Canadian Perspectives Survey Series 2 - Monitoring the Effects of COVID-19
For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.
Table of Contents
- Labour market impacts (LM)
- Mental health impacts (MH)
- Behaviours and health impacts (BH)
- Food security (FSC)
Labour market impacts (LM)
Labour market impacts (LM) - Question identifier:LM_R05
The following questions concern your activities during the week of ^REFDATE_E.
Labour market impacts (LM) - Question identifier:LM_Q05
During that week, did you work at a job or business?
Select "Yes" if you worked at least one hour:
for pay (wages, salary, etc.)
in self-employment.
Select "No" if you:
were away from work for the entire week for a reason such as vacation, illness, work schedule or layoff
did not have a job or business.
- 1: Yes
- 2: No
Labour market impacts (LM) - Question identifier:LM_Q10
During that week, did you have a job or business from which you were absent?
Select "Yes" if you:
were away from work for the entire week for a reason such as vacation, illness, parental leave or work schedule
were self-employed with a business, but no work was available.
Select "No" if you:
did not have a job or business
had a casual job, but no work was available.
- 1: Yes
- 2: No
Labour market impacts (LM) - Question identifier:LM_Q15
What was the main reason you were absent from work that week?
Would you say:
- 1: Planned absence not related to COVID-19 (e.g., vacation, work schedule, maternity or parental leave, seasonal job or business)
- 2: Unplanned absence not related to COVID-19 (e.g., illness or disability other than COVID-19, caring for children or elder relative for non-COVID-19 reasons, labour dispute (strike or lockout))
- 3: Business closure or layoff related to COVID-19
- 4: Personal circumstances related to COVID-19 (e.g., personal safety, own or household member's diagnosis, self-isolation after recent travel, taking care of children due to school closure)
Labour market impacts (LM) - Question identifier:LM_Q20
Which of the following best describes your usual place of work at your main job or business?
Exclude any recent changes related to COVID-19.
Would you say:
- 1: Work at a fixed location outside the home
- 2: Work outside the home with no fixed location (e.g., driving, making sales calls)
- 3: Work at home
Labour market impacts (LM) - Question identifier:LM_Q25
During the week of ^REFDATE_E, in which of these locations did you work the most hours?
Would you say:
- 1: At a fixed location outside the home
- 2: Outside the home with no fixed location (e.g., driving, making sales calls)
- 3: At home
- 4: Absent from work
Labour market impacts (LM) - Question identifier:LM_Q30
To what extent do you agree or disagree with the following statement?
I might lose my main job or main self-employment income source in the next four weeks.
Would you say that you:
- 1: Strongly agree
- 2: Agree
- 3: Neither agree nor disagree
- 4: Disagree
- 5: Strongly disagree
Labour market impacts (LM) - Question identifier:LM_Q35
Since March 15, did you make a new application for any of the following types of Employment Insurance benefits or for the Canada Emergency Response Benefit?
Select all that apply.
- 1: Regular
- 2: Sickness
- 3: Caregiving or compassionate care
- 4: Work-sharing
- 5: Other Employment Insurance benefit
- 6: Canada Emergency Response Benefit (CERB)
- 7: Did not apply for any benefits
Labour market impacts (LM) - Question identifier:LM_Q40
Which of the following best describes the impact of COVID-19 on your ability to meet financial obligations or essential needs, such as rent or mortgage payments, utilities and groceries?
- 1: Major impact
- 2: Moderate impact
- 3: Minor impact
- 4: No impact
- 5: Too soon to tell
Mental health impacts (MH)
Mental health impacts (MH) - Question identifier:MH_Q05
In general, how would you describe your mental health?
Would you say:
- 1: Excellent
- 2: Very good
- 3: Good
- 4: Fair
- 5: Poor
Mental health impacts (MH) - Question identifier:MH_Q15A
Over the last 2 weeks, how often have you been bothered by the following problems?
Feeling nervous, anxious or on edge
- 1: Not at all
- 2: Several days
- 3: More than half the days
- 4: Nearly every day
Mental health impacts (MH) - Question identifier:MH_Q15B
Over the last 2 weeks, how often have you been bothered by the following problems?
Not being able to stop or control worrying
- 1: Not at all
- 2: Several days
- 3: More than half the days
- 4: Nearly every day
Mental health impacts (MH) - Question identifier:MH_Q15C
Over the last 2 weeks, how often have you been bothered by the following problems?
Worrying too much about different things
- 1: Not at all
- 2: Several days
- 3: More than half the days
- 4: Nearly every day
Mental health impacts (MH) - Question identifier:MH_Q15D
Over the last 2 weeks, how often have you been bothered by the following problems?
Trouble relaxing
- 1: Not at all
- 2: Several days
- 3: More than half the days
- 4: Nearly every day
Mental health impacts (MH) - Question identifier:MH_Q15E
Over the last 2 weeks, how often have you been bothered by the following problems?
Being so restless that it is hard to sit still
- 1: Not at all
- 2: Several days
- 3: More than half the days
- 4: Nearly every day
Mental health impacts (MH) - Question identifier:MH_Q15F
Over the last 2 weeks, how often have you been bothered by the following problems?
Becoming easily annoyed or irritable
- 1: Not at all
- 2: Several days
- 3: More than half the days
- 4: Nearly every day
Mental health impacts (MH) - Question identifier:MH_Q15G
Over the last 2 weeks, how often have you been bothered by the following problems?
Feeling afraid as if something awful might happen
- 1: Not at all
- 2: Several days
- 3: More than half the days
- 4: Nearly every day
Behaviours and health impacts (BH)
Behaviours and health impacts (BH) - Question identifier:BH_Q20
Which of the following precautions have you taken to reduce your risk of exposure to COVID-19?
Select all that apply.
- 01: Stocked up on essentials at a grocery store or pharmacy
- 02: Filled prescriptions
- 03: Made a plan for caring for household members who are ill
- 04: Made a plan for other non-household members (e.g., elderly relatives)
- 05: Made a plan for communicating with family, friends and neighbours
- 06: Avoided leaving the house for non-essential reasons
- 07: Used physical distancing when out in public (i.e., made changes in your everyday routine to minimize close contact with others.)
- 08: Avoided crowds and large gathering
- 09: Washed your hands more regularly
- 10: Avoided touching your face
- 11: Cancelled travel
- 12: Worked from home
- 13: Other
- 14: None of the above
Behaviours and health impacts (BH) - Question identifier:BH_Q35A
Are you doing any of the following activities for your health?
Communication with friends and family
- 1: Yes, for my mental health
- 2: Yes, for my physical health
- 3: Yes, for both my mental and physical health
- 4: No
Behaviours and health impacts (BH) - Question identifier:BH_Q35B
Are you doing any of the following activities for your health?
Meditation
- 1: Yes, for my mental health
- 2: Yes, for my physical health
- 3: Yes, for both my mental and physical health
- 4: No
Behaviours and health impacts (BH) - Question identifier:BH_Q35C
Are you doing any of the following activities for your health?
Exercise outdoors
- 1: Yes, for my mental health
- 2: Yes, for my physical health
- 3: Yes, for both my mental and physical health
- 4: No
Behaviours and health impacts (BH) - Question identifier:BH_Q35D
Are you doing any of the following activities for your health?
Exercise indoors
- 1: Yes, for my mental health
- 2: Yes, for my physical health
- 3: Yes, for both my mental and physical health
- 4: No
Behaviours and health impacts (BH) - Question identifier:BH_Q35E
Are you doing any of the following activities for your health?
Changing my food choices
- 1: Yes, for my mental health
- 2: Yes, for my physical health
- 3: Yes, for both my mental and physical health
- 4: No
Behaviours and health impacts (BH) - Question identifier:BH_Q40A
Have your weekly habits changed for any of the following activities?
Consuming alcohol
- 1: Increased
- 2: Decreased
- 3: No change
Behaviours and health impacts (BH) - Question identifier:BH_Q40B
Have your weekly habits changed for any of the following activities?
Using tobacco products
- 1: Increased
- 2: Decreased
- 3: No change
Behaviours and health impacts (BH) - Question identifier:BH_Q40C
Have your weekly habits changed for any of the following activities?
Consuming cannabis
- 1: Increased
- 2: Decreased
- 3: No change
Behaviours and health impacts (BH) - Question identifier:BH_Q40D
Have your weekly habits changed for any of the following activities?
Eating junk food or sweets
- 1: Increased
- 2: Decreased
- 3: No change
Behaviours and health impacts (BH) - Question identifier:BH_Q40E
Have your weekly habits changed for any of the following activities?
Watching television
- 1: Increased
- 2: Decreased
- 3: No change
Behaviours and health impacts (BH) - Question identifier:BH_Q40F
Have your weekly habits changed for any of the following activities?
Spending time on the internet
- 1: Increased
- 2: Decreased
- 3: No change
Behaviours and health impacts (BH) - Question identifier:BH_Q40G
Have your weekly habits changed for any of the following activities?
Playing video games
- 1: Increased
- 2: Decreased
- 3: No change
Behaviours and health impacts (BH) - Question identifier:BH_Q40H
Have your weekly habits changed for any of the following activities?
Playing board games
- 1: Increased
- 2: Decreased
- 3: No change
Behaviours and health impacts (BH) - Question identifier:BH_Q110
Excluding members of your household, how many people in total did you come in close contact with yesterday?
'Close contact' means within 2 meters or 6 feet.
Include any people such as co-workers, relatives, neighbours, delivery workers, other shoppers, health professionals and restaurant employees.
Was it:
- 1: No contact with people outside my household
- 2: 1 to 2 individuals
- 3: Between 3 to 5 individuals
- 4: 6 or more individuals
Behaviours and health impacts (BH) - Question identifier:BH_Q115
Excluding members of your household, how many people in total did you come in close contact with during the last 7 days?
'Close contact' means within 2 meters or 6 feet.
Include any people such as co-workers, relatives, neighbours, delivery workers, other shoppers, health professionals and restaurant employees.
Was it:
- 1: No contact with people outside my household
- 2: Between 1 to 3 individuals
- 3: Between 4 and 8 individuals
- 4: Between 9 and 15 individuals
- 5: 16 or more individuals
Food security (FSC)
Food security (FSC) - Question identifier:FSC_Q05A
The following questions are about the food situation for your household in the past 30 days.
Please indicate if the statements are often true, sometimes true, or never true for you and other household members.
In the past 30 days, the food that you or other household members bought just didn't last, and there wasn't any money to get more
- 1: Often true
- 2: Sometimes true
- 3: Never true
Food security (FSC) - Question identifier:FSC_Q05B
The following questions are about the food situation for your household in the past 30 days.
Please indicate if the statements are often true, sometimes true, or never true for you and other household members.
In the past 30 days, you or other household members couldn't afford to eat balanced meals
- 1: Often true
- 2: Sometimes true
- 3: Never true
Food security (FSC) - Question identifier:FSC_Q10A
In the past 30 days, did you or other adults in your household ever cut the size of your meals or skip meals because there wasn't enough money for food?
- 1: Yes
- 2: No
Food security (FSC) - Question identifier:FSC_Q10B
How many days did this happen?
Min = 0; Max = 99
Number of days
Food security (FSC) - Question identifier:FSC_Q15
In the past 30 days, did you personally ever eat less than you felt you should because there wasn't enough money to buy food?
- 1: Yes
- 2: No
Food security (FSC) - Question identifier:FSC_Q20
In the past 30 days, were you personally ever hungry but didn't eat because you couldn't afford enough food?
- 1: Yes
- 2: No
Food security (FSC) - Question identifier:FSC_Q25A
In the past 30 days did you or other household members access food or meals, at no cost to you, from a community organization?
'Community organization' can include food banks, community centres, school programs, faith-based organizations, or donations from community gardens.
- 1: Yes
- 2: No
Food security (FSC) - Question identifier:FSC_Q25B
How many times in the past 30 days?
- 1: One time
- 2: 2 or 3 times
- 3: 4 or more times
- Date modified: