Impacts of COVID-19 on Canadians - Testing and Vaccination (ICC-TV)
For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.
Table of Contents
- COVID-19 Tests (TST)
- COVID-19 Vaccination (VAC)
- Household Characteristics (HLD)
- Geography (GEO)
- Disability status (DIS)
- Indigenous identity (ABM)
- Sociodemographic characteristics (PG)
- Demographic questions (DEM1)
- Age (AGE)
- Gender (GDR)
COVID-19 Tests (TST)
COVID-19 Tests (TST) - Question identifier:TST_R05
There are two common types of COVID-19 tests.
- The first is a PCR test, often used in health care settings, that is sent to a lab and produces the most accurate result.
- The second type is a rapid antigen test (RAT), often called a rapid test, which produces a result within minutes.
COVID-19 Tests (TST) - Question identifier:TST_Q05
Since December 1, 2021, have you taken a PCR COVID-19 test?
- 1: Yes
- 2: No
COVID-19 Tests (TST) - Question identifier:TST_Q10
Was the result of at least one of your tests positive?
- 1: Yes
- 2: No
COVID-19 Tests (TST) - Question identifier:TST_Q11
Are there any children under age 18 in the household?
- 1: Yes, under age 5
- 2: Yes, age 5 to 11
- 3: Yes, age 12 to 17
- 4: No
COVID-19 Tests (TST) - Question identifier:TST_Q12
Since December 1, 2021, have any of the children in your household taken a PCR COVID-19 test?
- 1: Yes
- 2: No
COVID-19 Tests (TST) - Question identifier:TST_Q13
Was the result of at least one of their tests positive?
- 1: Yes
- 2: No
COVID-19 Tests (TST) - Question identifier:TST_R15
The following questions are about your experience with rapid tests for COVID-19.
COVID-19 Tests (TST) - Question identifier:TST_Q37
Since December 1, 2021, have any of the children in your household taken a COVID-19 rapid test?
- 1: Yes
- 2: No
COVID-19 Tests (TST) - Question identifier:TST_Q39
Was the result of at least one of their rapid tests positive?
- 1: Yes
- 2: No
COVID-19 Tests (TST) - Question identifier:TST_Q15
Since December 1, 2021, have you taken a COVID-19 rapid test?
- 1: Yes
- 2: No
COVID-19 Tests (TST) - Question identifier:TST_Q20
Was the result of at least one of your rapid tests positive?
- 1: Yes
- 2: No
COVID-19 Tests (TST) - Question identifier:TST_Q25
What did you do following a positive result on a rapid test?
- 1: Self-isolated
- 2: Informed recent contacts
- 3: Took a PCR test for confirmation
- 4: Took a second rapid test later
- 5: Self-reported COVID-19 rapid test result to the provincial website
- 6: None of the above
COVID-19 Tests (TST) - Question identifier:TST_Q30
Why did you take a COVID-19 rapid test?
- 01: I was experiencing symptoms
- 02: I was exposed to someone who was suspected to have, or tested positive for COVID-19
- 03: I planned on visiting with family or friends
- 04: I planned on attending an event (e.g., spiritual services, concerts, sporting events, funerals)
- 05: I previously attended an event or gathering with others
- 06: For school or work
- 07: For participation in sports
- 08: Before or after travelling
- 09: Other
COVID-19 Tests (TST) - Question identifier:TST_Q35
Since December 1, 2021, did you obtain any rapid tests or rapid test kits?
- 1: Yes
- 2: No
COVID-19 Tests (TST) - Question identifier:TST_Q40
Where have you obtained COVID-19 rapid tests or rapid test kits?
- 01: School of any household member
- 02: Pharmacy
- 03: Purchased from a store or online (Exclude pharmacies.)
- 04: Distribution centres in the community (Include distribution centres in stores, public spaces and temporary locations. Exclude pharmacies.)
- 05: Employer or workplace
- 06: Long term care or seniors residences (e.g., retirement home)
- 07: Health care facility
- 08: Received from friends, family, or another member of the community
- 09: Other
COVID-19 Tests (TST) - Question identifier:TST_Q45
Since December 1, 2021, was there a time you would have liked to have a COVID-19 rapid test for yourself or a child in the household, but did not get one?
- 1: Yes
- 2: No
COVID-19 Tests (TST) - Question identifier:TST_Q50
In which month did this happen?
- 1: December 2021
- 2: January 2022
- 3: February or March 2022
COVID-19 Tests (TST) - Question identifier:TST_Q55
Why did you not get a COVID-19 rapid test?
- 01: Assumed there were none available
- 02: Tried but no tests or appointments were available
- 03: Did not know where to get them or when to go
- 04: Time when they were available was not suitable for my schedule
- 05: Wait time at place where tests were being distributed or administered was too long
- 06: Available tests were too expensive
- 07: Self-isolating at the time
- 08: Difficulty getting to the location due to distance or accessibility issues
- 09: Other
COVID-19 Vaccination (VAC)
COVID-19 Vaccination (VAC) - Question identifier:VAC_Q05
Have you been vaccinated against COVID-19?
- 1: Yes, fully vaccinated (Fully vaccinated generally means that you received at least two doses of a vaccine)
- 2: Yes, partially vaccinated
- 3: No
Household Characteristics (HLD)
Household Characteristics (HLD) - Question identifier:HLD_Q05
Since December 1, 2021, were you or anyone in your household considered an "essential worker"?
- 1: Yes, I was considered an essential worker
- 2: Yes, one or more members of my household were considered essential workers
- 3: No, no one in my household was considered an essential worker
Geography (GEO)
Geography (GEO) - Question identifier:GEO_Q05
To determine which geographic region you live in, please provide your postal code.
Long Answer Length = 7
Disability status (DIS)
Disability status (DIS) - Question identifier:DIS_Q05
Do you identify as a person with a disability?
- 1: Yes
- 2: No
Indigenous identity (ABM)
Indigenous identity (ABM) - Question identifier:ABM_Q01
Are you First Nations, Métis or Inuk (Inuit)?
Would you say:
- 1: No, not First Nations, Métis, or Inuk (Inuit)
- 2: Yes, First Nations (North American Indian)
- 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:
- 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
Demographic questions (DEM1)
Demographic questions (DEM1) - Question identifier:DEM1_Q30A
Where were you born?
- 1: Born in Canada
- 2: Born outside Canada
Demographic questions (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
Demographic questions (DEM1) - Question identifier:DEM1_Q30C
Are you a landed immigrant or permanent resident?
- 1: No
- 2: Yes
Demographic questions (DEM1) - Question identifier:DEM1_Q35
In what year did you first become a landed immigrant or a permanent resident?
Min = 0; Max = 9999
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
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