Field Service Report
Contact Details
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Dealer / Service Centre
*
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Vehicle
OEM
*
Kenworth
Freightliner
Western Star
Other
Model
Fleet Name
Chassis Number
*
Mileage
*
Date in Service
-
Day
-
Month
Year
Date
Build
Original
Rebuild
Original Purchase Invoice Number (If Available)
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Equipment
Select components of concern
Select Component(s)
*
Drive/Rear Axle
Driveshaft
Steer Axle
Steer Shaft
Other
Description of Failure
What Was Vehicle Doing at the Time of Failure?
Was Dana Australia Contacted for Advice?
Please Select
Yes
No
Name of Dana Contact:
Has an Investigation Into Cause of Failure Been Completed?
Please Select
Yes
No
Type of Investigation Completed?
Has OEM Area Service Manager Been Notified of Failure?
Please Select
Yes
No
Drive/Rear Axle
Axle Model
Please Select
D170
D190
DSH40
S170
S190
T78-190P
R22BS
Axle Ratio
Driveshaft
Driveshaft Series
Please Select
SPL Series
10 Series
Super Duty
Compact Series
Driveshaft Type
Please Select
Main Drive
Centre Bearing
Interaxle
Steer Shaft
Steer Axle
Axle Model
Please Select
E-1322I
E-1462I
E-1462W
D-2000F
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Details
Description of service requirements
Description of Failure
*
Action Taken
Support Requested
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Supporting Documentation
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