Respondent No.
: _________ Department of Pest Management Time:__________
Visayas State University
Data Sheet on Pesticide Use among Local Farmers
(Pesticide Use: Knowledge, Attitude and Practices of Local Farmers)
Part I: Respondent and Household Characteristics
1 Complete Name:
2 Gender: Address:
3 Age: 4 Height: 5 Weight:
6 Educational background: ☐ None ☐ Elementary
☐ HS ☐ College Course:
☐ Grade 7 ☐ 1st Year
☐ Grade 8 ☐ 2nd Year
☐ Grade 9 ☐ 3rd Year
☐ Grade 10 ☐ 4th Year
☐ Grade 11 ☐ Others
☐ Grade 12 Specify:
7 How long have you been living in this area?
8 How far is your house from your farm?
9 How long have you been working in your farm?
10 If new farmer, what was your previous job?
11 Who has the primary responsibility in all the farming activities (land preparation, planting, management, harvesting, etc.)?
☐ Myself ☐ Others (Specify)
12 How often do you visit your farm (in hours/day and days/week)? hrs/day days/wk
13 How many family members do you have?
14 Do you have farm workers to help you in the farm management? ☐ Yes ☐ No
If yes, how many: Main laborer/workers
Supplement workers
Dependent workers
15 Do your family members have jobs aside from farming? ☐ Yes ☐ No
Specify:
Part II: Respondent Property and Crop Characterization
16 How large is your farm?
17 Do you own the farm? ☐ Yes ☐ No
18 If not, what is your agreement with the farm owner?
☐ Caretaker ☐ Tenant
☐ Sharecropper ☐ Casual
19 Number of planting season per year
20 Do you use fertilizers for the crops? ☐ Yes ☐ No
Specify:
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Survey Questionnaire
Respondent No.: _________ Department of Pest Management Time:__________
Visayas State University
21 Do you use synthetic pesticides against the pests and diseases of the crops? ☐ Yes ☐ No
22 Pesticides being used:
Date Applied Trade name a.i. and % a.i.* Amount Crop/Stage Target Pests Means of Application
*You may add another sheet of questionnaire if the space is not enough.
23 Other means of managing pests and diseases in your farm aside from pesticide reliance: ☐ Yes ☐ No
If yes, specify:
24 Reasons why you rely on pesticide application:
☐ Pesticides are cheaper ☐ Time efficient during application
☐ Provides high harvest ☐ Effectivity
☐ Influence/recommended by others ☐ Accessibility (e.g. , market)
☐ The only known practice ☐ Others (Specify):
25 Decision on choosing the pesticides to be used
☐ Myself ☐ Land Owner ☐ Others (Specify):
26 Upon purchase of pesticides, does it have any label?
☐ Yes ☐ Sometimes ☐ No
27 How often do you change the brands of pesticides?
☐ I used only one brand
☐ Sometime
☐ Always
28 Do you observe rotation of the diffent classification of pesticides?
☐ Yes ☐ Sometimes ☐ No
29 Who is responsible in applying the pesticides? ☐ Me ☐ Others (Specify)
30 Dosage of pesticides used ☐ Based on the recommended rate
☐ Based on the preference (adjustments)
☐ Based on the advise of others
31 Why do you change the dosage of the pesticides being applied to your crops?
☐ Recommended by others
☐ Pest outbreak
☐ Pest resistance
☐ Increase effectivity
☐ Others (Specify):
32 Do you use pesticide cocktails? ☐ Yes ☐ No
If yes, what brands/types of pesticides do you mix?
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Survey Questionnaire
Respondent No.: _________ Department of Pest Management Time:__________
Visayas State University
33 Reasons of mixing different brands/types of pesticides: ☐ Recommended by others
☐ Pest outbreak
☐ Pest resistance
☐ Increase effectivity
☐ Others (Specify):
34 Do the mixing of pesticides and changing of dosage have increased your yield? ☐ Yes ☐ No
35 Yield during the last cropping season:
36 Do you use different pesticide dosage in dry and wet season? ☐ Yes ☐ No
If yes, how much? Dry Season
Wet Season
Part III: Knowledge and/or Training
37 Have you received any basic training on safe handling and applying pesticides?
☐ Yes ☐ No
If yes, what kind of training?
If no, do you have any access with someone who can provide you such training?
Are you willing to attend/participate in pesticide use and safe handling seminar? ☐ Yes ☐ No
Why or why not?
What seminars/trainings do you need?
Please suggest some topics.
38 Where did you learn on how to apply pesticides?
☐ Reading the label ☐ Training from farmers' association
☐ Through other farmers ☐ Training from the local government
☐ Training from TESDA/ATI ☐ Others (Specify):
39 Did you observe any effects on your health in using pesticides?
☐ None so far ☐ Major Effect
☐ Slight Effect ☐ Lethal/Fatal Effect
Part IV: Protection Habits
40 Kindly answer the following questions by checking either yes or no.
Habits Before Application
Do you read the label? ☐ Yes ☐ No
Do you understand the labels? ☐ Yes ☐ No
If you cannot read, do you let others read it for you? ☐ Yes ☐ No
Do you follow the label? ☐ Yes ☐ No
Do you use gloves while mixing the pesticides? ☐ Yes ☐ No
Do you use goggles while mixing the pesticides? ☐ Yes ☐ No
Do blow the nozzle when it is clogged? ☐ Yes ☐ No
Personal protective Equipment while spraying
Gloves ☐ Yes ☐ No
Hat (Other head gears) ☐ Yes ☐ No
Masks ☐ Yes ☐ No
Long-sleeved clothes ☐ Yes ☐ No
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Survey Questionnaire
Respondent No.: _________ Department of Pest Management Time:__________
Visayas State University
Long pants ☐ Yes ☐ No
Do you observe wind direction before spraying? ☐ Yes ☐ No
Do you spray even when it is windy? ☐ Yes ☐ No
Do you smoke while spraying? ☐ Yes ☐ No
Do you eat or drink while spraying? ☐ Yes ☐ No
Do you change clothes after spraying? ☐ Yes ☐ No
Did you bury you empty pesticide bottles? ☐ Yes ☐ No
Do you store pesticides along with your food and medicines? ☐ Yes ☐ No
41 Where do you wash your spray containers or knapsack sprayers?
☐ In the field/farm ☐ At home (e.g., faucet)
☐ In the river/irrigation canal ☐ At the well/Near the source of water
42 Where do you usually throw the water residue after washing?
43 How do you wash your spray container or knapsack sprayer or do you have a personal protocol in washing? Please specify.
44 How many days do you let to pass before re-entering the rice fields after spraying?
45 Are there any social actions against pesticide use in your area? ☐ Yes ☐ No
If yes, how often? ☐ Sometimes ☐ Often ☐ Always
46 Where do you store the pesticides when not in use?
47 How long do you store the opened pesticides?
Part V: Health
48 Do you smoke or maybe betel-chewing (mamá )? ☐ Yes ☐ No
What type of cigarette do you smoke?
☐ Pipe ☐ Cigarette w/ filter ☐ Dried tobacco leaves ☐ e-cigarette
49 How many sticks do you consume in a day?
50 Age started smoking?
51 If you are an ex-smoker, how many years have you stopped smoking?
52 Do you drink any alcoholic beverages? ☐ Yes ☐ No
If yes, specify:
How often do you drink?
53 Do you have any perceived symptoms of possible pesticide poisoning while spraying? ☐ Yes ☐ No
If yes, what symptoms? ☐ Dry throat ☐ Difficulty in breathing
☐ Excessive sweating ☐ Salivating
☐ Eye irritation ☐ Skin irritation
☐ Diarrhea ☐ Cough
☐ Headache ☐ Nausea
☐ Others (Specify)
54 Do you think it was caused by the use of pesticides? ☐ Yes ☐ No
55 Did you consult a doctor? ☐ Yes ☐ No
If yes, what was the diagnosis?
If no, why?
56 Are there any sick members of your family? ☐ Yes ☐ No
If yes, what was the sickness?
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Survey Questionnaire
Respondent No.: _________ Department of Pest Management Time:__________
Visayas State University
Is there any history of this sickness in your family? ☐ Yes ☐ No
57 Do you know any farmer who died within the last 3 years? ☐ Yes ☐ No
If yes, do you think it was caused by pesticide use? ☐ Yes ☐ No
If not, what is the cause then?
58 Do you think pesticide use has negative short term impacts on your health?
☐ No impact at all ☐ Slight impacts ☐ Huge impacts ☐ Fatal impacts
59 Do you think pesticide use has negative long term impacts on your health?
☐ No impact at all ☐ Slight impacts ☐ Huge impacts ☐ Fatal impacts
Part VI: Environment
60 Do you think that pesticide uses have negative effects in our environment?
☐ No impact at all ☐ Slight impacts ☐ Huge impacts ☐ Fatal impacts
61 Have you experienced any water contamination due to pesticide use? ☐ Yes ☐ No
62 Have you witnessed any death of non-target organisms (natural enemies, pollinators, fishes, frogs, birds, etc.) due to pesticide use?
☐ Yes ☐ No
If yes, specify what non-target organisms:
Specify if you know how to distinguish between target (pest) and non-target organisms.
We appreciate your effort, time and participation in this interview. Rest assured that your identity and the information you provided will
be used for research or for academic purposes only.
Part VII: Interviewer Debriefing Questions (For the Interviewer Only)
63 Do you think the respondent answered truthfully?
☐ Very uncertain ☐ Moderately certain ☐ Neutral
☐ Moderately uncertain ☐ Very certain
64 Please write your comments, suggestion and/or recommendation during your interview and for the improvement of this questionnaire.
Interviewer Name and Signature: Date:
~END~
This survey questionnaire is part of the PPrt 132 Laboratory Exercise number 6 (First Semester AY 2021-2022).
Modified from Perez et al., 2015. Pesticide use among farmers in Mindanao, Southern Philippines. AES Bioflux 7(1): 90-108.
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Survey Questionnaire
