car
B ... After starting your car but before driving away
C ... Within 5 minutes of starting your car and driving away
D ... On the road - Inconvenience but not hazardous
E ... On the road - Hazardous situation - Traffic
F ... On the road - Hazardous situation - Weather
G ... On the road - Hazardous situation - Bad place to be stranded
4a .. Do you have any additional comments regarding the above:
_______________________________
(5) 1st __c___ 2nd __c___ 3rd _____ 4th _____ WEATHER ... Was the weather:
A ... Hot (85 degrees or higher)
B ... Mild (between 50 and 85 degrees)
C ... Cold - Above Freezing (between 32 and 50 degrees)
D ... Cold - Below Freezing (below 32 degrees)
5a .. Do you have any other comments regarding the weather (snow, rain, sleet, etc):
___rain both times_____________________________
(6) 1st __a___ 2nd __g___ 3rd _____ 4th _____ AFTER THE FAILURE OCCURRED ... Once you noticed this problem
with your car what did you do:
A ... Turned off the ignition ... Had it flatbedded to the dealer
B ... Pulled to the side of the road ... had it flatbedded to the dealer
C ... Drove to a safe parking spot ... Had it flatbedded to the dealer
D ... Drove until you felt you were a traffic hazard and concerned for your safety ... Have it flatbedded to the dealer
E ... Drove until additional symptoms made you too concerned to drive further ... Had it flatbedded to the dealer
F ... Drove home ... Had it flatbedded to the dealer
G ... Drove directly to the dealer
6a .. Any other comments regarding the above:
_______________________________________
(7) __d___ DRIVING STYLE ... Is your driving style typically:
A ... Gentle
B ... Moderate
C ... Moderate and sometimes aggressive
D ... Aggressive and sometimes moderate
E ... Aggressive
(8) 1st ___e__ 2nd ___c__ 3rd _____ 4th _____ DEALER RESPONSES ... What did your dealer tell you when the car was brought in:
A .. Car ready .. Or ... Will be ready within one day.
B ... Parts are on order. One week estimate.
C ... Parts are on order. Two week estimate.
D ... Parts are on order. Three week estimate.
E ... Parts are on order. Estimate more than 3 weeks.
F ... Parts are on order. No idea of when they'll be in.
J ... Comments _________________________
(9) 1st __a___ 2nd __a___ 3rd _____ 4th _____ COIL REPLACEMENT ... Did the dealer replace
your coil(s) with the latest revision coil (Part # 06B-905-115-J for 1.8T -or- 06C-905-115-E for 3.0):
A ... Yes
B ... No
C ... Don't know
(10) 1st ___b__ 2nd __a___ 3rd _____ 4th _____ 'ALL' COIL REPLACEMENT ... Did the dealer replace 'all' your coils?
A ... Yes
B ... No
C ... Don't know
(11) - LOCATION ... Geographically, where did the failure occur (Closest major city and State or Province):
1st _______hartford,ct________________________________
2nd ___hartford, ct____________________________________
3rd _______________________________________
4th _______________________________________
(12) - MILEAGE ... What was the mileage on your car when your coil failure occurred.
1st ____7000___________________________________
2nd ____10000___________________________________
3rd _______________________________________
4th _______________________________________
(13) - WHEN ... In what 'month' and 'year' did this failure occur:
1st ____12/02___________________________________
2nd ____2/03___________________________________
3rd _______________________________________
4th _______________________________________
(14) - CAR BUILD DATE/PURCHASE DATE ... When was your car built/delivered (month/year) ... (Look inside your driver door pillar for build date).
Build date: ___03/02______________________________
Date you took delivery: ___07/02____________________
(15) 1st __c___ 2nd __c___ 3rd _____ 4th _____ DISRUPTION ... How serious was the effect of this problem on your planned activities ...
A ... Inconvenient .. Comments _________________________________________
B ... Disruptive .. Comments ___________________________________________
C ... VERY Disruptive .. Comments ______________________________________
D ... Screwed things up royally .. Comments _______________________________
E ... My workplace was affected .. Comments ______________________________
F ... My family was affected .. Comments __________________________________
G ... Travel or vacation plans were affected .. Comments _____________________
H ... Scheduled appointment was affected .. Comments ______________________
J ... Stranded during a trip .. Comments ___________________________________
K ... No disruption to my life what-so-ever .. Comments ______________________
L ... Other __________________________________________________ _________
(16) 1st __d___ 2nd __a___ 3rd _____ 4th _____INDICATORS ... In days prior to your coil failure, did your car provide any hints that car trouble was brewing such as:
A ... Change in the way the car idles
B ... Recent change in the way the car starts
C ... Poorer than normal gas mileage
D ... None
E ... Other _________________________________________
(17) 1st __a___ 2nd __a___ 3rd _____ 4th _____FAILED COIL ... If you know for certain the part number or the revision of the coil(s) that failed, please note it here: (If you get a chance, please ask. There are rumors of failures of the latest rev coils. We need substantiation).
A ... 1.8t Part # 06B-905-115-H (Rev H)
B ... 1.8T Part # 06B-905-115-J (Rev J)
C ... 3.0 Part # 06C-905-115-D (Rev D)
D ... 3.0 Part # 06C-905-115-E (Rev D)
E ... Other ______________________
F ... Don't know for sure
(18) __b___ NUMBER OF SURVEYS SUBMITTED ... Please indicate the number of 'Failed Coilpack' surveys or questionnaires you've filled out for us (including this one):
A ... One
B ... Two
C ... Three
D ... Four
(19) - VENTING AND CUSSING ... Add any comments below that you'd like to share:
(1) CAR ... Describe your car:
Make _______
Model ______
Year ___02____
Engine type ____1.8t___
Auto/Manual ___m____
FWD/AWD ___awd____
(2) _____ NUMBER OF FAILURES ... Is this survey for your:
A ... 1st. Coil failure
B ..x. 2nd. Coil failure
C ... 3rd. Coil failure
D ... 4th. Coil failure
SYMPTOMS ... Check all symptoms that occurred for each failure:
A ... 1st__x___2nd__x___3rd_____4th_____Shaking
B ... 1st___x__2nd__x___3rd_____4th_____ Vibration
C ... 1st__x___2nd___x__3rd_____4th_____Rough Idle
D ... 1st__x___2nd___x__3rd_____4th_____Flashing Engine Warning Light
E ... 1st_____2nd_____3rd_____4th_____Steady Engine Warning Light
F ... 1st_____2nd_____3rd_____4th_____Minor loss of power while driving
G ... 1st_____2nd_____3rd_____4th_____Moderate loss of power whild driving
H ... 1st___x__2nd__x___3rd_____4th_____Major loss of power while driving
I ... 1st_____2nd_____3rd_____4th_____Total loss of power while driving
J ... 1st_____2nd_____3rd_____4th_____Got progressively worse with time.
K ... 1st_____2nd_____3rd_____4th_____Could not keep the engine running
L ... 1st_____2nd_____3rd_____4th_____Didn't try to drive it
3a .. Do you have any other comments regarding the symptoms you experienced:
_______________________________
(4) 1st __c___ 2nd _c____ 3rd _____ 4th _____ WHEN FIRST NOTICED ... Did you first notice the problem:
A ... Upon starting your car
B ... After starting your car but before driving away
C ... Within 5 minutes of starting your car and driving away
D ... On the road - Inconvenience but not hazardous
E ... On the road - Hazardous situation - Traffic
F ... On the road - Hazardous situation - Weather
G ... On the road - Hazardous situation - Bad place to be stranded
4a .. Do you have any additional comments regarding the above:
_______________________________
(5) 1st __c___ 2nd __c___ 3rd _____ 4th _____ WEATHER ... Was the weather:
A ... Hot (85 degrees or higher)
B ... Mild (between 50 and 85 degrees)
C ... Cold - Above Freezing (between 32 and 50 degrees)
D ... Cold - Below Freezing (below 32 degrees)
5a .. Do you have any other comments regarding the weather (snow, rain, sleet, etc):
___rain both times_____________________________
(6) 1st __a___ 2nd __g___ 3rd _____ 4th _____ AFTER THE FAILURE OCCURRED ... Once you noticed this problem
with your car what did you do:
A ... Turned off the ignition ... Had it flatbedded to the dealer
B ... Pulled to the side of the road ... had it flatbedded to the dealer
C ... Drove to a safe parking spot ... Had it flatbedded to the dealer
D ... Drove until you felt you were a traffic hazard and concerned for your safety ... Have it flatbedded to the dealer
E ... Drove until additional symptoms made you too concerned to drive further ... Had it flatbedded to the dealer
F ... Drove home ... Had it flatbedded to the dealer
G ... Drove directly to the dealer
6a .. Any other comments regarding the above:
_______________________________________
(7) __d___ DRIVING STYLE ... Is your driving style typically:
A ... Gentle
B ... Moderate
C ... Moderate and sometimes aggressive
D ... Aggressive and sometimes moderate
E ... Aggressive
(8) 1st ___e__ 2nd ___c__ 3rd _____ 4th _____ DEALER RESPONSES ... What did your dealer tell you when the car was brought in:
A .. Car ready .. Or ... Will be ready within one day.
B ... Parts are on order. One week estimate.
C ... Parts are on order. Two week estimate.
D ... Parts are on order. Three week estimate.
E ... Parts are on order. Estimate more than 3 weeks.
F ... Parts are on order. No idea of when they'll be in.
J ... Comments _________________________
(9) 1st __a___ 2nd __a___ 3rd _____ 4th _____ COIL REPLACEMENT ... Did the dealer replace
your coil(s) with the latest revision coil (Part # 06B-905-115-J for 1.8T -or- 06C-905-115-E for 3.0):
A ... Yes
B ... No
C ... Don't know
(10) 1st ___b__ 2nd __a___ 3rd _____ 4th _____ 'ALL' COIL REPLACEMENT ... Did the dealer replace 'all' your coils?
A ... Yes
B ... No
C ... Don't know
(11) - LOCATION ... Geographically, where did the failure occur (Closest major city and State or Province):
1st _______hartford,ct________________________________
2nd ___hartford, ct____________________________________
3rd _______________________________________
4th _______________________________________
(12) - MILEAGE ... What was the mileage on your car when your coil failure occurred.
1st ____7000___________________________________
2nd ____10000___________________________________
3rd _______________________________________
4th _______________________________________
(13) - WHEN ... In what 'month' and 'year' did this failure occur:
1st ____12/02___________________________________
2nd ____2/03___________________________________
3rd _______________________________________
4th _______________________________________
(14) - CAR BUILD DATE/PURCHASE DATE ... When was your car built/delivered (month/year) ... (Look inside your driver door pillar for build date).
Build date: ___03/02______________________________
Date you took delivery: ___07/02____________________
(15) 1st __c___ 2nd __c___ 3rd _____ 4th _____ DISRUPTION ... How serious was the effect of this problem on your planned activities ...
A ... Inconvenient .. Comments _________________________________________
B ... Disruptive .. Comments ___________________________________________
C ... VERY Disruptive .. Comments ______________________________________
D ... Screwed things up royally .. Comments _______________________________
E ... My workplace was affected .. Comments ______________________________
F ... My family was affected .. Comments __________________________________
G ... Travel or vacation plans were affected .. Comments _____________________
H ... Scheduled appointment was affected .. Comments ______________________
J ... Stranded during a trip .. Comments ___________________________________
K ... No disruption to my life what-so-ever .. Comments ______________________
L ... Other __________________________________________________ _________
(16) 1st __d___ 2nd __a___ 3rd _____ 4th _____INDICATORS ... In days prior to your coil failure, did your car provide any hints that car trouble was brewing such as:
A ... Change in the way the car idles
B ... Recent change in the way the car starts
C ... Poorer than normal gas mileage
D ... None
E ... Other _________________________________________
(17) 1st __a___ 2nd __a___ 3rd _____ 4th _____FAILED COIL ... If you know for certain the part number or the revision of the coil(s) that failed, please note it here: (If you get a chance, please ask. There are rumors of failures of the latest rev coils. We need substantiation).
A ... 1.8t Part # 06B-905-115-H (Rev H)
B ... 1.8T Part # 06B-905-115-J (Rev J)
C ... 3.0 Part # 06C-905-115-D (Rev D)
D ... 3.0 Part # 06C-905-115-E (Rev D)
E ... Other ______________________
F ... Don't know for sure
(18) __b___ NUMBER OF SURVEYS SUBMITTED ... Please indicate the number of 'Failed Coilpack' surveys or questionnaires you've filled out for us (including this one):
A ... One
B ... Two
C ... Three
D ... Four
(19) - VENTING AND CUSSING ... Add any comments below that you'd like to share:
#2
Got it .. Logged it .. Thanks a lot bridge! By the way, is your car chipped (CPU mod)? New survey Q
This was added to question #1 by request:
Aftermarket CPU upgrade (chipped) .. No _____ .. Yes ______ .. If so, manufactured by ________________
Aftermarket CPU upgrade (chipped) .. No _____ .. Yes ______ .. If so, manufactured by ________________
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