This file contains the structured survey instrument used to collect data on antibiotic use in poultry farming in Burkina Faso. It includes socio‑demographic variables (age, gender, education, marital status, occupation), farm characteristics (production system, flock size, years of practice), and detailed questions on antibiotic practices such as reasons for use (prevention, treatment, growth promotion), types of antibiotics administered, compliance with withdrawal periods, and access to veterinary services. The questionnaire also integrates sections on biosafety practices, farmer awareness, and training needs. All items are presented in bilingual format (French–English) to facilitate international collaboration and ensure consistency in data collection. This file serves as a methodological annex to the dataset, providing transparency on survey design and enabling replication or adaptation in similar research contexts.