Questionnaire on noise : the core set
This is a core set of questions relating to the monitoring of environmental noise. It is a sub-set of a somewhat longer -but still limited- set of questions. The numbers (A1, B2...) refer to this facultative list. At the end -section F- are some very general questions that should be asked anyway, so they are incorporated in the core, even if they dont relate to noise. There are very few routings, all questions would have to be put to the respondent to answer.
A.1 |
How long do you live in this house |
.. Year (if shorter then 1 year: end) |
B1
Next is a zero to ten opinion scale for how much (..source..) noise bothers, disturbs or annoys you when you are here at home. If you are not at all annoyed choose zero, if you are extremely annoyed choose ten, if you are somewhere in between, choose a number between zero and ten. Thinking about the last 12 months or so, what number from zero to ten best shows how much you are bothered or annoyed by (..source..) noise?
0= not at all annoyed |
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10= very much annoyed |
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0 |
1 |
2 |
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4 |
5 |
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9 |
10 |
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(This table is for orientation: suit the response categories to your needs. )
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0 |
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9 |
10 |
a |
Urban traffic |
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b |
Traffic on highways, motorways, and the like. |
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c |
passenger cars |
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d |
delivery vans |
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e |
heavy truck/ freight transport vehicles |
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f |
motor bikes |
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g |
mopeds |
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h |
Civil aircraft |
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i |
Military aircraft |
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j |
General aviation |
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k |
delivery of shops and business |
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l |
neighbours |
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m |
Passenger trains |
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n |
Freight trains |
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o |
trams or metro |
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p |
industry |
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q. |
Delivery of shops and business |
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r |
bars/disco |
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s |
luna parks etc |
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t |
noisy sports (shooting, car/ motorcycle races etc) |
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others |
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B3 To what extent do you consider yourself sensitive to noise ?
0 = not at all sensitive |
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10= very sensitive |
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0 |
1 |
2 |
8 |
4 |
5 |
6 |
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10 |
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E1 At what time do you usually go to sleep on working days?
(This table is for orientation:suit the response categories to your needs. )
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before 21.00 hour |
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between 21.00 and21.30 hour |
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between 21.30 and 22.00 hour |
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between 22.00 and 22.30 hour |
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between 22.30 and 23.00 hour |
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between 23.00 and 23.30 hour |
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between 23.30 and 24.00 hour |
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after 24.00 hour |
E2 At what time do you usually wake up on working days?
(This table is for orientation: suit the response categories to your needs. )
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before 05.00 hour |
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between 05.00 and 05.30 hour |
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between 05.30 and 06.00 hour |
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between 06.00 and 06.30 hour |
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between 06.30 and 07.00 hour |
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between 07.00 and 07.30 hour |
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between 07.30 and 08.00 hour |
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after 08.00 hour |
E3 At what time do you usually go to sleep on weekends?
(This table is for orientation:suit the response categories to your needs. )
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before 21.00 hour |
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between 21.00 and 21.30 hour |
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between 21.30 and 22.00 hour |
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between 22.00 and 22.30 hour |
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between 22.30 and 23.00 hour |
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between 23.00 and 23.30 hour |
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between 23.30 and 24.00 hour |
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after 24.00 hour |
E4 At what time do you usually wake up on weekends?
(This table is for orientation:suit the response categories to your needs. )
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before 06.00 hour |
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between 06.00 and 06.30 hour |
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between 06.30 and 07.00 hour |
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between 07.00 and 07.30 hour |
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between 07.30 and 08.00 hour |
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between 08.00 and 08.30 hour |
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between 08.30 and 09.00 hour |
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after 09.00 hour |
E5 Do you usually sleep (nap) at other times during the day?
If yes: between .. and .. hour
E8
Next is a zero to ten opinion scale for how much (..source..) noise disturbs your sleep when you are at home. If you are not at all annoyed choose zero, if you are extremely annoyed choose ten, if you are somewhere in between, choose a number between zero and ten that best reflects the extent to which your sleep is disturbed. Thinking about the last 12 months or so, what number from zero to ten best shows how much your sleep is disturbed by (..source..) noise ?
0= not at all disturbed |
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10= very much disturbed |
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0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
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0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
a |
Urban traffic |
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b |
Traffic on highways, motorways, and the like. |
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c |
passenger cars |
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d |
delivery vans |
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e |
heavy truck/ freight transport vehicles |
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f |
motor bikes |
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g |
mopeds |
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h |
Civil aircraft |
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i |
Military aircraft |
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j |
General aviation |
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k |
delviry of shops and business |
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l |
neighbours |
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m |
Passenger trains |
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n |
Freight trains |
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o |
trams or metro |
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p |
industry |
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q. |
Delivery of shops and business |
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r |
bars/disco |
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s |
luna parks etc |
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t |
noisy sports (shooting,car/ motorcycle races etc) |
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u |
unknown source |
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F1 What is your age?
F2 Male or female?
.. male
.. female
F3 civil status?
.. married or stable relationship
.. single
F4 What the highest educational level you succesfully completed.
(Please only 1 answer)
.. no education
.. primary school
.. Professional education
.. high school or comparable
.. higher professional education
.. university
.. other
F5 Which description fits you best?
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I am paid to work 32 Hour of more per week |
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I am paid to work between l9 and 32 hour per week |
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I am paid to work less then 19 hour per week |
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I am full time housewife/houseman |
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I am pensioned |
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I am studying- |
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I work as a volunteer |
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Unemployed |
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I am invalid |
F6
Do you regularly work night shifts, so you have to sleep in day time?
.. yes
.. no
.. not employed