Portrait of Canadian Society - Perceptions of Life During the Pandemic
For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.
Table of Contents
- Respondent confirmation (RC)
- General health (GEN)
- Life satisfaction (LSM)
- Physical activity (PHS)
- Satisfaction (DOS)
- View of the future (FO)
- Age (AGE)
- Gender (GDR)
Respondent confirmation (RC)
Respondent confirmation (RC) - Question identifier:RC_R01
The following questions are for ^NAME_OR_EMAIL.
General health (GEN)
General health (GEN) - Question identifier:GEN_R01
The following questions are about health. By health, we mean not only the absence of disease or injury but also physical, mental and social well-being.
General health (GEN) - Question identifier:GEN_Q01
In general, how is your health?
Would you say:
- 1: Excellent
- 2: Very good
- 3: Good
- 4: Fair
- 5: Poor
General health (GEN) - Question identifier:GEN_Q02
In general, how is your mental health?
Would you say:
- 1: Excellent
- 2: Very good
- 3: Good
- 4: Fair
- 5: Poor
Life satisfaction (LSM)
Life satisfaction (LSM) - Question identifier:LSM_Q01
Using a scale of 0 to 10, where 0 means "Very dissatisfied" and 10 means "Very satisfied", how do you feel about your life as a whole right now?
- 00: 0 - Very dissatisfied
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10 - Very satisfied
Physical activity (PHS)
Physical activity (PHS) - Question identifier:PHS_Q10
In the past week, how many times did you participate in moderate or vigorous physical activity for leisure, work, housework or transportation?
Min = 0; Max = 99
Physical activity (PHS) - Question identifier:PHS_Q20
About how much time did you spend on [this/each] occasion?
- 1: 0 to 15 minutes
- 2: 16 to 30 minutes
- 3: 31 to 60 minutes
- 4: More than 1 hour
Satisfaction (DOS)
Satisfaction (DOS) - Question identifier:DOS_R01
The following questions ask how satisfied you feel about specific aspects of your life.
Satisfaction (DOS) - Question identifier:DOS_Q01
On a scale from 0 to 10, where 0 means you feel "Not at all satisfied" and 10 means you are "Completely satisfied", how satisfied are you with your standard of living?
- 00: 0 - Not at all satisfied
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10 - Completely satisfied
Satisfaction (DOS) - Question identifier:DOS_Q02
On a scale from 0 to 10, where 0 means you feel "Not at all satisfied" and 10 means you are "Completely satisfied", how satisfied are you with your health?
- 00: 0 - Not at all satisfied
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10 - Completely satisfied
Satisfaction (DOS) - Question identifier:DOS_Q03
On a scale from 0 to 10, where 0 means you feel "Not at all satisfied" and 10 means you are "Completely satisfied", how satisfied are you with what you are achieving in life?
- 00: 0 - Not at all satisfied
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10 - Completely satisfied
Satisfaction (DOS) - Question identifier:DOS_Q04
On a scale from 0 to 10, where 0 means you feel "Not at all satisfied" and 10 means you are "Completely satisfied", how satisfied are you with your personal relationships?
- 00: 0 - Not at all satisfied
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10 - Completely satisfied
Satisfaction (DOS) - Question identifier:DOS_Q05
On a scale from 0 to 10, where 0 means you feel "Not at all satisfied" and 10 means you are "Completely satisfied", how satisfied are you with your personal appearance, such as your weight, height, or features?
- 00: 0 - Not at all satisfied
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10 - Completely satisfied
Satisfaction (DOS) - Question identifier:DOS_Q06
On a scale from 0 to 10, where 0 means you feel "Not at all satisfied" and 10 means you are "Completely satisfied", how satisfied are you with how safe you feel?
- 00: 0 - Not at all satisfied
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10 - Completely satisfied
Satisfaction (DOS) - Question identifier:DOS_Q07
On a scale from 0 to 10, where 0 means you feel "Not at all satisfied" and 10 means you are "Completely satisfied", how satisfied are you with feeling part of your community?
- 00: 0 - Not at all satisfied
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10 - Completely satisfied
Satisfaction (DOS) - Question identifier:DOS_Q08
On a scale from 0 to 10, where 0 means you feel "Not at all satisfied" and 10 means you are "Completely satisfied", how satisfied are you with the amount of time you have to do the things that you like doing?
- 00: 0 - Not at all satisfied
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10 - Completely satisfied
Satisfaction (DOS) - Question identifier:DOS_Q09
On a scale from 0 to 10, where 0 means you feel "Not at all satisfied" and 10 means you are "Completely satisfied", how satisfied are you with the quality of your local environment such as access to green space, and air or water quality?
- 00: 0 - Not at all satisfied
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10 - Completely satisfied
View of the future (FO)
View of the future (FO) - Question identifier:FO_Q01
Thinking about your life in general, how often would you say you have a hopeful view of the future?
- 1: Always
- 2: Often
- 3: Sometimes
- 4: Rarely
- 5: Never
Age (AGE)
Age (AGE) - Question identifier:AGE_Q02
What is your age?
Min = 0; Max = 999
Gender (GDR)
Gender (GDR) - Question identifier:GDR_Q10
What is your gender?
- 1: Male
- 2: Female
- 3: Or please specify
- Date modified: