Fluid Leak / Fluid Loss Worksheet Fluid Leak / Fluid Loss Sheet Name Email Phone Number Vehicle Year / Make / Model Mileage What Did You Notice? Spot or puddle under vehicle Dripping fluid Wet area under hood Wet area underneath vehicle Burning smell Sweet smell Smoke or steam Fluid sprayed under hood Low fluid warning light Low fluid level Vehicle overheating Strong fuel smell Noise after fluid became low Unsure Please check all that apply. Other details about what you noticed How often does it happen? Every drive Frequently Sometimes Rarely Only once so far How noticeable is the concern? 1 2 3 4 5 6 7 8 9 10 1 = Very slight / barely noticeable. 10 = Extremely noticeable / severe. When did you first notice it? Suddenly Gradually over time Recently Since a repair/service Since hitting something (pothole, debris, curb, etc.) After long drive or trip After vehicle sat parked for awhile Additional details about when you first noticed it When are you MOST likely to notice it? After vehicle is parked overnight After driving While vehicle is running First thing in the morning After highway driving After long trips During hot weather During cold weather After using A/C or defrost After towing or heavy load Randomly / no pattern noticed Other duplicate-the-concern details What BEST describes what you saw? Few drops Small spot Medium puddle Large puddle Wet residue only Dripping while running Only appears after parked Spray or splatter under hood Smoke or steam visible Unsure If you saw fluid, what did it LOOK like? Clear like water Oily Thick Thin/watery Sticky Dirty or dark Bright colored Unsure Did you notice any smells? Burning smell Sweet smell Fuel/gasoline smell Hot oil smell Chemical smell No smell noticed Unsure Does the vehicle seem to lose fluid? No noticeable fluid loss Occasionally needs topping up Frequently needs topping up Warning light comes on Vehicle overheated or became low Unsure If you added fluid, what type was added? Engine oil Coolant/antifreeze Brake fluid Power steering fluid Washer fluid Transmission fluid Fuel Unsure Optional. If fluid was added, how often? Once only Monthly Weekly Every few days Daily Unsure Where do you notice it MOST? Front of vehicle Middle of vehicle Rear of vehicle Driver side Passenger side Under hood Under vehicle Inside vehicle Unsure Are any warning lights on? Check Engine Light Oil Light Coolant Temperature Warning Brake Warning Light Low Washer Fluid Warning Other Warning Light No warning lights Have any repairs been done recently? No recent repairs Oil change/service Cooling system repair Brake repair Transmission repair Engine repair Tire or suspension work Other repair/service Additional details about recent repairs Is there anything else you think would help us understand or duplicate the concern? What do YOU think the concern might be? Example: oil leak, coolant leak, fuel smell, etc. Submit If you are human, leave this field blank. Δ
