This questionnaire template help you to make a questionnaire to study on industrial revitalization for any industry. This template is made by Ritu Saha, Noshin Nawar and Laila Arjuman.

1. PABNA UNIVERSITY OF SCIENCE & TECHNOLOGY
Department of Urban & Regional Planning
Questionnaire on Industrial Revitalization of North Bengal Paper Mill, Paksi, Pabna.
(Academic Purpose Only)
For labor:
Personal Information
Name: Sex: Male
Age: Female
Marital status: Married Religion:
Unmarried Educational Background:
Previous Position: Current Profession:
Address:
Contract number:
Household Information
Total family members:
Total earning members in family:
Current monthly income:
Previous monthly income:
Total household income:
Industrial Information
1 = good, 2 = moderate, 3 = poor
Condition Description
Past Present
Transportation Network
Drainage system
Fire Protection System
Security System

2. Facilities for labor:
1 = good, 2 = moderate, 3 = poor
1. What was their duration of working hour?
Ans:
2. If they had any overtime?
O Yes O No
3. Were there enough machineries for their work?
O Yes O No
4. Tell about the condition of machineries?
a) good b) moderate c) poor
5. Had any emergency exit?
O Yes O No
6. How was the working environment?
a) good b) moderate c) poor
7. Had any training facilities for labor?
O Yes O No
8. Causes of breakdown:
9. Effects on labor for shutting down of industry:
Facilities Condition
Past Present
Accommodation
Educational
Health
Recreational
Sanitation
Others
Tiffin facility O Yes O No a) good b) moderate c) poor
Vacation O Yes O No a) good b) moderate c) poor
Increment O Yes O No a) good b) moderate c) poor
Bonus O Yes O No a) good b) moderate c) poor

3. PABNA UNIVERSITY OF SCIENCE & TECHNOLOGY
Department of Urban & Regional Planning
Questionnaire on Industrial Revitalization of North Bengal Paper Mill, Paksi, Pabna.
(Academic Purpose Only)
For staff:
Personal Information
Name: Sex: Male
Age: Female
Marital status: Married Religion:
Unmarried Educational Background:
Previous Position: Current Profession:
Address:
Contract number:
Household Information
Total family members:
Total earning members in family:
Current monthly income(own):
Previous monthly income(own):
Total household income:
Industrial Information
1. Factory establishment and area information:
Total area
Policy making period
Name of Government (taken policy of paper mill)
Construction starting period
Construction ending period

4. 2. Workers and working hour information:
3. Machineries and raw materials information:
Types of raw materials
Amount of raw materials(per day)
Amount of raw materials(per year)
Types of chemical compounds
 Did they use any foreign chemical compounds?
O Yes O No
Please specify the country name: …………………….
Raw
materials
Chemicals machineries
Cost
Quality
Availability
1 = high, 2 = moderate, 3 = poor
4. Production Information:
Commercial production starting period
Production ability(per day)
Production ability(per year)
Paper price rate
Types of products
Amounts of export products
 How was the paper quality?
Ogood O moderate O poor
Construction company name
Scheme of project
estimate cost of project
Factory starting time
Factory ending time
Working hour started
Working hour ended
Total Workers number
Staffs number
Labor number

5.  How was the market demand of paper?
O high O moderate O poor
5. Infrastructure and Systems assessment:
1 = good, 2 = moderate, 3 = poor
 Had any alternate power supply?
O Yes O No
 Had any emergency exit?
O Yes O No
Water Supply system:
Source collection Treatment Distribution Condition
Past Present
Solid Waste management System:
Waste
generation
Collection Dumping Treatment Condition
Past Present
1 = good, 2 = moderate, 3 = poor
condition Description
past present
Infrastructure
Transportation
Network(Inside)
Transportation
Network(outside)
Drainage system
Storage system
Fire protection
system
Power supply
Security system

6. 6. Facilities for staff:
1 = good, 2 = moderate, 3 = poor
7. Industrial Impact Assessment:
Impact Economic Political Social Environmental
Past Positive
Negative
Present Positive
Negative
 Describe about historical background of the industry
 Describe about causes of breakdown of the industry.
 Suggestion for reopening.
Facilities Condition
Past Present
Accommodation
Educational
Health
Recreational
Sanitation
Others
Tiffin facility O Yes O No a) good b) moderate c) poor
Vacation O Yes O No a) good b) moderate c) poor
Increment O Yes O No a) good b) moderate c) poor
Bonus O Yes O No a) good b) moderate c) poor

7. PABNA UNIVERSITY OF SCIENCE & TECHNOLOGY
Department of Urban & Regional Planning
Questionnaire on Industrial Revitalization of North Bengal Paper Mill, Paksi, Pabna.
(Academic Purpose Only)
For urban dwellers:
Personal Information
Name: Sex: Male
Age: Female
Marital status: Married Religion:
Unmarried Educational Background:
Previous Position: Current Profession:
Address:
Contract number:
 Have any relationship with paper mill?
O Yes O No
If yes, please specify. ……………………..
Household Information
Total family members:
Total earning members in family:
Current monthly income:
Previous monthly income:
Total household income:
Industrial Information
1 = good, 2 = moderate, 3 = poor
Condition Description
Past Present
Transportation Network
Drainage system
Water Supply
Security

8. Industrial Impact Assessment:
Impact Economic Political Social Environmental
Past Positive
Negative
Present Positive
Negative
 Have any other facilities of the industry?
O Yes O No
If yes, please specify. ……………………..
 Causes of breakdown of the industry: