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Engine Failure Analysis: All Fields and Pictures Are Required (Two Pages)

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1K views2 pages

Engine Failure Analysis: All Fields and Pictures Are Required (Two Pages)

Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry's standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book. It has survived not only five centuries, but also the leap into electronic typesetting, remaining essentially unchanged. It was popularised in the 1960s with the release of Letraset sheets containing Lorem Ipsum passages, and more recently with desktop p

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ENGINE FAILURE ANALYSIS

*** Use this form for for pre-approvals or technical support ***

ALL FIELDS AND PICTURES ARE REQUIRED (Two Pages)

ENGINE FULL MODEL # AND TYPE:


(Example: GX160QX, GCV160S3A)
ENGINE SERIAL NUMBER:
(Stamped on Block; 5 Letters-7 Digits)

TYPE OF APPLICATION:
(Example: mower, packer)
BRAND AND MODEL NUMBER OF
APPLICATION:
APPLICATION SERIAL NUMBER:

RETAIL STORE:
DATE OF SALE:
TYPE OF USE: COMMERCIAL RENTAL RESIDENTIAL

CUSTOMER COMPLAINT:

DEFECT ANALYSIS:

CAUSE OF MFG DEFECT:

OIL CONDITION:
(If Debris In Oil Describe)
OIL LEVEL:
FULL LOW OVERFULL NONE LESS THAN HALF MORE THAN HALF
CONDITION OF AIR FILTER:
MISSING DAMAGED DIRTY CLEAN
OPERATION CONDITIONS:
DUST ENCLOSED DIRTY CLEAN
FUEL QUALITY:
MARKED OLD STORED FRESH
COMPRESSION/LEAK-DOWN:
COMPRESSION:
LEAK-DOWN %:
MAINTENANCE HISTORY:

• International Power Systems Inc. • 2875 Portland Dr. Oakville, ON L6H 5S4 •
• Toll Free: 1-877-477-3353 • Tel: 905-829-2140 • Fax: 905-829-2145 • www.ipspower.com •
warranty@ipspower.com
ENGINE FAILURE ANALYSIS

AFFECTED COMPONENTS:
(Please Check One)
PISTON CYLINDER CRANKSHAFT
CONNECTING ROD ENGINE CASES VALVE TRAIN
VALVES CAMSHAFT OTHER_______________

IF APPLICABLE – LIST PARTS NEEDED FOR REPAIR:

QUANTITY PRODUCT NUMBER PRODUCT DESCRIPTION

OTHER INFORMATION:

ALL THE FOLLOWING PHOTOS ARE REQUIRED:

 Overall Application  Cylinder Wall


(i.e. power washer, lawnmower, etc)
 Engine Exterior  Con-Rod Small End
 Air Box Inside  Con-Rod Big End
 Piston Top/Side/Underside, Bearing Surface  Crank Journals
 Piston Pin
 Serial Number of Engine  Proof of Purchase
(Stamped on Block)

Dealer Name: From:


Ship To Location: Phone Number:
Dealer Number: Email:
Date:

Return Completed Form With Pictures To: warranty@ipspower.com

PLEASE KEEP ALL OLD PARTS INVOLVED FOR A MINIMUM OF 90 DAYS AFTER YOUR CLAIM HAS BEEN PAID.

• International Power Systems Inc. • 2875 Portland Dr. Oakville, ON L6H 5S4 •
• Toll Free: 1-877-477-3353 • Tel: 905-829-2140 • Fax: 905-829-2145 • www.ipspower.com •
warranty@ipspower.com

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