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Questionnaire Name - Questionaire on noise

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1	What is your age?
	A- below 12 (0)  B- 13-18 (71)  C- 19-30 (17)  D- 31-50 (0)  E- above 50 (0)
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2	Male or female?
	A- Male (40)  B- Female (48)
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3	What the highest educational level you succesfully completed?
	A- No education (0)  B- Primary School (7)  C- Secondary School (71)  D- University (9)  E- Others (1)
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4	Please choose the description that fits you best:
	A- Work 32 hours or more per week (8)  B- Work between l9 and 32 hours per week (0)  C- Work less than l9 hours per week (0)  D- Full time housewife/houseman (0)  E- Retired (0)  F- Unemployed (1)  G- Students (79)
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5	To what extent do you consider yourself sensitive to noise ? Please choose from zero to ten where 0 means not at all sensitive and 10 means very sensitive.
	A- 0 (0)  B- 1 (0)  C- 2 (0)  D- 3 (2)  E- 4 (6)  F- 5 (6)  G- 6 (18)  H- 7 (18)  I- 8 (27)  J- 9 (7)  K- 10 (4)
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6	Do you prefer listening to music while working?
	A- Yes (42)  B- No (46)
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7	If yes, why?
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8	How often is your sleep disturbed by any sources of noise?
	A- Daily (8)  B- At least once a week (18)  C- At least once a month (16)  D- At least once in the past year (29)  E- Never (17)
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9	Please choose the best options from a zero to ten opinion scale for how much the following sources of 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. a. Urban traffic
	A- 0 (21)  B- 1 (16)  C- 2 (16)  D- 3 (8)  E- 4 (6)  F- 5 (5)  G- 6 (7)  H- 7 (3)  I- 8 (5)  J- 9 (1)  K- 10 (0)
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10	b. Heavy truck/ freight transport vehicles
	A- 0 (33)  B- 1 (12)  C- 2 (6)  D- 3 (8)  E- 4 (6)  F- 5 (2)  G- 6 (6)  H- 7 (9)  I- 8 (4)  J- 9 (1)  K- 10 (1)
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11	c. Motor bikes
	A- 0 (25)  B- 1 (15)  C- 2 (9)  D- 3 (6)  E- 4 (6)  F- 5 (9)  G- 6 (7)  H- 7 (7)  I- 8 (2)  J- 9 (1)  K- 10 (1)
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12	d. Aircraft
	A- 0 (46)  B- 1 (9)  C- 2 (5)  D- 3 (3)  E- 4 (4)  F- 5 (9)  G- 6 (2)  H- 7 (3)  I- 8 (5)  J- 9 (0)  K- 10 (2)
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13	e. Neighbours
	A- 0 (24)  B- 1 (12)  C- 2 (9)  D- 3 (14)  E- 4 (6)  F- 5 (2)  G- 6 (5)  H- 7 (5)  I- 8 (7)  J- 9 (1)  K- 10 (3)
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14	f. Industry
	A- 0 (59)  B- 1 (3)  C- 2 (2)  D- 3 (5)  E- 4 (2)  F- 5 (5)  G- 6 (6)  H- 7 (3)  I- 8 (3)  J- 9 (0)  K- 10 (0)
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15	g. Bars/disco
	A- 0 (59)  B- 1 (1)  C- 2 (2)  D- 3 (3)  E- 4 (4)  F- 5 (4)  G- 6 (3)  H- 7 (4)  I- 8 (2)  J- 9 (3)  K- 10 (3)
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16	h. Noisy sports (shooting, car/ motorcycle races, etc.)
	A- 0 (48)  B- 1 (5)  C- 2 (4)  D- 3 (4)  E- 4 (8)  F- 5 (6)  G- 6 (3)  H- 7 (3)  I- 8 (3)  J- 9 (3)  K- 10 (1)
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17	i. Building and demolishing
	A- 0 (34)  B- 1 (6)  C- 2 (7)  D- 3 (6)  E- 4 (5)  F- 5 (9)  G- 6 (2)  H- 7 (2)  I- 8 (5)  J- 9 (7)  K- 10 (5)
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18	j. Unknown source
	A- 0 (18)  B- 1 (10)  C- 2 (9)  D- 3 (4)  E- 4 (12)  F- 5 (12)  G- 6 (6)  H- 7 (4)  I- 8 (4)  J- 9 (3)  K- 10 (6)
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19	Have you ever experienced any of the following long term health effects due to noise exposure? a. Hearing damage
	A- Yes (8)  B- No (80)
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20	b. Hypertension
	A- Yes (14)  B- No (74)
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