High Beam Assist

Inspect the following items regarding the vehicle's state.

High Beam Assist Check List for Interview		Date of Vehicle Bring-in	Year Month Day
Customer's name		Registration No.	Initial year of registration Year Month Date
		Vehicle model	Frame number
Interviewer	Inspector	Engine type	Odometer reading
Customer specified content
Date and time when the symptom occurred	Year Month Date	Approximate time
Frequency of symptom occurrence	Always occurs Sometimes occurs (times per day/times per month)
Conditions upon symptom occurrence	Weather	Fine Cloudy Rainy Snowy Foggy Other ()
	Temperature	°C (°F) - °C (°F)
	Vehicle speed	km/h (MPH) to km/h (MPH)
	Road condition	Dry Wet Accumulated snow Unpaved road Bumps (uneven) Other ()
	Road conditions	Own vehicle	Straight Gentle right-hand curve Gentle left-hand curve Sharp right-hand curve Sharp left-hand curve Uphill Downhill Intersection Top of the hill Other ()
	Oncoming vehicle * Relative position from user's viewpoint		No oncoming vehicle Straight Gentle right-hand curve Gentle left-hand curve Sharp right-hand curve Sharp left-hand curve Uphill Downhill Intersection Top of the hill Other ()
	Headlight of oncoming vehicle * When the type is unknown, indicate the color.		HID/LED (white) Halogen Only one side was lit Other ()
Conditions upon symptom occurrence	Road conditions	Preceding vehicle	No preceding vehicle Straight Gentle right-hand curve Gentle left-hand curve Sharp right-hand curve Sharp left-hand curve Uphill Downhill Intersection Top of the hill Other ()
		Number of street light ahead	0 1 2 3 4 5 More ()
		Reflection board/Signs	0 1 2 3 4 5 More ()
			Red White Blue Other ()
	Vehicle status	Number of passengers:, (Front seats:/Rear seats:)
		Cargo room load capacity
		Tire inflation pressure (when vehicle was brought in) Front wheel kPa (psi) Rear wheel kPa (psi)
	Driving duration and distance with the described load condition	Distance km (mile) Time minutes
	Driving environment before symptom occurrence (Approximately 10 minutes before the occurrence)	Inner city (surroundings are bright by street lights) Suburbs (surroundings are relatively dark due to sparse street lights)
Accessory installation condition
Diagnostic code
Other NOTE: Describe things that were noticed, if any. Attach illustration or photo of the road ahead of the vehicle at the time of the symptom occurrence.