DISCLAIMER ABOUT QUESTONNAIRE
1. Know about basic information about the family.
2. Know about basic information regarding the problem.
3. Questions always being in multiple choice bases (90%).
4. Know about the problems associated with him/her regarding the problems.
5. About contingency recovery method/management from government.
Questionnaire about Air Pollution
Associated by : Prof. Pritam Paul , Kalyani
A. FAMILY STRUCTURE :-
1. Name of the respondent ________________________________________________
2. Address ______________________________________________________________
3. Number of family member _______________________________________________
4. Age of the respondent __________________________________________________
5. Sex - A. Male , B. Female , C. Others
6. Religion - A. Hindu , B. Muslim , C. Christian , D. Others (___________)
7. Cast - A. General , B. SC , C. ST , D. OBC-A , E. OBC-B , F. Others
8. Occupation – A. Cultivation , B. Industrialist , C. Service Man , D. Businessman , E. Others
(_____________)
9. Name of the Ward / Panchayet ___________________________________________
10. Thanna ______________________________________________________________
11. Block ________________________________________________________________
12. District _______________________________________________________________
13. State _________________________________________________________________
B. AIR POLLUTION PERCEPTION SURVEY :-
1. Do you aware about Air Pollution ? (Yes/No)
2. From where you get information about Air Pollution ?
(Radio/TV/Newspaper/Conversations/Social Media/Others__________)
3. Do you think Air Pollution is detrimental for human being ? (Yes/No)
4. How would rate the overall air quality in your area ? (Good/Moderate/Unhealthy for
sensitive group/Unhealthy/Toxic/Hazardous)
5. Do you think that previously (10 years ago) your area is much better than present
(Yes/No)
6. If yes , then what are the causes of deterioration of environment __________________
7. Based on your observation , rank the most common type of air pollution in the vicinity
(Rank them from 6 to 1) :
A. Dust from Construction _________________
B. Smoke from vehicle ____________________
C. Burning of Waste ______________________
D. Cutting of trees _______________________
E. Cigarette smoke _______________________
F. Garbage odors_________________________
8. To what extend Air pollution affecting you and your family ? (Very much affected
/affected a little/Not affected at all)
9. If very much affected , then what kind of disorder you are facing ?
A. Initiation to eyes/noses/throat (___)
B. Skin problems (___)
C. Filling Depressed (___)
D. Want to move other places (___)
E. Doing more to look after skin (___)
F. Doing more to stay healthy (___)
G. Asthma incident (___)
H. Fatigue/Drowsiness (___)
I. Breathlessness or having more difficulty in breathing (___)
J. Poor visibility (___)
K. Others (___)
10. Do you know the air pollution in your area is higher than other big cities ?
(Yes/No/Others)
11. Which fuel do you use for cooking food ? (Kerosene oil/Cake
dung/Coal/LPG/Microwave/Induction cooker/Others)
12. Do you think traffic policy should be more improve for controlling air pollution ?
(Yes/No)
13. Do you think Citizen should be come forward for the safety for their environment ?
(Yes/No)
14. Whether the ultimate solution to all the problems of Global Warming and climate
change is to make the people aware about its causes/consequences/control of energy
consumptions through education ? (Yes/No)
15. Do you know about air quality index ? (Yes/No)
16. Do you agree to bring changes in habits of daily life to minimized energy wastage ?
(Yes/No)
17. Do you agree that the environmental protection is the moral responsibility of all the
citizens ? (Yes/No)
18. Do you think student life is the period to lay foundations of intellectual and conscious
citizen ? (Yes/No)
19. Give your opinion to control the effect of air pollution/global warming/climate change
by value based impression
________________________________________________________________________
________________________________________________________________________
