We are interested in knowing your opinion on the haze. I hope you will kindly fill up the questionnaire without consulting your friends, relatives or leaving this site.

Demographic data  

Date : (dd/mm/yyyy)

Age in years:

Sex:Male Female


Town of residence:



 (i) Malaysia

(ii) Singapore

(iii) Indonesia

(iv) Brunei

(v) Philippines

(vi) Thailand

(vii) Others

If others, state country

Smoking status: SmokerNon smoker

Information on Air Pollution Index

  1. Do you feel you have enough information on the haze?
  2. YesNo

  3. What has the highest Air Pollution Category been where you live?
  4. Good Moderate Unhealthy Very unhealthy Hazardous Emergency Don't know


  5. What has the highest Air Pollution Index been where you live?

  7. Do you understand what the Air Pollution Index (API) means?
  8. YesNo

    If yes, (what are the 5 gases/ pollutants you think are measured to decide on the index. Please tick 5 pollutants

     (i) carbon monoxide

    (ii) carbon dioxide

    (iii) oxygen

    (iv) sulphur dioxide

    (v) nitrogen dioxide

    (vi) ozone

    (vii) particulate matter 10

    (viii) lead

    If no, would you like to know how the API is derived.



    5. The Air Pollution Index (API) is derived from (i) or (ii) below . Please tick one.


    (i) a composite index of all 5 pollutants


    (ii) the pollutant with the highest concentration

    6. Rank 1- 4 commonest source of information on the haze for you

     Radio 12 3 4

     Newspapers 12 3 4

     Television 12 3 4

     Internet12 3 4


    Health Effects


    7. Have you experienced any health effects from the haze?


    If yes, have you experienced :

      (i) Increased coughing due to the haze? YesNo

     (ii) Difficulty in breathing due to the haze?YesNo

      (iii) Skin irritation due to the haze? YesNo

      (iv) Eye irritation due to the haze? YesNo

     (v) Asthma attack due to the haze? YesNo

    8. Do you think that you are at an increased risk of developing any of the following diseases because of the haze.

      Lung diseaseYesNo

      Heart disease YesNo

      Cancer YesNo

     Peptic ulcer YesNo

      High blood pressure YesNo

      Kidney diseaseYesNo

      Tuberculosis YesNo

    9. Has the visibility during the haze affected your driving? YesNo

    If yes, have you:

    (i) at any time felt it was dangerous to drive? YesNo

    (ii) ever stopped driving because of poor visibility? YesNo

    Control Measures

    10. What do you think should be done to reduce the haze?

    Rank priority 1-5 in order of effectiveness. (1=most effective; 5=least effective)

     Help fight the forest fires 12 3 45

     Stricter enforcement of open burning in the country 12 3 45

     Restrict the entry of private vehicles into the city 12 3 45

     Increase checks on pollutant emissions from factories/vehicles 12 3 45

     Decrease dust pollution from construction activity12 3 45

    11. Should the general public be encouraged to wear masks? YesNo

    If yes, at what Air Pollution Index

    12. Do you think employees working outdoors most of the time should be provided

    with masks by the employers? YesNo

    Optional Question (In case there is a follow-up survey)


    Any Comments:

    Thank you for answering the above questions and participating in this survey.

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