This document will help you to prepare a questionnaire on Environmental Impact Assessment of Brickfield. This questionnaire is divided into two parts. One is the resident who are the dwellers around brickfield and another is the worker of brickfield.

1. Questionnaire No: ……….
Date: ……………………..
Thank you for your sincere coordination
Pabna University of Science & Technology
Environmental Impact Assessment of Brickfield: A Case Study of Pabna
Sadar Upazila
Questionnaire for Residents around Brickfield
Brickfield Location: …………………….
Personal Information:
Name
Address
Family Member
Number of school going children
1. Please, answer the following question.
Have any opinion? ……………………………………………………………………………
………………………………………………………………………………………………….
2. Have any establishment around 1km of brickfield?
area
office etc.)
3. Have you face any health problem after the construction of brickfield? Please fill up the
following boxes. (You may answer more than one)
If answer is others, please specify the name…………………………………………….
4. Please tell me about Brick kiln technology if you know.
5. Any Comments about Brickfield?
SL. No Environmental
Impacts
Adverse
effect
Moderate Minor effect No effect
1 Soil fertility
2 Agricultural production
3 Vegetation
4 Aquaculture
5 Air pollution

2. Questionnaire No: ……….
Date: ……………………..
Thank you for your sincere coordination
Pabna University of Science & Technology
Environmental Impact Assessment of Brickfield: A Case Study of Pabna
Sadar Upazila
Questionnaire for Workers in Brickfield
Brickfield Location: …………………….
Personal Information:
Name
Address
Family Member
Position in Brickfield
Number of school going children
1. How many water in everyday used for brick production and what is the source of water?
2. What are the materials used in brick production? (You may answer more than one)
Soil Cement
Source of Soil and Sand: …………………………………………………………..
3. Which materials are used in burning of bricks?
4. Have you face any health problem because of working in brickfield? Please fill up the
following boxes. (You may answer more than one)
If answer is others, please specify the name…………………………………………….
5. Please tell me about Brick kiln technology if you know.
6. Give you any compensation to the responsible authority for reducing the environmental
effects.
Any Comments……………………………………………………………………………….
7. Any Comments about the total performance of Brickfield?