Canadian Perspectives Survey Series 1 - Impacts of COVID-19 (CPSS-COVID)

For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.

Show all instructions

Table of Contents

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?

  • 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?

  • 1: Yes
  • 2: No

Labour Market Impacts (LM) - Question identifier:LM_Q15

What was the main reason you were absent from work that week?

  • 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., 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?

  • 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?

  • 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.

  • 1: Strongly agree
  • 2: Agree
  • 3: Neither agree nor disagree
  • 4: Disagree
  • 5: Strongly disagree

Labour Market Impacts (LM) - Question identifier:LM_Q35

During the week of ^REFDATE_E did you make a new application for any of the following types of Employment Insurance benefits?

  • 1: Regular
  • 2: Sickness
  • 3: Caregiving or compassionate care
  • 4: Work-sharing
  • 5: Other Employment Insurance benefit
  • 6: Did not apply for any Employment Insurance 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

Labour Market Impacts (LM) - Question identifier:LM_Q45A

Have you received relief for any of the following financial obligations?
Rent or mortgage payments

  • 1: Yes
  • 2: No
  • 3: Not required

Labour Market Impacts (LM) - Question identifier:LM_Q45B

Have you received relief for any of the following financial obligations?
Car payments

  • 1: Yes
  • 2: No
  • 3: Not required

Labour Market Impacts (LM) - Question identifier:LM_Q45C

Have you received relief for any of the following financial obligations?
Other household bills

  • 1: Yes
  • 2: No
  • 3: Not required

Behaviours and Health Impacts (BH)

Behaviours and Health Impacts (BH) - Question identifier:BH_Q05

What is your main source of information to find out about COVID-19?

  • 01: News outlets including local, national and international sources
  • 02: Federal health agency (e.g., website, public service announcements)
  • 03: Provincial health agency (e.g., website, public service announcements)
  • 04: Municipal health agency (e.g., website, public service announcements)
  • 05: Federal daily announcements by public health and political leaders
  • 06: Provincial daily announcements by public health and political leaders
  • 07: Social media (e.g., Facebook, Instagram, SnapChat, TikTok, Twitter, YouTube)
  • 08: Family, friends or colleagues
  • 09: Health professionals
  • 10: Schools, universities, colleges (e.g., email, website)
  • 11: Place of employment
  • 12: Other
  • 13: I do not look for information about this

Behaviours and Health Impacts (BH) - Question identifier:BH_Q10

Which source of information is the most helpful to learn about current public health measures?

  • 01: News outlets including local, national and international sources
  • 02: Federal health agency (e.g., website, public service announcements)
  • 03: Provincial health agency (e.g., website, public service announcements)
  • 04: Municipal health agency (e.g., website, public service announcements)
  • 05: Federal daily announcements by public health and political leaders
  • 06: Provincial daily announcements by public health and political leaders
  • 07: Social media (e.g., Facebook, Instagram, SnapChat, TikTok, Twitter, YouTube)
  • 08: Family, friends or colleagues
  • 09: Health professionals
  • 10: Schools, universities, colleges (e.g., email, website)
  • 11: Place of employment
  • 12: Other

Behaviours and Health Impacts (BH) - Question identifier:BH_Q15A

Are you getting enough information about COVID -19?
From your municipal health agency

  • 1: Too little
  • 2: About right
  • 3: Too much

Behaviours and Health Impacts (BH) - Question identifier:BH_Q15B

Are you getting enough information about COVID -19?
From federal health agencies

  • 1: Too little
  • 2: About right
  • 3: Too much

Behaviours and Health Impacts (BH) - Question identifier:BH_Q15C

Are you getting enough information about COVID -19?
From health professionals

  • 1: Too little
  • 2: About right
  • 3: Too much

Behaviours and Health Impacts (BH) - Question identifier:BH_Q15D

Are you getting enough information about COVID -19?
From news outlets

  • 1: Too little
  • 2: About right
  • 3: Too much

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?

  • 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 social 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_Q25

In general, how is your health?

  • 1: Excellent
  • 2: Very good
  • 3: Good
  • 4: Fair
  • 5: Poor

Behaviours and Health Impacts (BH) - Question identifier:BH_Q30

In general, how is your mental health?

  • 1: Excellent
  • 2: Very good
  • 3: Good
  • 4: Fair
  • 5: Poor

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_Q45

Do you have a compromised immune system?

  • 1: Yes
  • 2: No

Behaviours and Health Impacts (BH) - Question identifier:BH_Q50

Do you have diabetes or a chronic condition affecting your lungs, heart or kidneys?

  • 1: Yes
  • 2: No

Behaviours and Health Impacts (BH) - Question identifier:BH_Q55A

How concerned are you about each of the following impacts of COVID-19?
My own health

  • 1: Not at all
  • 2: Somewhat
  • 3: Very
  • 4: Extremelly

Behaviours and Health Impacts (BH) - Question identifier:BH_Q55B

How concerned are you about each of the following impacts of COVID-19?
Member of the household's health

  • 1: Not at all
  • 2: Somewhat
  • 3: Very
  • 4: Extremelly

Behaviours and Health Impacts (BH) - Question identifier:BH_Q55C

How concerned are you about each of the following impacts of COVID-19?
Vulnerable people's health

  • 1: Not at all
  • 2: Somewhat
  • 3: Very
  • 4: Extremelly

Behaviours and Health Impacts (BH) - Question identifier:BH_Q55D

How concerned are you about each of the following impacts of COVID-19?
Canadian population's health

  • 1: Not at all
  • 2: Somewhat
  • 3: Very
  • 4: Extremelly

Behaviours and Health Impacts (BH) - Question identifier:BH_Q55E

How concerned are you about each of the following impacts of COVID-19?
World population's health

  • 1: Not at all
  • 2: Somewhat
  • 3: Very
  • 4: Extremelly

Behaviours and Health Impacts (BH) - Question identifier:BH_Q55F

How concerned are you about each of the following impacts of COVID-19?
Overloading the health system

  • 1: Not at all
  • 2: Somewhat
  • 3: Very
  • 4: Extremelly

Behaviours and Health Impacts (BH) - Question identifier:BH_Q55G

How concerned are you about each of the following impacts of COVID-19?
Civil disorder

  • 1: Not at all
  • 2: Somewhat
  • 3: Very
  • 4: Extremelly

Behaviours and Health Impacts (BH) - Question identifier:BH_Q55H

How concerned are you about each of the following impacts of COVID-19?
Maintaining social ties

  • 1: Not at all
  • 2: Somewhat
  • 3: Very
  • 4: Extremelly

Behaviours and Health Impacts (BH) - Question identifier:BH_Q55I

How concerned are you about each of the following impacts of COVID-19?
Ability to cooperate and support one another during the crisis

  • 1: Not at all
  • 2: Somewhat
  • 3: Very
  • 4: Extremelly

Behaviours and Health Impacts (BH) - Question identifier:BH_Q55J

How concerned are you about each of the following impacts of COVID-19?
Ability to cooperate and support one another after the crisis

  • 1: Not at all
  • 2: Somewhat
  • 3: Very
  • 4: Extremelly

Behaviours and Health Impacts (BH) - Question identifier:BH_Q55K

How concerned are you about each of the following impacts of COVID-19?
Family stress from confinement

  • 1: Not at all
  • 2: Somewhat
  • 3: Very
  • 4: Extremelly

Behaviours and Health Impacts (BH) - Question identifier:BH_Q55L

How concerned are you about each of the following impacts of COVID-19?
Violence in the home

  • 1: Not at all
  • 2: Somewhat
  • 3: Very
  • 4: Extremelly

Behaviours and Health Impacts (BH) - Question identifier:BH_Q60A

In the last week, that is ^REFDATE_E, how often did you do each of the following activities?
Went shopping at the grocery store or drugstore

  • 1: Daily or more
  • 2: 4 or 5 times
  • 3: 1 to 3 times
  • 4: Never

Behaviours and Health Impacts (BH) - Question identifier:BH_Q60B

In the last week, that is ^REFDATE_E, how often did you do each of the following activities?
Used a delivery service for groceries or for a drugstore

  • 1: Daily or more
  • 2: 4 or 5 times
  • 3: 1 to 3 times
  • 4: Never

Behaviours and Health Impacts (BH) - Question identifier:BH_Q60C

In the last week, that is ^REFDATE_E, how often did you do each of the following activities?
Used a food delivery service for prepared food

  • 1: Daily or more
  • 2: 4 or 5 times
  • 3: 1 to 3 times
  • 4: Never

Behaviours and Health Impacts (BH) - Question identifier:BH_Q60D

In the last week, that is ^REFDATE_E, how often did you do each of the following activities?
Ate at a restaurant

  • 1: Daily or more
  • 2: 4 or 5 times
  • 3: 1 to 3 times
  • 4: Never

Behaviours and Health Impacts (BH) - Question identifier:BH_Q60E

In the last week, that is ^REFDATE_E, how often did you do each of the following activities?
Attended a public event

  • 1: Daily or more
  • 2: 4 or 5 times
  • 3: 1 to 3 times
  • 4: Never

Behaviours and Health Impacts (BH) - Question identifier:BH_Q60F

In the last week, that is ^REFDATE_E, how often did you do each of the following activities?
Travelled for work

  • 1: Daily or more
  • 2: 4 or 5 times
  • 3: 1 to 3 times
  • 4: Never

Behaviours and Health Impacts (BH) - Question identifier:BH_Q65

Did you travel outside of Canada or were you exposed to someone who travelled outside of Canada in the last 4 weeks?

  • 1: Yes, I traveled outside of Canada
  • 2: Yes, I was exposed to someone who travelled outside of Canada
  • 3: No

Behaviours and Health Impacts (BH) - Question identifier:BH_Q70

Did you self-isolate after travelling or after being exposed?

  • 1: Yes, with symptoms (e.g., cough, fever, difficulty breathing, pneumonia in both lungs)
  • 2: Yes, without symptoms
  • 3: No
Date modified: