Noise Survey


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):
  Name (First):
City/Town:   Country:      

Sex:    Female     Male


Highest level of education:
High School or less     

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):
  (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     

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:
  By-law Office
  Condo. Board

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)?

Don't care

21. Do you have any additional comments?



Last Updated: 23-Dec-2006
2006 NoiseWatch