Questionnaire of the 2022 Canadian COVID-19 Antibody and Health Survey (CCAHS) wave 1

Archived Content

Information identified as archived is provided for reference, research or record keeping purposes. It is not subject to the Government of Canada Web Standards and has not been altered or updated since it was archived. Please contact us to request a format other than those available.

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

Show all instructions

Table of Contents

Verification 1 (NAM)

Verification 1 (NAM) - Question identifier:NAM_Q01A

What is your name?
First name

Long Answer Length = 25

Verification 1 (NAM) - Question identifier:NAM_Q01B

What is your name?
Last name

Long Answer Length = 30

Verification 2 (AGE)

Verification 2 (AGE) - Question identifier:AGE_Q02

What is your age?

Min = 0; Max = 999

Verification 2 (AGE) - Question identifier:AGE_Q01A

What is your date of birth?

Year

Min = 1899; Max = 2018

Verification 2 (AGE) - Question identifier:AGE_Q01B

What is your date of birth?

Month

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Verification 2 (AGE) - Question identifier:AGE_Q01C

What is your date of birth?

Day

  • 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
  • 21: 21
  • 22: 22
  • 23: 23
  • 24: 24
  • 25: 25
  • 26: 26
  • 27: 27
  • 28: 28
  • 29: 29
  • 30: 30
  • 31: 31

General health 1 (GEN)

General health 1 (GEN) - Question identifier:GEN_R01

The following question is about health. By health we mean not only the absence of disease or injury, but also physical, mental and social well being.

General health 1 (GEN) - Question identifier:GEN_Q01

In general, how is your health?

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

General health 1 (GEN) - Question identifier:GEN_Q05

In general, how is your mental health?

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

General health 2 (HWT)

General health 2 (HWT) - Question identifier:HWT_Q05A

How tall are you without shoes on?

Feet

Min = 0; Max = 9

General health 2 (HWT) - Question identifier:HWT_Q05B

Inches

  • 00: 0
  • 01: 1
  • 02: 2
  • 03: 3
  • 04: 4
  • 05: 5
  • 06: 6
  • 07: 7
  • 08: 8
  • 09: 9
  • 10: 10
  • 11: 11

General health 2 (HWT) - Question identifier:HWT_Q05C

Centimetres

Min = 0; Max = 999

General health 2 (HWT) - Question identifier:HWT_Q40A

How much do you weigh?

Weight

Min = 0; Max = 999

General health 2 (HWT) - Question identifier:HWT_Q40B

Pounds or kilograms

  • 1: Pounds
  • 2: Kilograms

Chronic symptoms (CHS)

Chronic symptoms (CHS) - Question identifier:CHS_R05

The next question is about long-term health symptoms. These are physical or mental symptoms which are expected to last or have already lasted 6 months or more. They may be related to a health condition you have, or be of unknown cause.

Chronic symptoms (CHS) - Question identifier:CHS_Q05

Do you have any of the following long-term health symptoms?

  • 01: Pain (Exclude headache.)
  • 02: Shortness of breath or difficulty breathing
  • 03: Difficulty speaking or hoarseness
  • 04: Cough
  • 05: Headache
  • 06: Chest tightness
  • 07: Symptoms relating to the heart (e.g., fast, pounding or irregular heartbeat)
  • 08: Fatigue, tiredness or loss of energy
  • 09: General weakness
  • 10: Difficulty swallowing
  • 11: Loss of appetite
  • 12: Loss of taste or smell
  • 13: Feeling thirsty
  • 14: Nausea, vomiting
  • 15: Upset stomach, bloating, gas
  • 16: Heartburn or indigestion
  • 17: Frequent urination
  • 18: Irregular bowel movements or habits (e.g., diarrhea, constipation, blood in stool)
  • 19: Change in body weight (Exclude changes due to a diet modification, exercise or surgery.)
  • 20: Dizziness
  • 21: Feeling hot or cold (body temperature changes)
  • 22: Numbness or tingling
  • 23: Fainting
  • 24: Swelling
  • 25: Skin irritation (e.g., rash, eczema
    Exclude acne.)
  • 26: Joint inflammation
  • 27: Stiffness
  • 28: Difficulty falling or staying asleep
  • 29: Difficulty thinking or problem solving (brain fog)
  • 30: Confusion, memory loss
  • 31: Loss of interest in activities
  • 32: Sadness, pessimism, hopelessness or depression
  • 33: Stress or anxiety
  • 34: Other
  • 35: None of the above

Chronic symptoms (CHS) - Question identifier:CHS_Q10_01

When did you first begin to experience this symptom? Year
Pain

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_02

When did you first begin to experience this symptom? Year
Shortness of breath or difficulty breathing

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_03

When did you first begin to experience this symptom? Year
Difficulty speaking or hoarseness

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_04

When did you first begin to experience this symptom? Year
Cough

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_05

When did you first begin to experience this symptom? Year
Headache

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_06

When did you first begin to experience this symptom? Year
Chest tightness

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_07

When did you first begin to experience this symptom? Year
Symptoms relating to the heart

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_08

When did you first begin to experience this symptom? Year
Fatigue, tiredness or loss of energy

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_09

When did you first begin to experience this symptom? Year
General weakness

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_10

When did you first begin to experience this symptom? Year
Difficulty swallowing

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_11

When did you first begin to experience this symptom? Year
Loss of appetite

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_12

When did you first begin to experience this symptom? Year
Loss of taste or smell

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_13

When did you first begin to experience this symptom? Year
Feeling thirsty

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_14

When did you first begin to experience this symptom? Year
Nausea, vomiting

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_15

When did you first begin to experience this symptom? Year
Upset stomach, bloating, gas

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_16

When did you first begin to experience this symptom? Year
Heartburn or indigestion

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_17

When did you first begin to experience this symptom? Year
Frequent urination

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_18

When did you first begin to experience this symptom? Year
Irregular bowel movements or habits

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_19

When did you first begin to experience this symptom? Year
Change in body weight

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_20

When did you first begin to experience this symptom? Year
Dizziness

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_21

When did you first begin to experience this symptom? Year
Feeling hot or cold (body temperature changes)

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_22

When did you first begin to experience this symptom? Year
Numbness or tingling

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_23

When did you first begin to experience this symptom? Year
Fainting

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_24

When did you first begin to experience this symptom? Year
Swelling

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_25

When did you first begin to experience this symptom? Year
Skin irritation

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_26

When did you first begin to experience this symptom? Year
Joint inflammation

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_27

When did you first begin to experience this symptom? Year
Stiffness

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_28

When did you first begin to experience this symptom? Year
Difficulty falling or staying asleep

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_29

When did you first begin to experience this symptom? Year
Difficulty thinking or problem solving (brain fog)

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_30

When did you first begin to experience this symptom? Year
Confusion, memory loss

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_31

When did you first begin to experience this symptom? Year
Loss of interest in activities

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_32

When did you first begin to experience this symptom? Year
Sadness, pessimism, hopelessness or depression

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_33

When did you first begin to experience this symptom? Year
Stress or anxiety

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q10_34

When did you first begin to experience this symptom? Year
[Other symptom]

Min = 0; Max = 9999

Chronic symptoms (CHS) - Question identifier:CHS_Q15_01

When did you first begin to experience this symptom? Month
Pain

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_02

When did you first begin to experience this symptom? Month
Shortness of breath or difficulty breathing

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_03

When did you first begin to experience this symptom? Month
Difficulty speaking or hoarseness

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_04

When did you first begin to experience this symptom? Month
Cough

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_05

When did you first begin to experience this symptom? Month
Headache

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_06

When did you first begin to experience this symptom? Month
Chest tightness

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_07

When did you first begin to experience this symptom? Month
Symptoms relating to the heart

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_08

When did you first begin to experience this symptom? Month
Fatigue, tiredness or loss of energy

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_09

When did you first begin to experience this symptom? Month
General weakness

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_10

When did you first begin to experience this symptom? Month
Difficulty swallowing

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_11

When did you first begin to experience this symptom? Month
Loss of appetite

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_12

When did you first begin to experience this symptom? Month
Loss of taste or smell

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_13

When did you first begin to experience this symptom? Month
Feeling thirsty

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_14

When did you first begin to experience this symptom? Month
Nausea, vomiting

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_15

When did you first begin to experience this symptom? Month
Upset stomach, bloating, gas

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_16

When did you first begin to experience this symptom? Month
Heartburn or indigestion

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_17

When did you first begin to experience this symptom? Month
Frequent urination

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_18

When did you first begin to experience this symptom? Month
Irregular bowel movements or habits

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_19

When did you first begin to experience this symptom? Month
Change in body weight

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_20

When did you first begin to experience this symptom? Month
Dizziness

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_21

When did you first begin to experience this symptom? Month
Feeling hot or cold (body temperature changes)

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_22

When did you first begin to experience this symptom? Month
Numbness or tingling

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_23

When did you first begin to experience this symptom? Month
Fainting

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_24

When did you first begin to experience this symptom? Month
Swelling

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_25

When did you first begin to experience this symptom? Month
Skin irritation

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_26

When did you first begin to experience this symptom? Month
Joint inflammation

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_27

When did you first begin to experience this symptom? Month
Stiffness

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_28

When did you first begin to experience this symptom? Month
Difficulty falling or staying asleep

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_29

When did you first begin to experience this symptom? Month
Difficulty thinking or problem solving (brain fog)

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_30

When did you first begin to experience this symptom? Month
Confusion, memory loss

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_31

When did you first begin to experience this symptom? Month
Loss of interest in activities

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_32

When did you first begin to experience this symptom? Month
Sadness, pessimism, hopelessness or depression

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_33

When did you first begin to experience this symptom? Month
Stress or anxiety

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q15_34

When did you first begin to experience this symptom? Month
[Other symptom]

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic symptoms (CHS) - Question identifier:CHS_Q20

Which of the following best describes the frequency with which you experience any of your symptoms?

  • 1: Every day
  • 2: Almost every day
  • 3: At least once a week
  • 4: At least once a month
  • 5: Less than once a month
  • 9: DK

Chronic symptoms (CHS) - Question identifier:CHS_Q25

When you experience your symptoms, which of the following best describes the overall intensity of the symptoms?

  • 1: Very strong
  • 2: Strong
  • 3: Medium
  • 4: Weak
  • 5: Very weak
  • 9: DK

Chronic symptoms (CHS) - Question identifier:CHS_Q30

Overall, since you started having symptoms, how have they changed?

  • 1: Improved
  • 2: Worsened
  • 3: Stayed about the same
  • 9: DK

Chronic conditions (CHC)

Chronic conditions (CHC) - Question identifier:CHC_Q05

Do you have cancer?

  • 1: Yes
  • 2: No
  • 9: DK

Chronic conditions (CHC) - Question identifier:CHC_Q10

Have you ever been diagnosed with cancer?

  • 1: Yes
  • 2: No
  • 9: DK

Chronic conditions (CHC) - Question identifier:CHC_R15

The next question is about long-term health conditions. These are conditions which are expected to last or have already lasted 6 months or more and have been diagnosed by a health professional.

Chronic conditions (CHC) - Question identifier:CHC_Q15

Do you have any of the following long-term health conditions?

  • 01: Chronic lung condition (e.g., emphysema or bronchitis)
  • 02: Sleep apnea
  • 03: Asthma
  • 04: Chronic heart disease
  • 05: Diabetes (Exclude gestational diabetes.)
  • 06: Chronic kidney disease
  • 07: Liver disease (e.g., chronic hepatitis)
  • 08: High blood pressure
  • 09: Chronic blood disorder
  • 10: Osteoporosis
  • 11: Back problems
  • 12: Urinary incontinence
  • 13: Bowel disorder
  • 14: A weakened immune system (e.g., due to disease or medication)
  • 15: Chronic neurological disorder
  • 16: Chronic fatigue syndrome or Fibromyalgia
  • 17: The effects of a stroke
  • 18: Alzheimer's disease or other dementia
  • 19: Mental health condition (e.g., depression, anxiety)
  • 20: Arthritis
  • 21: Other
  • 22: None of the above

Chronic conditions (CHC) - Question identifier:CHC_Q20_01

When were you first diagnosed with this condition? Year
Chronic lung condition

Min = 0; Max = 9999

Chronic conditions (CHC) - Question identifier:CHC_Q20_02

When were you first diagnosed with this condition? Year
Sleep apnea

Min = 0; Max = 9999

Chronic conditions (CHC) - Question identifier:CHC_Q20_03

When were you first diagnosed with this condition? Year
Asthma

Min = 0; Max = 9999

Chronic conditions (CHC) - Question identifier:CHC_Q20_04

When were you first diagnosed with this condition? Year
Chronic heart disease

Min = 0; Max = 9999

Chronic conditions (CHC) - Question identifier:CHC_Q20_05

When were you first diagnosed with this condition? Year
Diabetes

Min = 0; Max = 9999

Chronic conditions (CHC) - Question identifier:CHC_Q20_06

When were you first diagnosed with this condition? Year
Chronic kidney disease

Min = 0; Max = 9999

Chronic conditions (CHC) - Question identifier:CHC_Q20_07

When were you first diagnosed with this condition? Year
Liver disease

Min = 0; Max = 9999

Chronic conditions (CHC) - Question identifier:CHC_Q20_08

When were you first diagnosed with this condition? Year
High blood pressure

Min = 0; Max = 9999

Chronic conditions (CHC) - Question identifier:CHC_Q20_09

When were you first diagnosed with this condition? Year
Chronic blood disorder

Min = 0; Max = 9999

Chronic conditions (CHC) - Question identifier:CHC_Q20_10

When were you first diagnosed with this condition? Year
Osteoporosis

Min = 0; Max = 9999

Chronic conditions (CHC) - Question identifier:CHC_Q20_11

When were you first diagnosed with this condition? Year
Back problems

Min = 0; Max = 9999

Chronic conditions (CHC) - Question identifier:CHC_Q20_12

When were you first diagnosed with this condition? Year
Urinary incontinence

Min = 0; Max = 9999

Chronic conditions (CHC) - Question identifier:CHC_Q20_13

When were you first diagnosed with this condition? Year
Bowel disorder

Min = 0; Max = 9999

Chronic conditions (CHC) - Question identifier:CHC_Q20_14

When were you first diagnosed with this condition? Year
A weakened immune system

Min = 0; Max = 9999

Chronic conditions (CHC) - Question identifier:CHC_Q20_15

When were you first diagnosed with this condition? Year
Chronic neurological disorder

Min = 0; Max = 9999

Chronic conditions (CHC) - Question identifier:CHC_Q20_16

When were you first diagnosed with this condition? Year
Chronic fatigue syndrome or Fibromyalgia

Min = 0; Max = 9999

Chronic conditions (CHC) - Question identifier:CHC_Q20_17

When were you first diagnosed with this condition? Year
The effects of a stroke

Min = 0; Max = 9999

Chronic conditions (CHC) - Question identifier:CHC_Q20_18

When were you first diagnosed with this condition? Year
Alzheimer's disease or other dementia

Min = 0; Max = 9999

Chronic conditions (CHC) - Question identifier:CHC_Q20_19

When were you first diagnosed with this condition? Year
Mental health condition

Min = 0; Max = 9999

Chronic conditions (CHC) - Question identifier:CHC_Q20_20

When were you first diagnosed with this condition? Year
Arthritis

Min = 0; Max = 9999

Chronic conditions (CHC) - Question identifier:CHC_Q20_21

When were you first diagnosed with this condition? Year
[Other condition]

Min = 0; Max = 9999

Chronic conditions (CHC) - Question identifier:CHC_Q25_01

When were you first diagnosed with this condition? Month
Chronic lung condition

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic conditions (CHC) - Question identifier:CHC_Q25_02

When were you first diagnosed with this condition? Month
Sleep apnea

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic conditions (CHC) - Question identifier:CHC_Q25_03

When were you first diagnosed with this condition? Month
Asthma

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic conditions (CHC) - Question identifier:CHC_Q25_04

When were you first diagnosed with this condition? Month
Chronic heart disease

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic conditions (CHC) - Question identifier:CHC_Q25_05

When were you first diagnosed with this condition? Month
Diabetes

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic conditions (CHC) - Question identifier:CHC_Q25_06

When were you first diagnosed with this condition? Month
Chronic kidney disease

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic conditions (CHC) - Question identifier:CHC_Q25_07

When were you first diagnosed with this condition? Month
Liver disease

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic conditions (CHC) - Question identifier:CHC_Q25_08

When were you first diagnosed with this condition? Month
High blood pressure

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic conditions (CHC) - Question identifier:CHC_Q25_09

When were you first diagnosed with this condition? Month
Chronic blood disorder

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic conditions (CHC) - Question identifier:CHC_Q25_10

When were you first diagnosed with this condition? Month
Osteoporosis

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic conditions (CHC) - Question identifier:CHC_Q25_11

When were you first diagnosed with this condition? Month
Back problems

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic conditions (CHC) - Question identifier:CHC_Q25_12

When were you first diagnosed with this condition? Month
Urinary incontinence

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic conditions (CHC) - Question identifier:CHC_Q25_13

When were you first diagnosed with this condition? Month
Bowel disorder

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic conditions (CHC) - Question identifier:CHC_Q25_14

When were you first diagnosed with this condition? Month
A weakened immune system

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic conditions (CHC) - Question identifier:CHC_Q25_15

When were you first diagnosed with this condition? Month
Chronic neurological disorder

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic conditions (CHC) - Question identifier:CHC_Q25_16

When were you first diagnosed with this condition? Month
Chronic fatigue syndrome or Fibromyalgia

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic conditions (CHC) - Question identifier:CHC_Q25_17

When were you first diagnosed with this condition? Month
The effects of a stroke

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic conditions (CHC) - Question identifier:CHC_Q25_18

When were you first diagnosed with this condition? Month
Alzheimer's disease or other dementia

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic conditions (CHC) - Question identifier:CHC_Q25_19

When were you first diagnosed with this condition? Month
Mental health condition

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic conditions (CHC) - Question identifier:CHC_Q25_20

When were you first diagnosed with this condition? Month
Arthritis

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic conditions (CHC) - Question identifier:CHC_Q25_21

When were you first diagnosed with this condition? Month
[Other condition]

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Chronic conditions (CHC) - Question identifier:CHC_Q30

Considering together all of the long-term health [symptoms/conditions/symptoms and conditions] you reported, how often do they limit your daily activities?

  • 1: Never
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always

COVID-19 status (CS)

COVID-19 status (CS) - Question identifier:CS_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, often called a rapid test, which produces a result within minutes.

COVID-19 status (CS) - Question identifier:CS_Q05

Have you ever had a positive result on a COVID-19 test?

  • 1: Yes
  • 2: No
  • 3: Waiting for results

COVID-19 status (CS) - Question identifier:CS_Q08

Have you ever had a positive result on a PCR (lab) type COVID-19 test?

  • 1: Yes
  • 2: No
  • 9: DK

COVID-19 status (CS) - Question identifier:CS_Q10

Were you hospitalized for COVID-19?

  • 1: Yes
  • 2: No

COVID-19 status (CS) - Question identifier:CS_Q15

Do you think you have ever had COVID-19?

  • 1: Yes
  • 2: No
  • 9: DK

COVID-19 status (CS) - Question identifier:CS_Q16

Why do you think you had COVID-19?

  • 1: Had symptoms related to COVID-19
  • 2: A member of my household was suspected to have, or tested positive for COVID-19
  • 3: Had an exposure to someone not living with me who was suspected to have, or tested positive for COVID-19
  • 4: Received a notification or alert that I was a high-risk exposure to someone who was suspected to have, or tested positive for COVID-19
  • 5: Other

COVID-19 status (CS) - Question identifier:CS_Q17

Did you ever have symptoms related to COVID-19 but tested negative on a rapid antigen COVID-19 test?

  • 1: Yes
  • 2: No

COVID-19 status (CS) - Question identifier:CS_Q20

Has anyone else living in your household had a positive result on a PCR or rapid COVID-19 test?

  • 1: Yes
  • 2: No
  • 9: DK

COVID-19 status (CS) - Question identifier:CS_Q25

From March 2020 until today, did you experience any new unexplained symptoms lasting 2 or more months?

  • 1: Yes
  • 2: No
  • 9: DK

COVID-19 status (CS) - Question identifier:CS_Q30

What were these symptoms?

  • 01: Fatigue, tiredness or loss of energy
  • 02: Difficulty thinking or problem solving (brain fog)
  • 03: Shortness of breath or difficulty breathing
  • 04: Coughing
  • 05: Fever
  • 06: Chest pain
  • 07: Stress or anxiety
  • 08: Sadness, pessimism, hopelessness or depression
  • 09: Pain (e.g., muscular, abdominal, joint
    Exclude chest pain or headache.)
  • 10: Symptoms relating to the heart (e.g., fast, pounding or irregular heartbeat)
  • 11: Headache
  • 12: General weakness
  • 13: Loss of taste or smell
  • 14: Other

COVID-19 status (CS) - Question identifier:CS_Q35A

[When was your first positive COVID-19 test taken?/When do you think you first had COVID-19?]

Time of Month

  • 1: Early
  • 2: Middle
  • 3: Late

COVID-19 status (CS) - Question identifier:CS_Q35B

[When was your first positive COVID-19 test taken?/When do you think you first had COVID-19?]

Month

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

COVID-19 status (CS) - Question identifier:CS_Q35C

[When was your first positive COVID-19 test taken?/When do you think you first had COVID-19?]

Year

  • 1: 2020
  • 2: 2021
  • 3: 2022

COVID-19 status (CS) - Question identifier:CS_Q40

[When you had your first positive test/When you thought you first had COVID-19], how severe were your symptoms?

  • 1: No symptoms
  • 2: Mild symptoms - didn't affect my daily life
  • 3: Moderate symptoms - some effect on my daily life
  • 4: Severe symptoms - significant effect on my daily life

COVID-19 status (CS) - Question identifier:CS_Q45

Did you experience any symptoms 3 or more months after [your first COVID-19 symptoms started/your first positive test/you thought you first had COVID-19]?

  • 1: Yes
  • 2: No
  • 3: I [started feeling symptoms/had a first positive test/think I first had COVID-19] less than 3 months ago
  • 9: DK

COVID-19 status (CS) - Question identifier:CS_Q50

Please describe the COVID-19 infection [you had/you thought you had].

  • 1: I had symptoms from my initial infection that lasted 3 or more months.
  • 2: I recovered from my initial infection, but developed symptoms again.

COVID-19 status (CS) - Question identifier:CS_Q55

What symptoms did you experience 3 or more months after [your first COVID-19 symptoms started/your first positive test/you thought you first had COVID-19]?

  • 01: Fatigue, tiredness or loss of energy
  • 02: Difficulty thinking or problem solving (brain fog)
  • 03: Shortness of breath or difficulty breathing
  • 04: Coughing
  • 05: Fever
  • 06: Chest pain
  • 07: Stress or anxiety
  • 08: Sadness, pessimism, hopelessness or depression
  • 09: Pain (e.g., muscular, abdominal, joint
    Exclude chest pain or headache.)
  • 10: Symptoms relating to the heart (e.g., fast, pounding or irregular heartbeat)
  • 11: Headache
  • 12: General weakness
  • 13: Loss of taste or smell
  • 14: Other

COVID-19 status (CS) - Question identifier:CS_Q60

Do you still have any of these symptoms today?

  • 1: Yes
  • 2: No
  • 9: DK

COVID-19 status (CS) - Question identifier:CS_Q65

How long [have/did] these symptoms [lasted/last]?

  • 1: Less than 2 months
  • 2: Between 2 months and less than 3 months
  • 3: Between 3 months and less than 6 months
  • 4: Between 6 months and less than 1 year
  • 5: 1 year or longer

COVID-19 status (CS) - Question identifier:CS_Q70

Considering together all of these [unexplained symptoms/symptoms related to your suspected COVID-19 illness/symptoms related to your COVID-19 illness], how often [do/did] they limit your daily activities?

  • 1: Never
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always

COVID-19 vaccination (VX)

COVID-19 vaccination (VX) - Question identifier:VX_R05

The following questions are about vaccination against COVID-19.

COVID-19 vaccination (VX) - Question identifier:VX_Q05

Have you been vaccinated against COVID-19?

  • 1: Yes
  • 2: No

COVID-19 vaccination (VX) - Question identifier:VX_Q10

How many doses of the COVID-19 vaccine have you received so far?

  • 1: One dose
  • 2: Two doses
  • 3: More than two doses

COVID-19 vaccination (VX) - Question identifier:VX_Q15A

When did you receive your first dose of a COVID-19 vaccine?

Month

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

COVID-19 vaccination (VX) - Question identifier:VX_Q15B

When did you receive your first dose of a COVID-19 vaccine?

Year

  • 1: 2020
  • 2: 2021
  • 3: 2022

COVID-19 vaccination (VX) - Question identifier:VX_Q20

Which vaccine did you receive for your first dose?

  • 1: Pfizer and BioNTech mRNA vaccine
  • 2: Moderna mRNA vaccine
  • 3: AstraZeneca Oxford vaccine
  • 4: Other — specify:
  • 9: DK

COVID-19 vaccination (VX) - Question identifier:VX_Q25A

When did you receive your second dose of a COVID-19 vaccine?

Month

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

COVID-19 vaccination (VX) - Question identifier:VX_Q25B

When did you receive your second dose of a COVID-19 vaccine?

Year

  • 1: 2020
  • 2: 2021
  • 3: 2022

COVID-19 vaccination (VX) - Question identifier:VX_Q30

Which vaccine did you receive for your second dose?

  • 1: Pfizer and BioNTech mRNA vaccine
  • 2: Moderna mRNA vaccine
  • 3: AstraZeneca Oxford vaccine
  • 4: Other — specify:
  • 9: DK

COVID-19 vaccination (VX) - Question identifier:VX_Q35A

When did you receive your third dose of a COVID-19 vaccine?

Month

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

COVID-19 vaccination (VX) - Question identifier:VX_Q35B

When did you receive your third dose of a COVID-19 vaccine?

Year

  • 1: 2020
  • 2: 2021
  • 3: 2022

COVID-19 vaccination (VX) - Question identifier:VX_Q40

Which vaccine did you receive for your third dose?

  • 1: Pfizer and BioNTech mRNA vaccine
  • 2: Moderna mRNA vaccine
  • 3: AstraZeneca Oxford vaccine
  • 4: Other — specify:
  • 9: DK

Interactions with the health care system 1 (IPH)

Interactions with the health care system 1 (IPH) - Question identifier:IPH_Q05

In the past 12 months, which of the following health care services did you need?

  • 01: Consultation or treatment from a family doctor or nurse practitioner
  • 02: Consultation with a specialist medical doctor (e.g., surgeon, allergist, orthopedist, or cardiologist)
  • 03: Treatment for or monitoring of a chronic condition (e.g., high blood pressure, heart disease, kidney disease, diabetes
    Exclude cancer.)
  • 04: Cancer treatment (e.g., radiation, chemotherapy)
  • 05: Screening or diagnostic testing (excluding COVID-19 testing) (e.g., cancer screening, diagnostic imaging, blood tests)
  • 06: Reproductive care or gynaecological services (e.g., prenatal or postnatal, maternity, fertility, treatment of gynaecological concerns or problems, abortion or pregnancy termination services)
  • 07: Surgery (Include any past or scheduled surgical procedures.)
  • 08: Mental health or addiction services such as counselling or therapy
  • 09: Dental care, such as dental cleaning, denture fitting, cavity fillings
  • 10: Other
  • 11: None of the above

Interactions with the health care system 1 (IPH) - Question identifier:IPH_Q10

In the past 12 months, did you experience any of the following difficulties getting the health care service you needed?

  • 01: Difficulty getting a referral
  • 02: One or more of your appointments was cancelled, rescheduled or delayed due to the COVID-19 pandemic
  • 03: One or more of your appointments was cancelled, rescheduled or delayed due to other reasons (Exclude any reason related to the COVID-19 pandemic.)
  • 04: Waited too long between booking appointment and health care service
  • 05: Service not available in your area
  • 06: Transportation (e.g., travel restrictions, lack of public transportation)
  • 07: Cost
  • 08: Quarantine rules or office closures
  • 09: Service not available in the official language of your choice
  • 10: Lack of availability of culturally appropriate health services
  • 11: Lack of First Nations, Métis or Inuit traditional medicines, healing or wellness practices
  • 12: Other
  • 13: None of the above

Interactions with the health care system 1 (IPH) - Question identifier:IPH_Q15

Think of the difficulties you experienced getting health care service in the last 12 months. Were any of these difficulties related to getting care for the long-term health [symptoms/conditions/symptoms and conditions] you previously reported?

  • 1: Yes
  • 2: No

Interactions with the health care system 1 (IPH) - Question identifier:IPH_Q20

Think of the difficulties you experienced getting health care service in the last 12 months. Were any of these difficulties related to getting care for the [unexplained symptoms/symptoms related to your suspected COVID-19 illness/symptoms related to your COVID-19 illness] you previously reported?

  • 1: Yes
  • 2: No

Interactions with the health care system 2 (AHC)

Interactions with the health care system 2 (AHC) - Question identifier:AHC_Q05A

Consultation or treatment from a family doctor or nurse practitioner

What type of appointments did you have?

  • 1: Over the phone
  • 2: Video meeting
  • 3: In person
  • 4: Appointment has not yet been scheduled
  • 5: Other

Interactions with the health care system 2 (AHC) - Question identifier:AHC_Q05B

Consultation with a specialist medical doctor

What type of appointments did you have?

  • 1: Over the phone
  • 2: Video meeting
  • 3: In person
  • 4: Appointment has not yet been scheduled
  • 5: Other

Interactions with the health care system 2 (AHC) - Question identifier:AHC_Q05C

Mental health or addiction services such as counselling or therapy

What type of appointments did you have?

  • 1: Over the phone
  • 2: Video meeting
  • 3: In person
  • 4: Appointment has not yet been scheduled
  • 5: Other

Medication use (MEU)

Medication use (MEU) - Question identifier:MEU_Q05

In the past 12 months, have you taken or were you prescribed any prescription medications?

  • 1: Yes
  • 2: No

Medication use (MEU) - Question identifier:MEU_Q10

In the past 12 months, how often did you take your prescription medications?

  • 1: Every day
  • 2: Almost every day
  • 3: At least once a week
  • 4: At least once a month
  • 5: Less than once a month
  • 6: Never
  • 9: DK

Medication use (MEU) - Question identifier:MEU_Q15

Were any of the medications you took, or were prescribed, for the long-term health [symptoms/conditions/symptoms and conditions] you previously reported?

  • 1: Yes
  • 2: No

Medication use (MEU) - Question identifier:MEU_Q20

How effective were your medications at managing or improving your [symptoms/conditions/symptoms and conditions]?

  • 1: Very effective
  • 2: Effective
  • 3: Somewhat effective
  • 4: Not very effective
  • 5: Not at all effective
  • 6: Not applicable
  • 9: DK

Medication use (MEU) - Question identifier:MEU_Q25

Were any of the medications you took, or were prescribed, for the [unexplained symptoms/symptoms related to your suspected COVID-19 illness/symptoms related to your COVID-19 illness] you previously reported?

  • 1: Yes
  • 2: No

Medication use (MEU) - Question identifier:MEU_Q30

How effective were your medications at managing or improving your [unexplained symptoms/symptoms related to your suspected COVID-19 illness/symptoms related to your COVID-19 illness]?

  • 1: Very effective
  • 2: Effective
  • 3: Somewhat effective
  • 4: Not very effective
  • 5: Not at all effective
  • 6: Not applicable
  • 9: DK

Medication use (MEU) - Question identifier:MEU_Q35

In the past 12 months, how often did you take over-the-counter medications?

  • 1: Every day
  • 2: Almost every day
  • 3: At least once a week
  • 4: At least once a month
  • 5: Less than once a month
  • 6: Never
  • 9: DK

Risk factors (RF)

Risk factors (RF) - Question identifier:RF_Q05

Do you currently smoke tobacco?

  • 1: Yes
  • 2: No
  • 9: DK

Risk factors (RF) - Question identifier:RF_Q10

How often?

  • 1: Daily
  • 2: Less than daily

Sex and gender (GDR)

Sex and gender (GDR) - Question identifier:GDR_R05

The following questions are about sex at birth and gender.

Sex and gender (GDR) - Question identifier:GDR_Q05

What was your sex at birth?

  • 1: Male
  • 2: Female

Sex and gender (GDR) - Question identifier:GDR_Q10

What is your gender?

  • 1: Male
  • 2: Female
  • 3: Or please specify

Sex and 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/Specify other/Information not provided]

Pregnancy status (PRG)

Pregnancy status (PRG) - Question identifier:PRG_Q05

It is important to know when analyzing health whether or not the person is pregnant.

Are you pregnant?

  • 1: Yes
  • 2: No
  • 9: DK

Sexual orientation (SOR)

Sexual orientation (SOR) - Question identifier:SOR_Q01

What is your sexual orientation?

  • 1: Heterosexual
  • 2: Lesbian or gay
  • 3: Bisexual
  • 4: Or please specify

Disability status (DIS)

Disability status (DIS) - Question identifier:DIS_Q05

Do you identify as a person with a disability?

  • 1: Yes
  • 2: No
  • 9: DK

Household size (HHC)

Household size (HHC) - Question identifier:HHC_Q01

Including yourself, how many people 18 years of age or older live in your household?

Number of people

  • 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

Dwelling (DW)

Dwelling (DW) - Question identifier:DW_Q05

What type of dwelling is this?

  • 01: Single detached
  • 02: Double
  • 03: Row or Terrace
  • 04: Duplex
  • 05: Low-rise apartment of fewer than 5 stories or a flat
  • 06: High-rise apartment of 5 stories or more
  • 07: Institution
  • 08: Hotel, rooming or lodging house, camp
  • 09: Mobile home
  • 10: Other

Education (household) (ED)

Education (household) (ED) - Question identifier:ED_Q05

What is the highest certificate, diploma, or degree that anyone in this household has completed?

  • 1: Less than high school diploma or its equivalent
  • 2: High school diploma or a high school equivalency certificate
  • 3: Trade 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, degree above the bachelor's level

Indigenous identity (ABM)

Indigenous identity (ABM) - Question identifier:ABM_Q01

Are you First Nations, Métis or Inuk (Inuit)?

  • 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

Linking and sharing 1 (LNK)

Linking and sharing 1 (LNK) - Question identifier:LNK_R01

To enhance the data from this survey and to minimize the reporting burden for respondents, Statistics Canada will combine your responses with information from the tax data of all members of your household. Statistics Canada and the ministry of health for your home province or territory may also add information from other surveys or administrative sources.

For Quebec residents, the Institut de la statistique du Québec may add information from other surveys or administrative sources.

Linking and sharing 2 (HN)

Linking and sharing 2 (HN) - Question identifier:HN_R01

Having a provincial or territorial health number will assist Statistics Canada in linking the survey data to the provincial or territorial health information.

Linking and sharing 2 (HN) - Question identifier:HN_Q01

Do you have a health card?

  • 1: Yes
  • 2: No

Linking and sharing 2 (HN) - Question identifier:HN_Q02

For which province or territory is your health card?

Health card province

  • 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

Linking and sharing 2 (HN) - Question identifier:HN_Q03

What is your health card number?

Health card number

Long Answer Length = 12

Linking and sharing 3 (SHR)

Linking and sharing 3 (SHR) - Question identifier:SHR_R01

To avoid duplication of surveys, Statistics Canada may enter into agreements to share the data from this survey, including name, address, telephone number and health card number, with provincial and territorial ministries of health, Health Canada and the Public Health Agency of Canada. For Quebec residents, Statistics Canada may also enter into an agreement with the Institut de la statistique du Québec to share the same information.

The Institut de la statistique du Québec and provincial ministries of health may make this data available to local health authorities. Local health authorities will not receive any identifiers, only the postal code.

Linking and sharing 3 (SHR) - Question identifier:SHR_Q01

These organizations have agreed to keep the data confidential and use it only for statistical purposes.

Do you agree to share the data provided?

  • 1: Yes
  • 2: No

Linking and sharing 4 (TAX)

Linking and sharing 4 (TAX) - Question identifier:TAX_R01

To reduce the number of questions in this questionnaire, Statistics Canada will use information from your tax forms submitted to the Canada Revenue Agency. With your consent Statistics Canada will share this information from your tax forms with your provincial and territorial ministries of health, Health Canada and the Public Health Agency of Canada.

Quebec residents will also have their tax form information shared with the Institut de la statistique du Québec.

These organizations have agreed to keep the information confidential and to use it only for statistical and research purposes.

Linking and sharing 4 (TAX) - Question identifier:TAX_Q01

Do you give Statistics Canada permission to share your tax information?

  • 1: Yes
  • 2: No

Contact information 1 (NAD)

Contact information 1 (NAD) - Question identifier:NAD_Q01

Statistics Canada may contact you in the future to follow-up on some of the information you have provided. Please provide the following information:

Mailing address

Civic number

Min = 0; Max = 999999

Contact information 1 (NAD) - Question identifier:NAD_Q02

Civic number suffix

Long Answer Length = 3

Contact information 1 (NAD) - Question identifier:NAD_Q06

Apartment number

Long Answer Length = 6

Contact information 1 (NAD) - Question identifier:NAD_Q03

Street Name

Long Answer Length = 50

Contact information 1 (NAD) - Question identifier:NAD_Q04

Street type

  • 1: List of street types

Contact information 1 (NAD) - Question identifier:NAD_Q05

Street direction

  • 01: East
  • 02: North
  • 03: Northeast
  • 04: Northwest
  • 05: South
  • 06: Southeast
  • 07: Southwest
  • 08: West

Contact information 1 (NAD) - Question identifier:NAD_Q13

Rural address

Long Answer Length = 60

Contact information 1 (NAD) - Question identifier:NAD_Q07

City, municipality, town, village, Indian reserve

Long Answer Length = 50

Contact information 1 (NAD) - Question identifier:NAD_Q10

Province or territory

  • 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

Contact information 1 (NAD) - Question identifier:NAD_Q08

Postal code

Long Answer Length = 6

Contact information 2 (EA)

Contact information 2 (EA) - Question identifier:EA_Q01

Email address

Long Answer Length = 254

Contact information 3 (CEL)

Contact information 3 (CEL) - Question identifier:CEL_Q01

Telephone number

Long Answer Length = 12

Sharing (MSH)

Sharing (MSH) - Question identifier:MSH_R01

To avoid duplication of surveys, Statistics Canada has signed agreements to share the data from this survey with McGill University. McGill is the legal entity representing the COVID-19 Immunity Task Force (CITF). The CITF is a group of scientists and experts who use data to support decision-makers in their efforts to protect Canadians and minimize the impact of the COVID-19 pandemic.

With your consent, your survey responses and postal code will be shared with McGill and the CITF. Names, addresses, telephone numbers, email addresses and health card numbers will not be shared.

Sharing (MSH) - Question identifier:MSH_Q01

McGill and the CITF have agreed to keep the data confidential and use it only for statistical purposes.

Do you agree to share the data provided?

  • 1: Yes
  • 2: No

Dried blood spot screening (DBS)

Dried blood spot screening (DBS) - Question identifier:DBS_R01

To ensure it is safe for you to take the dried blood spot finger prick test, we need to ask about your current health and physical conditions.

Dried blood spot screening (DBS) - Question identifier:DBS_Q51

Do you have a blood clotting condition such as haemophilia or Von Willebrand disease?

  • 1: Yes
  • 2: No

Dried blood spot screening (DBS) - Question identifier:DBS_Q52

Have you received chemotherapy in the past four weeks?

  • 1: Yes
  • 2: No

Dried blood spot screening (DBS) - Question identifier:DBS_Q57A

Have you ever had a mastectomy, partial mastectomy or lumpectomy?

  • 1: Yes
  • 2: No

Dried blood spot screening (DBS) - Question identifier:DBS_Q57B

On which side?

  • 1: Left
  • 2: Right
  • 3: Both

Dried blood spot screening (DBS) - Question identifier:DBS_R58

Due to the responses you provided to the preceding screening questions, you have been excluded from participating in the dried blood spot finger prick test. Do not complete the dried blood spot finger prick test.

Dried blood spot testing and consent (DBT)

Dried blood spot testing and consent (DBT) - Question identifier:DBT_R01

You received a testing kit from Statistics Canada with the letter that invited you to complete this questionnaire. A purpose of the kit is to collect drops of blood by using the dried blood spot (finger prick) method at home. Your blood will be used to determine if you have antibodies to the virus that causes COVID-19. To obtain accurate results, it is important to carefully follow the instructions provided in the kit.

Dried blood spot testing and consent (DBT) - Question identifier:DBT_Q50A

I understood the instructions provided in the kit and the risks associated with testing. I have also read and understood the steps taken for the secure storage of my blood sample. I am choosing to consent or not consent to the following:
Participating in the dried blood spot test

  • 1: Yes, I consent
  • 2: No, I do not consent

Dried blood spot testing and consent (DBT) - Question identifier:DBT_Q50B

I understood the instructions provided in the kit and the risks associated with testing. I have also read and understood the steps taken for the secure storage of my blood sample. I am choosing to consent or not consent to the following:
Receiving results for the dried blood spot test

  • 1: Yes, I consent
  • 2: No, I do not consent

Dried blood spot testing and consent (DBT) - Question identifier:DBT_Q50C

I understood the instructions provided in the kit and the risks associated with testing. I have also read and understood the steps taken for the secure storage of my blood sample. I am choosing to consent or not consent to the following:
Storage of my dried blood spot for future health studies

  • 1: Yes, I consent
  • 2: No, I do not consent

Dried blood spot testing and consent (DBT) - Question identifier:DBT_R55

Please perform the dried blood spot test as indicated in the instructions. If you would like more information before proceeding, please contact us by phone at 1-888-253-1087 or by email at statcan.ccahs-ecsac.statcan@statcan.gc.ca <mailto:statcan.ccahs-ecsac.statcan@statcan.gc.ca>.

Dried blood spot testing and consent (DBT) - Question identifier:DBT_Q55

Have you completed the dried blood spot test?

  • 1: Yes
  • 2: No
Report a problem on this page

Is something not working? Is there information outdated? Can't find what you're looking for?

Please contact us and let us know how we can help you.

Privacy notice

Date modified: