Impacts of COVID-19 on Canadians - Experiences of Discrimination
For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.
Table of Contents
- Discrimination (DIS)
- Discrimination in different situations (DTS)
- Sense of belonging - Neighbourhood (BEL)
- Trust in institutions (TII)
- Access to health care services (HCS)
- Long-term conditions (LTC)
- Education (ED)
- Language (LAN)
- Indigenous identity (IS)
- Sociodemographic characteristics (PG)
- Demographic questions 1 (DEM1)
- Gender (GDR)
- Demographic questions (DEM)
- Sexual orientation (SOR)
- Sign-up (UCE)
Discrimination (DIS)
Discrimination (DIS) - Question identifier:DIS_R05
The next questions are about your experience with discrimination before and during the COVID-19 pandemic.
Discrimination (DIS) - Question identifier:DIS_Q05
In the 2 years before the COVID-19 pandemic, have you experienced discrimination or been treated unfairly by others in Canada because of any of the following?
Select all that apply.
- 01: Your Indigenous identity
- 02: Your ethnicity or culture
- 03: Your race or skin colour
- 04: Your religion
- 05: Your language
- 06: Your accent
- 07: Your physical appearance (Include discrimination on the basis of weight, height, hair style or colour, clothing, jewelry, tattoos and other physical characteristics. Exclude discrimination on the basis of skin colour.)
- 08: Your sex (Sex refers to sex assigned at birth.)
- 09: Your sexual orientation (e.g., heterosexual, lesbian, gay, bisexual)
- 10: Your gender identity or expression (Include gender diverse identities such as two-spirit or non-binary.)
- 11: Your age
- 12: A physical or mental disability
- 13: Some other reason
- 14: Did not experience discrimination
Discrimination (DIS) - Question identifier:DIS_Q10
Since the beginning of the COVID-19 pandemic, have you experienced discrimination or been treated unfairly by others in Canada because of any of the following?
Select all that apply.
- 01: Your Indigenous identity
- 02: Your ethnicity or culture
- 03: Your race or skin colour
- 04: Your religion
- 05: Your language
- 06: Your accent
- 07: Your physical appearance (Include discrimination on the basis of weight, height, hair style or colour, clothing, jewelry, tattoos and other physical characteristics. Exclude discrimination on the basis of skin colour.)
- 08: Your sex (Sex refers to sex assigned at birth.)
- 09: Your sexual orientation (e.g., heterosexual, lesbian, gay, bisexual)
- 10: Your gender identity or expression (Include gender diverse identities such as two-spirit or non-binary.)
- 11: Your age
- 12: A physical or mental disability
- 13: Some other reason
- 14: Did not experience discrimination
Discrimination in different situations (DTS)
Discrimination in different situations (DTS) - Question identifier:DTS_Q05
In the 2 years before the COVID-19 pandemic, in what types of situations have you experienced discrimination or been treated unfairly by others in Canada?
Select all that apply.
- 01: In a store, bank or restaurant
- 02: When attending school or classes
- 03: On the internet, including social media platforms
- 04: At work or when applying for a job or promotion
- 05: When seeking or applying for housing (e.g., buying or renting)
- 06: When interacting with the police
- 07: When interacting with the courts
- 08: When crossing the border into Canada (Exclude incidences of discrimination upon leaving Canada.)
- 09: While attending social gatherings
- 10: While using public areas, such as parks and sidewalks
- 11: While using public transit, such as buses, trains or taxis
- 12: Any other situation
Discrimination in different situations (DTS) - Question identifier:DTS_Q10
Since the beginning of the COVID-19 pandemic, in what types of situations have you experienced discrimination or been treated unfairly by others in Canada?
Select all that apply.
- 01: In a store, bank or restaurant
- 02: When attending school or classes
- 03: On the internet, including social media platforms
- 04: At work or when applying for a job or promotion
- 05: When seeking or applying for housing (e.g., buying or renting)
- 06: When interacting with the police
- 07: When interacting with the courts
- 08: When crossing the border into Canada (Exclude incidences of discrimination upon leaving Canada.)
- 09: While attending social gatherings
- 10: While using public areas, such as parks and sidewalks
- 11: While using public transit, such as buses, trains or taxis
- 12: Any other situation
Sense of belonging - Neighbourhood (BEL)
Sense of belonging - Neighbourhood (BEL) - Question identifier:BEL_Q05A
Using a scale from 1 to 4, where 1 means "Very weak" and 4 means "Very strong", how would you describe your sense of belonging to the following?
To your local community
- 1: Very weak
- 2: Somewhat weak
- 3: Somewhat strong
- 4: Very strong
- 5: Not applicable
Sense of belonging - Neighbourhood (BEL) - Question identifier:BEL_Q05B
Using a scale from 1 to 4, where 1 means "Very weak" and 4 means "Very strong", how would you describe your sense of belonging to the following?
To your town or city
- 1: Very weak
- 2: Somewhat weak
- 3: Somewhat strong
- 4: Very strong
- 5: Not applicable
Sense of belonging - Neighbourhood (BEL) - Question identifier:BEL_Q05C
Using a scale from 1 to 4, where 1 means "Very weak" and 4 means "Very strong", how would you describe your sense of belonging to the following?
To your province or territory
- 1: Very weak
- 2: Somewhat weak
- 3: Somewhat strong
- 4: Very strong
- 5: Not applicable
Sense of belonging - Neighbourhood (BEL) - Question identifier:BEL_Q05D
Using a scale from 1 to 4, where 1 means "Very weak" and 4 means "Very strong", how would you describe your sense of belonging to the following?
To Canada
- 1: Very weak
- 2: Somewhat weak
- 3: Somewhat strong
- 4: Very strong
- 5: Not applicable
Sense of belonging - Neighbourhood (BEL) - Question identifier:BEL_Q05E
Using a scale from 1 to 4, where 1 means "Very weak" and 4 means "Very strong", how would you describe your sense of belonging to the following?
To your country of origin
- 1: Very weak
- 2: Somewhat weak
- 3: Somewhat strong
- 4: Very strong
- 5: Not applicable
Sense of belonging - Neighbourhood (BEL) - Question identifier:BEL_Q05F
Using a scale from 1 to 4, where 1 means "Very weak" and 4 means "Very strong", how would you describe your sense of belonging to the following?
To people with the same race or skin colour as you
- 1: Very weak
- 2: Somewhat weak
- 3: Somewhat strong
- 4: Very strong
- 5: Not applicable
Sense of belonging - Neighbourhood (BEL) - Question identifier:BEL_Q05G
Using a scale from 1 to 4, where 1 means "Very weak" and 4 means "Very strong", how would you describe your sense of belonging to the following?
To people with the same ethnic or cultural background as you
- 1: Very weak
- 2: Somewhat weak
- 3: Somewhat strong
- 4: Very strong
- 5: Not applicable
Sense of belonging - Neighbourhood (BEL) - Question identifier:BEL_Q05H
Using a scale from 1 to 4, where 1 means "Very weak" and 4 means "Very strong", how would you describe your sense of belonging to the following?
To people with the same religion as you
- 1: Very weak
- 2: Somewhat weak
- 3: Somewhat strong
- 4: Very strong
- 5: Not applicable
Sense of belonging - Neighbourhood (BEL) - Question identifier:BEL_Q05I
Using a scale from 1 to 4, where 1 means "Very weak" and 4 means "Very strong", how would you describe your sense of belonging to the following?
To people who speak the same first language as you
- 1: Very weak
- 2: Somewhat weak
- 3: Somewhat strong
- 4: Very strong
- 5: Not applicable
Sense of belonging - Neighbourhood (BEL) - Question identifier:BEL_Q05J
Using a scale from 1 to 4, where 1 means "Very weak" and 4 means "Very strong", how would you describe your sense of belonging to the following?
To the online communities that you are most active in
Online communities include, but are not restricted to, social media groups such as Instagram, Facebook, Snapchat, WhatsApp, Twitter, LinkedIn, online gaming.
- 1: Very weak
- 2: Somewhat weak
- 3: Somewhat strong
- 4: Very strong
- 5: Not applicable
Trust in institutions (TII)
Trust in institutions (TII) - Question identifier:TII_Q05A
On a scale of 1 to 5, where 1 means "No trust at all" and 5 means "A great deal of trust", how much trust do you have in the following institutions in Canada?
The police
- 1: No trust at all
- 2: 2
- 3: 3
- 4: 4
- 5: A great deal of trust
Trust in institutions (TII) - Question identifier:TII_Q05B
On a scale of 1 to 5, where 1 means "No trust at all" and 5 means "A great deal of trust", how much trust do you have in the following institutions in Canada?
By-law officers
- 1: No trust at all
- 2: 2
- 3: 3
- 4: 4
- 5: A great deal of trust
Trust in institutions (TII) - Question identifier:TII_Q05C
On a scale of 1 to 5, where 1 means "No trust at all" and 5 means "A great deal of trust", how much trust do you have in the following institutions in Canada?
The court system
- 1: No trust at all
- 2: 2
- 3: 3
- 4: 4
- 5: A great deal of trust
Trust in institutions (TII) - Question identifier:TII_Q05D
On a scale of 1 to 5, where 1 means "No trust at all" and 5 means "A great deal of trust", how much trust do you have in the following institutions in Canada?
The school system
- 1: No trust at all
- 2: 2
- 3: 3
- 4: 4
- 5: A great deal of trust
Trust in institutions (TII) - Question identifier:TII_Q05E
On a scale of 1 to 5, where 1 means "No trust at all" and 5 means "A great deal of trust", how much trust do you have in the following institutions in Canada?
Federal government
- 1: No trust at all
- 2: 2
- 3: 3
- 4: 4
- 5: A great deal of trust
Trust in institutions (TII) - Question identifier:TII_Q05F
On a scale of 1 to 5, where 1 means "No trust at all" and 5 means "A great deal of trust", how much trust do you have in the following institutions in Canada?
Your provincial or territorial government
- 1: No trust at all
- 2: 2
- 3: 3
- 4: 4
- 5: A great deal of trust
Trust in institutions (TII) - Question identifier:TII_Q05G
On a scale of 1 to 5, where 1 means "No trust at all" and 5 means "A great deal of trust", how much trust do you have in the following institutions in Canada?
Your local government
Include local Indigenous governments.
- 1: No trust at all
- 2: 2
- 3: 3
- 4: 4
- 5: A great deal of trust
Trust in institutions (TII) - Question identifier:TII_Q05H
On a scale of 1 to 5, where 1 means "No trust at all" and 5 means "A great deal of trust", how much trust do you have in the following institutions in Canada?
The health care system
e.g., services that provide care, such as hospitals, doctors and clinics
- 1: No trust at all
- 2: 2
- 3: 3
- 4: 4
- 5: A great deal of trust
Trust in institutions (TII) - Question identifier:TII_Q05I
On a scale of 1 to 5, where 1 means "No trust at all" and 5 means "A great deal of trust", how much trust do you have in the following institutions in Canada?
Public health agencies
e.g., agencies that provide information about staying healthy and safe
- 1: No trust at all
- 2: 2
- 3: 3
- 4: 4
- 5: A great deal of trust
Trust in institutions (TII) - Question identifier:TII_Q05J
On a scale of 1 to 5, where 1 means "No trust at all" and 5 means "A great deal of trust", how much trust do you have in the following institutions in Canada?
Banks
- 1: No trust at all
- 2: 2
- 3: 3
- 4: 4
- 5: A great deal of trust
Trust in institutions (TII) - Question identifier:TII_Q05K
On a scale of 1 to 5, where 1 means "No trust at all" and 5 means "A great deal of trust", how much trust do you have in the following institutions in Canada?
Major corporations
- 1: No trust at all
- 2: 2
- 3: 3
- 4: 4
- 5: A great deal of trust
Trust in institutions (TII) - Question identifier:TII_Q05L
On a scale of 1 to 5, where 1 means "No trust at all" and 5 means "A great deal of trust", how much trust do you have in the following institutions in Canada?
Local merchants or business people
- 1: No trust at all
- 2: 2
- 3: 3
- 4: 4
- 5: A great deal of trust
Trust in institutions (TII) - Question identifier:TII_Q05M
On a scale of 1 to 5, where 1 means "No trust at all" and 5 means "A great deal of trust", how much trust do you have in the following institutions in Canada?
The Canadian media
- 1: No trust at all
- 2: 2
- 3: 3
- 4: 4
- 5: A great deal of trust
Access to health care services (HCS)
Access to health care services (HCS) - Question identifier:HCS_Q05A
Since the beginning of the COVID-19 pandemic, have you personally experienced problems accessing any of the following health care services?
Non-emergency surgery
e.g., cardiac, knee or hip replacement, cataract
- 1: Yes
- 2: No
- 3: I did not need the service
Access to health care services (HCS) - Question identifier:HCS_Q05B
Since the beginning of the COVID-19 pandemic, have you personally experienced problems accessing any of the following health care services?
Non-emergency diagnostic test
e.g., MRI, CT scan, ultrasound, angiogram
- 1: Yes
- 2: No
- 3: I did not need the service
Access to health care services (HCS) - Question identifier:HCS_Q05C
Since the beginning of the COVID-19 pandemic, have you personally experienced problems accessing any of the following health care services?
Appointment with your family doctor
- 1: Yes
- 2: No
- 3: I did not need the service
Access to health care services (HCS) - Question identifier:HCS_Q05D
Since the beginning of the COVID-19 pandemic, have you personally experienced problems accessing any of the following health care services?
Appointment with a medical specialist
e.g., cardiologist, optometrist, oncologist
- 1: Yes
- 2: No
- 3: I did not need the service
Access to health care services (HCS) - Question identifier:HCS_Q05E
Since the beginning of the COVID-19 pandemic, have you personally experienced problems accessing any of the following health care services?
Appointment for rehabilitative care
e.g., physiotherapist, massage therapist, chiropractor
- 1: Yes
- 2: No
- 3: I did not need the service
Access to health care services (HCS) - Question identifier:HCS_Q05F
Since the beginning of the COVID-19 pandemic, have you personally experienced problems accessing any of the following health care services?
Dental care
e.g., dentist, orthodontist
- 1: Yes
- 2: No
- 3: I did not need the service
Access to health care services (HCS) - Question identifier:HCS_Q05G
Since the beginning of the COVID-19 pandemic, have you personally experienced problems accessing any of the following health care services?
Help for mental health
e.g., counselling appointment, support group
- 1: Yes
- 2: No
- 3: I did not need the service
Access to health care services (HCS) - Question identifier:HCS_Q05H
Since the beginning of the COVID-19 pandemic, have you personally experienced problems accessing any of the following health care services?
Medical treatment
e.g., chemo, radiotherapy, dialysis
- 1: Yes
- 2: No
- 3: I did not need the service
Access to health care services (HCS) - Question identifier:HCS_Q05I
Since the beginning of the COVID-19 pandemic, have you personally experienced problems accessing any of the following health care services?
Natural medicine
e.g., naturopathy, acupuncture
- 1: Yes
- 2: No
- 3: I did not need the service
Access to health care services (HCS) - Question identifier:HCS_Q05J
Since the beginning of the COVID-19 pandemic, have you personally experienced problems accessing any of the following health care services?
Emergency services, urgent care
e.g., hospital emergency room
- 1: Yes
- 2: No
- 3: I did not need the service
Access to health care services (HCS) - Question identifier:HCS_Q05K
Since the beginning of the COVID-19 pandemic, have you personally experienced problems accessing any of the following health care services?
Other health care service
- 1: Yes
- 2: No
- 3: I did not need the service
Access to health care services (HCS) - Question identifier:HCS_Q10
Since the beginning of the COVID-19 pandemic, which of the following types of difficulties did you experience accessing health care services?
Select all that apply.
- 01: Difficulty getting a referral
- 02: Difficulty getting an appointment
- 03: Difficulty contacting a physician or nurse to get information or advice
- 04: Waited too long between booking an appointment and visit
- 05: Waited too long to get health care service (i.e., in-office waiting)
- 06: The service was not available at time required (i.e., reduced hours of operation)
- 07: Was refused service because I was experiencing symptoms of COVID-19 or because I was considered to have been at risk of exposure to COVID-19
- 08: Transportation problems
- 09: Language problem
- 10: Cost
- 11: Other types of difficulties accessing health care services
Access to health care services (HCS) - Question identifier:HCS_Q15
How was your health affected by the difficulty in accessing any of these health services?
Select all that apply.
- 1: Worry, anxiety or stress
- 2: Pain
- 3: Unable to do usual activities (e.g., caring for yourself or others, chores around the house, work)
- 4: Overall health deteriorated, condition got worse
- 5: Other impact
- 6: No impact
Long-term conditions (LTC)
Long-term conditions (LTC) - Question identifier:LTC_R05
The following questions are about any long-term conditions you may have.
Long-term conditions (LTC) - Question identifier:LTC_Q05
Do you have any of the following difficulties?
Include only difficulties or long-term conditions that have lasted or are expected to last for six or more months.
Select all that apply.
- 1: Difficulty seeing even when wearing glasses or contact lenses
- 2: Difficulty hearing even when using a hearing aid or cochlear implant
- 3: Difficulty walking, using stairs, using your hands or fingers or doing other physical activities
- 4: Difficulty learning, remembering or concentrating
- 5: Emotional, psychological or mental health conditions (e.g., anxiety, depression, bipolar disorder, substance abuse, anorexia)
- 6: Other health problem or long-term condition that has lasted or is expected to last for six or more months
- 7: I do not have any difficulty or long-term condition that has lasted or is expected to last for six or more months
Long-term conditions (LTC) - Question identifier:LTC_Q10
Do you identify as a person with a disability?
A person with a disability is a person who has a long-term difficulty or condition, such as vision, hearing, mobility, flexibility, dexterity, pain, learning, developmental, memory or mental health-related impairments, that limit their daily activities inside or outside the home such as at school, work, or in the community in general.
- 1: Yes
- 2: No
Education (ED)
Education (ED) - Question identifier:ED_Q05
What is the highest certificate, diploma or degree that you have completed?
- 1: Less than high school diploma or its equivalent
- 2: High school diploma or a high school equivalency certificate
- 3: Trades certificate or diploma
- 4: College, CEGEP or other non-university certificate or diploma (other than trades certificates or diplomas)
- 5: University certificate or diploma below the bachelor's level
- 6: Bachelor's degree (e.g., B.A., B.A. (Hons), B.Sc., B.Ed., LL.B.)
- 7: University certificate, diploma or degree above the bachelor's level
Language (LAN)
Language (LAN) - Question identifier:LAN_Q02
What language do you speak most often at home?
- 1: English
- 2: French
- 3: Other
Indigenous identity (IS)
Indigenous identity (IS) - Question identifier:IS_Q01
Are you First Nations, Métis or Inuk (Inuit)?
- 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.
Select all that apply.
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 1 (DEM1)
Demographic questions 1 (DEM1) - Question identifier:DEM1_Q30A
Where were you born?
- 1: Born in Canada
- 2: Born outside Canada
Demographic questions 1 (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 1 (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
Demographic questions 1 (DEM1) - Question identifier:DEM1_Q35
In what year did you first become a landed immigrant or a permanent resident?
Min = 0; Max = 9999
If exact year is not known, enter best estimate.
Year of immigration
Gender (GDR)
Gender (GDR) - Question identifier:GDR_R05
The following questions are about sex at birth and gender.
Gender (GDR) - Question identifier:GDR_Q05
What is your sex at birth?
Sex refers to sex assigned at birth.
- 1: Male
- 2: Female
Gender (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.
Is it:
- 1: Male
- 2: Female
- 3: Or please specify
Gender (GDR) - Question identifier:GDR_R15
Please verify that all of the information is correct.
Your information
Sex assigned at birth: [Male/Female/Information not provided]
Gender: [Male/Female/^GDR_S10/Information not provided]
If all the information is correct, then press the Next button.
To make changes, please press the Previous button.
Demographic questions (DEM)
Demographic questions (DEM) - Question identifier:DEM_Q05
What is your age?
Min = 0; Max = 999
Age in years
Demographic questions (DEM) - Question identifier:DEM_Q11
What is your marital status?
Is it:
- 1: Married (For Quebec residents only, select the "Married" category if your marital status is "civil union".)
- 2: Living common law (Two people who live together as a couple but who are not legally married to each other.)
- 3: Never married (not living common law)
- 4: Separated (not living common law)
- 5: Divorced (not living common law)
- 6: Widowed (not living common law)
Demographic questions (DEM) - Question identifier:DEM_Q13
Including yourself, how many people live in your household?
Note: Press the help button (?) for additional information, including who to include and who not to include.
- 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
Demographic questions (DEM) - Question identifier:DEM_Q14
Including yourself, how many of these people are less than 18 years of age?
Note: Press the help button (?) for additional information, including who to include and who not to include.
- 00: 0
- 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
Demographic questions (DEM) - Question identifier:DEM_Q15
To determine which geographic region you live in, please provide your postal code.
Long Answer Length = 6
Postal Code
Example: A9A 9A9
Sexual orientation (SOR)
Sexual orientation (SOR) - Question identifier:SOR_Q01
What is your sexual orientation?
Would you say you are:
- 1: Heterosexual
- 2: Lesbian or gay
- 3: Bisexual
- 4: Or please specify
Sign-up (UCE)
Sign-up (UCE) - Question identifier:UCE_R05
Would you like to sign-up for future surveys?
Statistics Canada is planning a series of surveys about important social topics. These surveys will be sent out every month or two and will ask about a wide variety of issues such as COVID-19, fake news, digital technologies, health, education and justice.
By participating in this survey series, you will be able to share your opinions and thoughts on these issues and compare your ideas with those of other Canadians.
Sign-up (UCE) - Question identifier:UCE_Q01
Would you like to sign-up for future surveys?
- 1: Yes
- 2: No
Sign-up (UCE) - Question identifier:UCE_Q05B
Please provide the following information so we can email or text you to participate in this survey series.
Email address
Long Answer Length = 80
Example: user@example.gov.ca
Sign-up (UCE) - Question identifier:UCE_Q05C
Please provide the following information so we can email or text you to participate in this survey series.
Cellular number
Long Answer Length = 10
Example: 123-123-1234
Sign-up (UCE) - Question identifier:UCE_R09
Thank you for signing up. We will contact you soon.
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