Impacts of COVID-19 on Health Care Workers: Infection Prevention and Control
For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.
Table of Contents
- Employment (EMP)
- Job Environment (ENV)
- Infection prevention and control and personal protective equipment (PPE)
- General health (GEN)
- Demographic questions (AGE)
- Demographic questions (GDR)
- Demographic questions (DEM)
- Indigenous identity (IS)
- Sociodemographic characteristics (PG)
- Place of birth, immigration and citizenship (DEM1)
- Future surveys (UCE)
- Data sharing agreements (DSA)
Employment (EMP)
Employment (EMP) - Question identifier:EMP_R05
The next questions are about your experience in the workplace during the COVID-19 pandemic.
Employment (EMP) - Question identifier:EMP_Q05
Are you a health care worker or do you work in a health care setting?
This includes people who provide:
- health care services directly to individuals
- technical support to medical staff, e.g., receptionist, technician
- support services in a health care setting, e.g., cleaning and food services staff, security.
- 1: Yes
- 2: No
Employment (EMP) - Question identifier:EMP_Q10
Are you self-employed?
- 1: Yes
- 2: No
Employment (EMP) - Question identifier:EMP_Q15
What is your occupation?
- 01: General practitioner or family medicine physician
- 02: Specialist physician
- 03: Nurse (Includes registered nurses, nurse practitioners, psychiatric nurses, clinical nurse specialists, or registered or licensed practical nurses.)
- 04: Personal support worker or personal care aide (Includes continuing care assistants, disability support workers, health care assistants/aides, home support attendants, "auxiliaries", orderlies, personal care attendants, resident attendants, etc.)
- 05: Paramedic or emergency medical personnel
- 06: Respiratory therapist
- 07: Medical technologist or technician, or laboratory technician or worker (Includes clinical laboratory workers, phlebotomists, radiation technologists, ultrasound technologists, etc.)
- 08: Pharmacist
- 09: Psychologist, social worker or counsellor (Includes clinical therapists, psychotherapists, etc.)
- 10: Dental professional (Includes dentists, dental hygienists, etc.)
- 11: Optometrist or optician
- 12: Chiropractor or massage therapist
- 13: Physiotherapist or occupational therapist
- 14: Naturopath, nutritionist or dietitian
- 15: Midwife
- 16: Student in a health related field
- 17: Other health care provider (Includes audiologists, speech language pathologists, etc.)
- 18: Other occupation working in health care setting (Includes medical receptionists, cleaners, food service workers, security, researchers, volunteers, 911 dispatchers.)
Employment (EMP) - Question identifier:EMP_Q20
[What is your occupation? Nurse]
Please specify.
- 1: Registered Nurse
- 2: Nurse Practitioner
- 3: Licensed/Registered Practical Nurse
- 4: Registered Psychiatric Nurse
- 5: Clinical Nurse Specialist
Employment (EMP) - Question identifier:EMP_Q25
[What is your occupation? Other occupation working in health care setting]
Please specify.
- 01: Medical receptionist or clerical staff
- 02: Cleaner
- 03: Food service worker
- 04: Security
- 05: Researcher
- 06: 911 dispatcher
- 07: Volunteer
- 08: Other
Employment (EMP) - Question identifier:EMP_Q30
Have you worked at all since March 2020?
- 1: Yes
- 2: No
Employment (EMP) - Question identifier:EMP_Q35
When you worked, did you primarily work:
- 1: Full-time
- 2: Part-time
Employment (EMP) - Question identifier:EMP_Q40
How many years have you worked in your current occupation?
Number of years
- 00: Less than one year
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10
- 11: 11
- 12: 12
- 13: 13
- 14: 14
- 15: 15
- 16: 16
- 17: 17
- 18: 18
- 19: 19
- 20: 20 or more
Employment (EMP) - Question identifier:EMP_Q45
Since March 2020, at how many health care job locations did you work?
- 1: 1
- 2: 2
- 3: 3 or more
Job Environment (ENV)
Job Environment (ENV) - Question identifier:ENV_R05
The following questions refer to your primary job location since March 2020. If you worked at multiple locations, please think of the job location at which you worked the most hours.
Job Environment (ENV) - Question identifier:ENV_Q05
At which type of health care job location did you work the most hours?
- 01: Hospital
- 02: Specialized medical facility - inpatient care (e.g., rehabilitation centre, mental health or addictions treatment centre, cancer centre, birth centre, etc.)
- 03: Outpatient medical care such as general practitioner's office or walk-in clinic (Include urgent care clinic, specialist's office outside of the hospital, etc.)
- 04: Dental office
- 05: Other medical office or clinic (e.g., counselling, dietary, optical, rehabilitation, or chiropractic, physiotherapy or massage therapy clinic.)
- 06: Public health centre (Include centres that provide primary health or health promotion services to individuals, families, or communities. Services may include immunization, health education and counselling, and health assessment and screening.)
- 07: Long-term care facility or seniors residence
- 08: Retail pharmacy
- 09: Laboratory or diagnostic clinic (Include centres that collect samples, conduct ultrasounds or x-rays, etc. or laboratories that conduct analysis on specimens.)
- 10: Mobile unit or ambulance
- 11: Congregate or communal living setting (e.g., shelter, group home, prison or correctional facility, etc.)
- 12: Client or patient's home
- 13: Teleworking from home
- 14: Other
Job Environment (ENV) - Question identifier:ENV_Q10
[At which type of health care job location did you work the most hours? Long-term care facility or seniors residence] Is this facility:
- 1: Publicly funded
- 2: Privately funded
- 3: Both publicly and privately funded
- 4: Don't know
Job Environment (ENV) - Question identifier:ENV_Q15
[At which type of health care job location did you work the most hours? Congregate or communal living setting] Is this facility:
- 1: Publicly funded
- 2: Privately funded
- 3: Both publicly and privately funded
- 4: Don't know
Job Environment (ENV) - Question identifier:ENV_Q20
What is the province or territory of your primary job location?
- 10: Newfoundland and Labrador
- 11: Prince Edward Island
- 12: Nova Scotia
- 13: New Brunswick
- 24: Quebec
- 35: Ontario
- 46: Manitoba
- 47: Saskatchewan
- 48: Alberta
- 59: British Columbia
- 60: Yukon
- 61: Northwest Territories
- 62: Nunavut
Job Environment (ENV) - Question identifier:ENV_Q25A
Since March 2020, what type of contact did you have with people at your primary job location?
Worked in direct contact with confirmed or suspected cases of COVID-19
- 1: Yes
- 2: No
Job Environment (ENV) - Question identifier:ENV_Q25B
[Since March 2020, what type of contact did you have with people at your primary job location?]
Worked in direct contact with people who were not suspected or confirmed cases of COVID-19
- 1: Yes
- 2: No
Job Environment (ENV) - Question identifier:ENV_Q25C
[Since March 2020, what type of contact did you have with people at your primary job location?]
Did not work in direct contact with people
Includes interacting with clients and colleagues.
- 1: Yes
- 2: No
Job Environment (ENV) - Question identifier:ENV_Q30
Since March 2020, did you perform or assist with aerosol generating medical procedures (AGMP)?
Note: An AGMP is any procedure conducted on a patient or client that can induce production of aerosols of various sizes. E.g., intubation and related procedures, such as manual ventilation, or open endotracheal suctioning; bronchoscopy; sputum induction; or non-invasive positive pressure ventilation such as CPAP or BiPAP.
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE)
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_R05
The following questions look at what preventative measures, procedures, or supports were available to you, and how effective they were. If you work at more than one location, please consider your primary job location.
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q05
Have you ever received formal training on the Infection Prevention and Control (IPC) practices or protocols for your job location?
Infection Prevention and Control refers to evidence-based practices and procedures that aim to prevent or reduce the risk of transmission of infections. E.g., hand hygiene, screening patients or clients, cohorting patients, cleaning or housekeeping practices, personal protective equipment, etc.
- 1: Yes
- 2: No
- 3: Workplace does not have an IPC policy
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q10
Since March 2020, were there new IPC protocols introduced or an increase in the IPC protocols and practices for your position?
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q15A
Since March 2020, which of the following IPC practices were newly introduced or increased?
Screening of patients or clients or staff
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q15B
[Since March 2020, which of the following IPC practices were newly introduced or increased?]
Requirement of patient or client to wear a mask
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q15C
[Since March 2020, which of the following IPC practices were newly introduced or increased?]
Hand hygiene
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q15D
[Since March 2020, which of the following IPC practices were newly introduced or increased?]
Personal protective equipment practices
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q15E
[Since March 2020, which of the following IPC practices were newly introduced or increased?]
Management of the flow or placement of patients or clients
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q15F
[Since March 2020, which of the following IPC practices were newly introduced or increased?]
Environmental cleaning and disinfection
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q15G
[Since March 2020, which of the following IPC practices were newly introduced or increased?]
Management of health care worker exposure
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q15H
[Since March 2020, which of the following IPC practices were newly introduced or increased?]
Visitor management
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q15I
[Since March 2020, which of the following IPC practices were newly introduced or increased?]
Handling of the deceased
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q15J
[Since March 2020, which of the following IPC practices were newly introduced or increased?]
Reduction or suspension of in-person contact
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q20
Since March 2020, has your position required the use of personal protective equipment (PPE)?
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q25
Have you ever received formal training on the proper use of PPE for your job location?
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q30A
Since March 2020, how would you describe your access to the following PPE at your primary job location?
Gloves
- 1: Not needed for job
- 2: Always available when needed
- 3: Usually available when needed
- 4: Sometimes available when needed
- 5: Never available when needed
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q30B
[Since March 2020, how would you describe your access to the following PPE at your primary job location?]
Mask
- 1: Not needed for job
- 2: Always available when needed
- 3: Usually available when needed
- 4: Sometimes available when needed
- 5: Never available when needed
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q30C
[Since March 2020, how would you describe your access to the following PPE at your primary job location?]
Respirator
e.g., N95, KN95
- 1: Not needed for job
- 2: Always available when needed
- 3: Usually available when needed
- 4: Sometimes available when needed
- 5: Never available when needed
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q30D
[Since March 2020, how would you describe your access to the following PPE at your primary job location?]
Gown
- 1: Not needed for job
- 2: Always available when needed
- 3: Usually available when needed
- 4: Sometimes available when needed
- 5: Never available when needed
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q30E
[Since March 2020, how would you describe your access to the following PPE at your primary job location?]
Face shield or visor
- 1: Not needed for job
- 2: Always available when needed
- 3: Usually available when needed
- 4: Sometimes available when needed
- 5: Never available when needed
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q30F
[Since March 2020, how would you describe your access to the following PPE at your primary job location?]
Eye protection or goggles
- 1: Not needed for job
- 2: Always available when needed
- 3: Usually available when needed
- 4: Sometimes available when needed
- 5: Never available when needed
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q30G
[Since March 2020, how would you describe your access to the following PPE at your primary job location?]
Hand sanitizer or other handwashing facilities
- 1: Not needed for job
- 2: Always available when needed
- 3: Usually available when needed
- 4: Sometimes available when needed
- 5: Never available when needed
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q30H
[Since March 2020, how would you describe your access to the following PPE at your primary job location?]
Other
- 1: Not needed for job
- 2: Always available when needed
- 3: Usually available when needed
- 4: Sometimes available when needed
- 5: Never available when needed
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q35A
In the past month, how would you describe your access to the following PPE at your primary job location?
Gloves
- 1: Not needed for job
- 2: Always available when needed
- 3: Usually available when needed
- 4: Sometimes available when needed
- 5: Never available when needed
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q35B
[In the past month, how would you describe your access to the following PPE at your primary job location?]
Mask
- 1: Not needed for job
- 2: Always available when needed
- 3: Usually available when needed
- 4: Sometimes available when needed
- 5: Never available when needed
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q35C
[In the past month, how would you describe your access to the following PPE at your primary job location?]
Respirator
e.g., N95, KN95
- 1: Not needed for job
- 2: Always available when needed
- 3: Usually available when needed
- 4: Sometimes available when needed
- 5: Never available when needed
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q35D
[In the past month, how would you describe your access to the following PPE at your primary job location?]
Gown
- 1: Not needed for job
- 2: Always available when needed
- 3: Usually available when needed
- 4: Sometimes available when needed
- 5: Never available when needed
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q35E
[In the past month, how would you describe your access to the following PPE at your primary job location?]
Face shield or visor
- 1: Not needed for job
- 2: Always available when needed
- 3: Usually available when needed
- 4: Sometimes available when needed
- 5: Never available when needed
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q35F
[In the past month, how would you describe your access to the following PPE at your primary job location?]
Eye protection or goggles
- 1: Not needed for job
- 2: Always available when needed
- 3: Usually available when needed
- 4: Sometimes available when needed
- 5: Never available when needed
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q35G
[In the past month, how would you describe your access to the following PPE at your primary job location?]
Hand sanitizer or other handwashing facilities
- 1: Not needed for job
- 2: Always available when needed
- 3: Usually available when needed
- 4: Sometimes available when needed
- 5: Never available when needed
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q35H
[In the past month, how would you describe your access to the following PPE at your primary job location?]
Other
- 1: Not needed for job
- 2: Always available when needed
- 3: Usually available when needed
- 4: Sometimes available when needed
- 5: Never available when needed
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q40A
At any time since March 2020, were there any of the following conditions or restrictions on the supply of PPE at your primary job location?
Restricted access to PPE
e.g., needing permission to use specified PPE
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q40B
[At any time since March 2020, were there any of the following conditions or restrictions on the supply of PPE at your primary job location?]
Extended use of PPE, beyond the normal use
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q40C
[At any time since March 2020, were there any of the following conditions or restrictions on the supply of PPE at your primary job location?]
Needed to supply your own PPE
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q40D
[At any time since March 2020, were there any of the following conditions or restrictions on the supply of PPE at your primary job location?]
Required to re-use PPE previously worn by you without decontamination
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q40E
[At any time since March 2020, were there any of the following conditions or restrictions on the supply of PPE at your primary job location?]
Required to re-use PPE previously worn by others without decontamination
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q40F
[At any time since March 2020, were there any of the following conditions or restrictions on the supply of PPE at your primary job location?]
Use of decontamination systems for N95s, surgical masks or other PPE so that they can be re-worn
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q40G
[At any time since March 2020, were there any of the following conditions or restrictions on the supply of PPE at your primary job location?]
Use of expired PPE
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q40H
[At any time since March 2020, were there any of the following conditions or restrictions on the supply of PPE at your primary job location?]
Use of wrong type of PPE
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q40I
[At any time since March 2020, were there any of the following conditions or restrictions on the supply of PPE at your primary job location?]
No conditions or restrictions on the supply of PPE
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q45A
During the past month, were there any of the following conditions or restrictions on the supply of PPE at your primary job location?
Restricted access to PPE
e.g., needing permission to use specified PPE
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q45B
[During the past month, were there any of the following conditions or restrictions on the supply of PPE at your primary job location?]
Extended use of PPE, beyond the normal use
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q45C
[During the past month, were there any of the following conditions or restrictions on the supply of PPE at your primary job location?]
Needed to supply your own PPE
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q45D
[During the past month, were there any of the following conditions or restrictions on the supply of PPE at your primary job location?]
Required to re-use PPE previously worn by you without decontamination
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q45E
[During the past month, were there any of the following conditions or restrictions on the supply of PPE at your primary job location?]
Required to re-use PPE previously worn by others without decontamination
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q45F
[During the past month, were there any of the following conditions or restrictions on the supply of PPE at your primary job location?]
Use of decontamination systems for N95s, surgical masks or other PPE so that they can be re-worn
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q45G
[During the past month, were there any of the following conditions or restrictions on the supply of PPE at your primary job location?]
Use of expired PPE
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q45H
[During the past month, were there any of the following conditions or restrictions on the supply of PPE at your primary job location?]
Use of wrong type of PPE
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q45I
[During the past month, were there any of the following conditions or restrictions on the supply of PPE at your primary job location?]
No conditions or restrictions on the supply of PPE
- 1: Yes
- 2: No
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q50A
Please indicate to what extent you agree or disagree with each statement.
If you work at more than one job location, please consider your primary location since March, 2020.
There was sufficient training on the proper use of PPE
e.g., how to put on and take off PPE without contaminating yourself or others
- 1: Strongly agree
- 2: Agree
- 3: Neither agree nor disagree
- 4: Disagree
- 5: Strongly disagree
- 6: N/A
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q50B
[Please indicate to what extent you agree or disagree with each statement.
If you work at more than one job location, please consider your primary location since March, 2020.]
There was sufficient training on infection prevention and control (IPC) guidelines or protocols
- 1: Strongly agree
- 2: Agree
- 3: Neither agree nor disagree
- 4: Disagree
- 5: Strongly disagree
- 6: N/A
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q50C
[Please indicate to what extent you agree or disagree with each statement.
If you work at more than one job location, please consider your primary location since March, 2020.]
Policies regarding PPE or IPC were consistently followed by others
- 1: Strongly agree
- 2: Agree
- 3: Neither agree nor disagree
- 4: Disagree
- 5: Strongly disagree
- 6: N/A
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q50D
[Please indicate to what extent you agree or disagree with each statement.
If you work at more than one job location, please consider your primary location since March, 2020.]
IPC policies were enforced and maintained
- 1: Strongly agree
- 2: Agree
- 3: Neither agree nor disagree
- 4: Disagree
- 5: Strongly disagree
- 6: N/A
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q50E
[Please indicate to what extent you agree or disagree with each statement.
If you work at more than one job location, please consider your primary location since March, 2020.]
You were not concerned about staff working at multiple job locations
- 1: Strongly agree
- 2: Agree
- 3: Neither agree nor disagree
- 4: Disagree
- 5: Strongly disagree
- 6: N/A
Infection prevention and control and personal protective equipment (PPE) - Question identifier:PPE_Q50F
[Please indicate to what extent you agree or disagree with each statement.
If you work at more than one job location, please consider your primary location since March, 2020.]
There was sufficient emphasis on and supports for employees to stay home when sick
- 1: Strongly agree
- 2: Agree
- 3: Neither agree nor disagree
- 4: Disagree
- 5: Strongly disagree
- 6: N/A
General health (GEN)
General health (GEN) - Question identifier:GEN_Q05
In general, how would you describe your health?
'Health' refers to not only the absence of disease or injury, but also to physical, mental and social well-being.
Would you say:
- 1: Excellent
- 2: Very good
- 3: Good
- 4: Fair
- 5: Poor
General health (GEN) - Question identifier:GEN_Q10
In general, how would you describe your mental health?
Would you say:
- 1: Excellent
- 2: Very good
- 3: Good
- 4: Fair
- 5: Poor
General health (GEN) - Question identifier:GEN_Q15
Compared to before the COVID-19 pandemic, how would you say your mental health is now?
Is it:
- 1: Much better now
- 2: Somewhat better now
- 3: About the same
- 4: Somewhat worse now
- 5: Much worse now
General health (GEN) - Question identifier:GEN_Q20
Thinking about the amount of stress in your life, how would you describe most of your days?
Would you say:
- 1: Not at all stressful
- 2: Not very stressful
- 3: A bit stressful
- 4: Quite a bit stressful
- 5: Extremely stressful
Demographic questions (AGE)
Demographic questions (AGE) - Question identifier:AGE_Q02
What is your age?
Min = 0; Max = 999
Age in years
Demographic questions (GDR)
Demographic questions (GDR) - Question identifier:GDR_Q10
What is your gender?
Gender refers to current gender which may be different from sex assigned at birth and may be different from what is indicated on legal documents.
- 1: Male
- 2: Female
- 3: Or please specify
Demographic questions (DEM)
Demographic questions (DEM) - Question identifier:DEM_Q05
To determine which geographic region you live in, please provide your home postal code.
Long Answer Length = 6
Postal Code
Example: A9A 9A9
Indigenous identity (IS)
Indigenous identity (IS) - Question identifier:IS_Q01
Are you First Nations, Métis or Inuk (Inuit)?
Would you say:
- 1: No
- 2: Yes, First Nations
- 3: Yes, Métis
- 4: Yes, Inuk (Inuit)
Sociodemographic characteristics (PG)
Sociodemographic characteristics (PG) - Question identifier:PG_Q05
The following question collects information in accordance with the Employment Equity Act and its Regulations and Guidelines to support programs that promote equal opportunity for everyone to share in the social, cultural, and economic life of Canada.
Are you:
Select all that apply.
- 01: White
- 02: South Asian (e.g., East Indian, Pakistani, Sri Lankan)
- 03: Chinese
- 04: Black
- 05: Filipino
- 06: Arab
- 07: Latin American
- 08: Southeast Asian (e.g., Vietnamese, Cambodian, Laotian, Thai)
- 09: West Asian (e.g., Iranian, Afghan)
- 10: Korean
- 11: Japanese
- 12: Other
Place of birth, immigration and citizenship (DEM1)
Place of birth, immigration and citizenship (DEM1) - Question identifier:DEM1_Q30A
Where were you born?
- 1: Born in Canada
- 2: Born outside Canada
Place of birth, immigration and citizenship (DEM1) - Question identifier:DEM1_Q30B
Are you a Canadian citizen?
- 1: Yes, a Canadian citizen by birth
- 2: Yes, a Canadian citizen by naturalization (Canadian citizen by naturalization refers to an immigrant who was granted citizenship of Canada under the Citizenship Act.)
- 3: No, not a Canadian citizen
Place of birth, immigration and citizenship (DEM1) - Question identifier:DEM1_Q30C
Are you a landed immigrant or permanent resident?
A landed immigrant or permanent resident is a person who has been granted the right to live in Canada permanently by immigration authorities.
- 1: No
- 2: Yes
Place of birth, immigration and citizenship (DEM1) - Question identifier:DEM1_Q35
In what year did you first become a landed immigrant or a permanent resident?
If exact year is not known, enter best estimate.
Min = 0; Max = 9999
Future surveys (UCE)
Future surveys (UCE) - Question identifier:UCE_Q01
Statistics Canada is planning future surveys on this topic, including a potential follow-up to this survey.
Would you like to sign-up for future surveys?
- 1: Yes
- 2: No
Future surveys (UCE) - Question identifier:UCE_Q05B
Please provide the following information so we can email you to participate in a follow-up survey or future surveys.
Email address
Long Answer Length = 80
Example: user@example.gov.ca
Data sharing agreements (DSA)
Data sharing agreements (DSA) - Question identifier:DSA_R01
To avoid duplication of questionnaires, Statistics Canada may enter into agreements to share the data from this questionnaire with the Public Health Agency of Canada, Health Canada[, the "Institut de la statistique du Québec/null] and provincial and territorial ministries of health. Only organizations that have agreed to keep your information confidential and use it only for statistical purposes will receive the data.
Data sharing agreements (DSA) - Question identifier:DSA_Q01
Do you agree to share your information with the Public Health Agency of Canada, Health Canada[, the "Institut de la statistique du Québec/null] and provincial and territorial ministries of health?
- 1: Yes
- 2: No
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