Noise Survey Purpose The following noise survey will be used by us to further our studies and research of noise pollution. All names and e-mail addresses will be kept strictly confidential. No e-mail addresses will ever be forwarded or distributed in any way to another organization, commercial or non-commercial. Please feel free to submit your comments, criticism, suggestions etc. Personal Information Name (Last): (optional) Name (First): (optional) City/Town: Country: E-mail: (optional) Sex: Female Male Age: Under 20 yrs. 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90 or over Highest level of education: High School or less College University Would you describe yourself as: Extroverted Introverted How many hours of sleep do you require? What time do you usually go to sleep? Noise-Related Information 1. Type of noise problem(s): Primary Concern: Secondary Concern(s): Air-conditioner Airplanes Basketball Playing Barking Dog(s) Children Shrieking Construction Idling Vehicles Jet Skiis Leaf Blowers Music (Background) Stereo Trains Traffic Air-conditioner Airplanes Basketball Playing Barking Dog(s) Children Shrieking Construction Idling Vehicles Jet Skiis Leaf Blowers Music (Background) Stereo Trains Traffic (Select all that apply by Ctrl , left-clicking): Not listed: Other: 2. Where does your primary noise problem occur? Home Work Stores Parks Cottage Country Other: 3. How long ago did this noise problem start? weeks ago months ago years ago 4. How often does this noise problem occur? times/day times/week times/month 5. What time of day does this primary noise problem usually occur? (Please check all that apply) Morning Afternoon Evening Night Weekend 6. What is the average duration of this noise problem? < 1 hr. 1-2 hrs. 2-3 hrs. 3-4 hrs. > 4 hrs. 7. Are you aware of the existence of noise by-laws (ordinances)? Yes No (If No, jump to question 9) 8. Do you think the existing noise by-laws are adequate? Yes No: Why not? 9. Have you ever complained to the noisemaker (if applicable)? Yes: How long did you wait before you complained? No: Why not? 10. Have you ever complained to any authorities? (if no, go to question 12) Yes No: Why not? 11. How helpful were the following? (Please check all that apply) Very helpful Somewhat helpful Not helpful If not helpful, please state the reasons: Boss By-law Office Condo. Board Congress-person Councillor Foreman Landlord MP MPP Police Supervisor Other: 12. Do you believe that you have become more sensitive to noise as a result of your noise problem(s)? Yes No 13. Do you experience any of the following physical symptoms of stress when you are exposed to noise? (Please check all that apply) sweating trembling racing heartbeat tension "knot in stomach" other (specify): 14. Do you ever experience any of the following emotions when you are exposed to noise? (Please check all that apply) violent thoughts anger helplessness depression feel trapped other (specify): Noise in Stores and Restaurants 15. Are you ever bothered by background music in stores and restaurants? Yes No (If No, jump to question 18) 16. Do you usually leave stores quickly and without buying anything if you are bothered by the background music? Yes No 17. Did you experience a serious noise problem before you became sensitive to background music in stores and restaurants? Yes No 18. Would you prefer that stores and restaurants: turn down the volume turn off all background music replace background music with "nature" sounds don't care Noisy Products 19. If two products were identical in all respects except for the noise that they produced, which would you buy? Noisier one Quieter one No difference 20. Would you like to see all products that emit sounds, federally rated in terms of noise (dB)? Yes No Don't care 21. Do you have any additional comments? Back Last Updated: 23-Dec-2006 © 2006 NoiseWatch
The following noise survey will be used by us to further our studies and research of noise pollution. All names and e-mail addresses will be kept strictly confidential. No e-mail addresses will ever be forwarded or distributed in any way to another organization, commercial or non-commercial. Please feel free to submit your comments, criticism, suggestions etc.
Personal Information
Sex: Female Male
Age: Under 20 yrs. 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90 or over
Highest level of education: High School or less College University
Would you describe yourself as: Extroverted Introverted
Noise-Related Information
1. Type of noise problem(s):
2. Where does your primary noise problem occur?
Home Work Stores Parks Cottage Country Other:
3. How long ago did this noise problem start?
weeks ago months ago years ago
4. How often does this noise problem occur?
times/day times/week times/month
5. What time of day does this primary noise problem usually occur? (Please check all that apply)
Morning Afternoon Evening Night Weekend
6. What is the average duration of this noise problem?
< 1 hr. 1-2 hrs. 2-3 hrs. 3-4 hrs. > 4 hrs.
7. Are you aware of the existence of noise by-laws (ordinances)?
Yes No (If No, jump to question 9)
8. Do you think the existing noise by-laws are adequate?
Yes No: Why not?
9. Have you ever complained to the noisemaker (if applicable)?
Yes: How long did you wait before you complained?
No: Why not?
10. Have you ever complained to any authorities? (if no, go to question 12)
11. How helpful were the following? (Please check all that apply)
12. Do you believe that you have become more sensitive to noise as a result of your noise problem(s)?
Yes No
13. Do you experience any of the following physical symptoms of stress when you are exposed to noise? (Please check all that apply)
14. Do you ever experience any of the following emotions when you are exposed to noise? (Please check all that apply)
Noise in Stores and Restaurants
15. Are you ever bothered by background music in stores and restaurants?
Yes No (If No, jump to question 18)
16. Do you usually leave stores quickly and without buying anything if you are bothered by the background music?
17. Did you experience a serious noise problem before you became sensitive to background music in stores and restaurants?
18. Would you prefer that stores and restaurants:
turn down the volume turn off all background music replace background music with "nature" sounds don't care
Noisy Products
19. If two products were identical in all respects except for the noise that they produced, which would you buy?
Noisier one Quieter one No difference
20. Would you like to see all products that emit sounds, federally rated in terms of noise (dB)?
Yes No Don't care
21. Do you have any additional comments?
Back