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Questionnaire
Effect of SMOG

Demographic Questionnaire
Part A: Please tick ( ) the most appropriate option.

1. Respondent Name: _________________

2. Gender:
 Male
 Female

3. Age:
 15 - 30
 31 - 45
 46 - 60
 Above 60

4. Education:
 Matriculation
 Intermediate
 Undergraduate
 Graduate
 Postgraduate
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Questionnaire on Smog's Impact on Health

Questionnaire is to find out the impact of smog on health; a Likert scale can be employed. Here are 25 important
questions for a helpful survey.
Note: Full form of these words;
1) Strongly Disagree [SD]
2) Disagree [D]
3) Neutral [N]
4) Agree [A]
5) Strongly Agree [SA]

Part B: Please tick ( ) the most appropriate option.

Sr Questions SD D N A SA
No.
1 you are aware about toxic smog 1 2 3 4 5
2 You feel uncomfortable in breathing at smog areas 1 2 3 4 5
3 People are getting sick in breathing diseases due to smog 1 2 3 4 5
4 Spending much time in smog environment can harm your health 1 2 3 4 5
5 you personally experienced problem of allergies due to smog 1 2 3 4 5
6 You ever visit doctor due to suffering in any disease by the cause of 1 2 3 4 5
smog affects
7 You ever suffer from coughing disease due to smog 1 2 3 4 5
8 You ever suffer from burning sensation in eyes due to smog 1 2 3 4 5
9 You ever suffer from lungs disease due to smog 1 2 3 4 5
10 Dangerous for people suffering from asthma 1 2 3 4 5
11 Smog can also kill plants 1 2 3 4 5
12 Using renewable sources of energy can reduce smog 1 2 3 4 5
13 Heavy presence of vehicles in cities a cause of smog 1 2 3 4 5
14 Existence of Heavy industries in the surrounding of big cities a reason 1 2 3 4 5
of smog
15 Strict regulations on industrial emissions would significantly reduce 1 2 3 4 5
smog levels in air
16 Does environmental and pollution control institutions need to revise 1 2 3 4 5
their instruction for vehicles and industries to control smog
17 you check air quality indexes before going outdoors routine wise 1 2 3 4 5
18 Awareness campaigns conduct to educate the public about smog's 1 2 3 4 5
impact on health can save people from diseases
19 You reformed your daily activities or routines due to concerns about 1 2 3 4 5
smog and health
20 You satisfied with the current air quality monitoring systems in place 1 2 3 4 5
21 By getting awareness about smog among people can reduce the health 1 2 3 4 5
risks
22 The effectiveness of masks or other protective measures against smog 1 2 3 4 5
can reduce health risks
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23 Government is doing a good job to reduce smog 1 2 3 4 5

24 Governmental quick actions aimed to be reducing smog immediately 1 2 3 4 5
25 Government new plan to do artificial rain in big cities can reduce level 1 2 3 4 5
of smog
26 Government is need to focus on electric vehicles to reduce pollution 1 2 3 4 5
and smog drastically
27 As per your opinion, developing new societies by preventing 1 2 3 4 5
agricultural land and cutting down green fields can a major reason of
smog in cities
28 Government instruction regarding more holidays, open markets very 1 2 3 4 5
late, and close markets earlier is a good step to save yourself from
smog
29 Government instruction regarding more holidays, open markets very 1 2 3 4 5
late, and close markets earlier can harmfully affect the economy of
Pakistan
30 How concerned are you about the long-term results or effects of smog 1 2 3 4 5
on children's health?
31 you actively participate in community efforts to address smog-related 1 2 3 4 5
issues
32 you know about any new inventions that help stop smog pollution 1 2 3 4 5
33 Our hospitals are fully equipped for the treatment about smog affected 1 2 3 4 5
patients
34 You have idea that smog relates to particular temperature 1 2 3 4 5
35 You have idea that smog is becoming dangerous for healthy lives of
human
36 Airplane flights can be either delay or cancel due to smog weather
37 Zero visibility during smog weather can be a cause of road accidents
38 As per you opinion that smog is an indirect indicator who affects our
economy

Part C: Write appropriate answer

In your opinion, what more can be done at the community level to reduce the impact of smog on health?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Suggestion:

______________________________________________________________________
______________________________________________________________________
____________________________
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Thank You