1. Does your car stop OK?
| Yes | No | Sometimes |
2. The brake pedal seems:
| To work OK | Too high | To pulsate or chatter |
| Hard | Too low | To work better when pumped |
| Soft | Spongy | To return too slowly |
3. Does the vehicle:
| Stop straight | Pull left only when braking |
| Always pull in one direction | Pull right only when braking |
4. Do the brakes:
| Grab | Seem to be dragging | Lock at times | Make noise |
| Describe noise:________________________________________________________ |
5. The Emergency/Park Brake:
| Is seldom used | Works OK | Doesn't work properly |
| Explain:_______________________________________________________________ |
6. Has the brake fluid been adding in the last 6 months?
| Yes | No |
7. Have the brakes been flushed and bled in the last 6 months?
| Yes | No |
| Adjusted? | |
| Yes | No |
8. Is dash brake light on?
| Yes | No |
9. Last time brakes were serviced and repaired?
| 3 Months | 6 Months | 9 Months | Longer |
10. Other problems:________________________________________________________________
_________________________________________________________________________________