Analysis sheet for coolant thermostat, form · of2010s000101a · Mercedes-Benz WIS

OF20.10-S-0001-01A

Analysis sheet for coolant thermostat, form

Engine	651 in model 447
Engine	651.955/956/957 in model 906
	with code XM0 (Facelift)


__________________________________________________________________________________________________________________________
Company-owned sales and service outlet/Dealer no.
	________________________________	__________________ (km / miles)
	Vehicle identification number	Distance traveled

	________________________________
	Engine no.

	________________________________	________________________
	Tester: Name	Phone number

	_________________
	Date

	_________________
	Model

 When replacing the coolant thermostat because of customer complaints as described in the document SI20.10-S-0004A this analysis sheet must be filled out! The filled out analysis sheet is to be attached to the TIPS case. The designated title for the TIPS case must be "Coolant thermostat on engine 651".
The TIPS case must also have the following information attached to it:

 Vehicle repair history

 Copy of the maintenance booklet or a corresponding printout from the Digital Service Booklet (DSB)

 Any available diagnosis documents (e.g. initial quick test, overview of previously conducted tests etc.)

Customer complaint is to be filled out by Service Advisor or Workshop Foreman:


Detailed	________________________________________________________________________________________________
Customer complaint:	________________________________________________________________________________________________
	________________________________________________________________________________________________

Vehicle usage profile:	Freeway_______ %	Country road_______ %	City_______ %

	Short distance	Trailer operation
	Yes ☐ / No ☐	Yes ☐ / No ☐

	Average daily driven distance data: _______ km / miles

In which driving condition does the complaint occur?	Outside temperature _________ °C / ℉
	Comments:
	________________________________________________________________________________________________
	________________________________________________________________________________________________
	________________________________________________________________________________________________
	________________________________________________________________________________________________

Workshop diagnosis:


Customer complaint verifiable?	Yes ☐ / No ☐	Conditional: ___________________________________________________________

Description of findings report:	___________________________________________________________________________________________
	___________________________________________________________________________________________
	___________________________________________________________________________________________

Conducted repair operations:	___________________________________________________________________________________________
	___________________________________________________________________________________________
	___________________________________________________________________________________________

Are any drive-relevant conversions or retrofits on the vehicle or have any been conducted on it?		Yes ☐ / No ☐

		If yes, which ones:
		___________________________________________________________________
		___________________________________________________________________
		___________________________________________________________________

Vehicle after the repair:

Repair successful?	Yes ☐ / No ☐

Customer satisfied?	Yes ☐ / No ☐

Further information that in your view could be helpful when investigating the causes:
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________

Miscellaneous:
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________