An interview schedule for a study on

“IMPACT OF AIR POLLUTION IN MYMENSINGH CITY”

Date: Sample No.:

Name of the respondent:
Address:

(Please provide the following information)

1. Age: ………………………….. years

2. Educational Qualification:
a) Cannot read and write:
b) Can sign only:
c) Have read up to class:
d) Have passed class:
3. Occupation:
4. Family size:
Please mention the number of your family member
Male: ………………………………….
Female: ………………………………..
Total: …………………………………..
5. Basic idea on air pollution
Have you heard about air pollution?
What do you mean by air pollution?
…………………………………………………………………………………………
…………………………………………………………………………………………
…………………………………………………………………………………………
 6. Causes of Air pollution:

SL Causes of air pollution Strongly Agree Neither Disagree Strongly

No. agree agree nor disagree
disagree
01 The largest source of air pollution in
cities is from vehicle exhaust fumes
02 Burning of fossil fuel such as coal,
petroleum natural gas etc.
responsible for air pollution
03 Smog generally pollute air of cities

04 Pollutants come from factories or

industries pollute air
05 Traditional cooking practice using
wood causes air pollution
06 Dust also can pollute air

07 Cigarette smoking is the cause of

indoor air pollution
08 Brick kiln greatly responsible for
polluting air
09 Rotten materials of dustbin pollute
ambient air
10 Volcanoes, dust storm, forest fire etc.
are causes of natural air pollution
11 Others …………………………..

7. Effects of air pollution:

Sl. Causes of air pollution Strongly Agree Neither Disagree Strongly
No. agree agree disagree
nor
disagree
01 Air pollution causes breathing
problems
02 It aggravates existing health
conditions
03 It effects on respiratory systems
 04 Air pollution causes, cough,
cancer etc. diseases
05 Children are more susceptible to
the adverse effects of air pollution
06 Seasonal changes occur due to
air pollution
07 Contribute global warming
08 Imbalance environmental
condition
09 Air pollution also affect plants and
animals
10 Smoking indirectly effect on non-
smokers specially children
11 Others
………………………………..

8. Strategy to manage the air pollution:

SL. Management Strategy Strongly Agree Neither disagree Strongly
NO. agree agree disagree
nor
disagree
01 Reduce the use of fossil fuels
02 Increase the solar power plant
03 Reduce the use of fossil fuels
04 Environment friendly technology
should be used
O5 Brick kiln should be established
outside the dwelling place
06 Waste disposal managed properly
07 People awareness can reduce the
effects of air pollution
08 Government should take some
necessary steps to face the
adverse effects of air pollution
09 Others……………………..

9. Do you use mask:

Do you use mask when go outside?
Yes: No:
 10. Communication exposure:
SL. Communication Media Extent of use
NO. Regularly Frequently Occasionally Not at all
01 Radio
02 Television
03 Daily newspaper or magazine
04 Internet
05 Use of folk media

11. Have you ever been participated in any Seminar or workshop about air
pollution?
a) Yes
b) No
If yes, then mention the nature and duration of your participation in the
following seminar/workshop:
Where:
When:
Duration:
Who or Whom arranged:

Thank you for giving up your time to complete this questionnaire.

………………………………………………
Signature of the interviewer
Date: …………………………………...