Canadian Perspectives Survey Series 1 - Impacts of COVID-19 (CPSS-COVID)
For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.
Table of Contents
Labour Market Impacts (LM)
Labour Market Impacts (LM) - Question identifier:LM_R05
The following questions concern your activities during the week of ^REFDATE_E.
Labour Market Impacts (LM) - Question identifier:LM_Q05
During that week, did you work at a job or business?
- 1: Yes
- 2: No
Labour Market Impacts (LM) - Question identifier:LM_Q10
During that week, did you have a job or business from which you were absent?
- 1: Yes
- 2: No
Labour Market Impacts (LM) - Question identifier:LM_Q15
What was the main reason you were absent from work that week?
- 1: Planned absence not related to COVID-19 (e.g., vacation, work schedule, maternity or parental leave, seasonal job or business)
- 2: Unplanned absence not related to COVID-19 (e.g., illness or disability other than COVID-19, caring for children or elder relative for non-COVID-19 reasons, labour dispute (strike or lockout))
- 3: Business closure or layoff related to COVID-19
- 4: Personal circumstances related to COVID-19 (e.g., own or household member's diagnosis, self-isolation after recent travel, taking care of children due to school closure)
Labour Market Impacts (LM) - Question identifier:LM_Q20
Which of the following best describes your usual place of work at your main job or business?
- 1: Work at a fixed location outside the home
- 2: Work outside the home with no fixed location (e.g., driving, making sales calls)
- 3: Work at home
Labour Market Impacts (LM) - Question identifier:LM_Q25
During the week of ^REFDATE_E, in which of these locations did you work the most hours?
- 1: At a fixed location outside the home
- 2: Outside the home with no fixed location (e.g., driving, making sales calls)
- 3: At home
- 4: Absent from work
Labour Market Impacts (LM) - Question identifier:LM_Q30
To what extent do you agree or disagree with the following statement?
I might lose my main job or main self-employment income source in the next four weeks.
- 1: Strongly agree
- 2: Agree
- 3: Neither agree nor disagree
- 4: Disagree
- 5: Strongly disagree
Labour Market Impacts (LM) - Question identifier:LM_Q35
During the week of ^REFDATE_E did you make a new application for any of the following types of Employment Insurance benefits?
- 1: Regular
- 2: Sickness
- 3: Caregiving or compassionate care
- 4: Work-sharing
- 5: Other Employment Insurance benefit
- 6: Did not apply for any Employment Insurance benefits
Labour Market Impacts (LM) - Question identifier:LM_Q40
Which of the following best describes the impact of COVID-19 on your ability to meet financial obligations or essential needs, such as rent or mortgage payments, utilities and groceries?
- 1: Major impact
- 2: Moderate impact
- 3: Minor impact
- 4: No impact
- 5: Too soon to tell
Labour Market Impacts (LM) - Question identifier:LM_Q45A
Have you received relief for any of the following financial obligations?
Rent or mortgage payments
- 1: Yes
- 2: No
- 3: Not required
Labour Market Impacts (LM) - Question identifier:LM_Q45B
Have you received relief for any of the following financial obligations?
Car payments
- 1: Yes
- 2: No
- 3: Not required
Labour Market Impacts (LM) - Question identifier:LM_Q45C
Have you received relief for any of the following financial obligations?
Other household bills
- 1: Yes
- 2: No
- 3: Not required
Behaviours and Health Impacts (BH)
Behaviours and Health Impacts (BH) - Question identifier:BH_Q05
What is your main source of information to find out about COVID-19?
- 01: News outlets including local, national and international sources
- 02: Federal health agency (e.g., website, public service announcements)
- 03: Provincial health agency (e.g., website, public service announcements)
- 04: Municipal health agency (e.g., website, public service announcements)
- 05: Federal daily announcements by public health and political leaders
- 06: Provincial daily announcements by public health and political leaders
- 07: Social media (e.g., Facebook, Instagram, SnapChat, TikTok, Twitter, YouTube)
- 08: Family, friends or colleagues
- 09: Health professionals
- 10: Schools, universities, colleges (e.g., email, website)
- 11: Place of employment
- 12: Other
- 13: I do not look for information about this
Behaviours and Health Impacts (BH) - Question identifier:BH_Q10
Which source of information is the most helpful to learn about current public health measures?
- 01: News outlets including local, national and international sources
- 02: Federal health agency (e.g., website, public service announcements)
- 03: Provincial health agency (e.g., website, public service announcements)
- 04: Municipal health agency (e.g., website, public service announcements)
- 05: Federal daily announcements by public health and political leaders
- 06: Provincial daily announcements by public health and political leaders
- 07: Social media (e.g., Facebook, Instagram, SnapChat, TikTok, Twitter, YouTube)
- 08: Family, friends or colleagues
- 09: Health professionals
- 10: Schools, universities, colleges (e.g., email, website)
- 11: Place of employment
- 12: Other
Behaviours and Health Impacts (BH) - Question identifier:BH_Q15A
Are you getting enough information about COVID -19?
From your municipal health agency
- 1: Too little
- 2: About right
- 3: Too much
Behaviours and Health Impacts (BH) - Question identifier:BH_Q15B
Are you getting enough information about COVID -19?
From federal health agencies
- 1: Too little
- 2: About right
- 3: Too much
Behaviours and Health Impacts (BH) - Question identifier:BH_Q15C
Are you getting enough information about COVID -19?
From health professionals
- 1: Too little
- 2: About right
- 3: Too much
Behaviours and Health Impacts (BH) - Question identifier:BH_Q15D
Are you getting enough information about COVID -19?
From news outlets
- 1: Too little
- 2: About right
- 3: Too much
Behaviours and Health Impacts (BH) - Question identifier:BH_Q20
Which of the following precautions have you taken to reduce your risk of exposure to COVID-19?
- 01: Stocked up on essentials at a grocery store or pharmacy
- 02: Filled prescriptions
- 03: Made a plan for caring for household members who are ill
- 04: Made a plan for other non-household members (e.g., elderly relatives)
- 05: Made a plan for communicating with family, friends and neighbours
- 06: Avoided leaving the house for non-essential reasons
- 07: Used social distancing when out in public (i.e., made changes in your everyday routine to minimize close contact with others.)
- 08: Avoided crowds and large gathering
- 09: Washed your hands more regularly
- 10: Avoided touching your face
- 11: Cancelled travel
- 12: Worked from home
- 13: Other
- 14: None of the above
Behaviours and Health Impacts (BH) - Question identifier:BH_Q25
In general, how is your health?
- 1: Excellent
- 2: Very good
- 3: Good
- 4: Fair
- 5: Poor
Behaviours and Health Impacts (BH) - Question identifier:BH_Q30
In general, how is your mental health?
- 1: Excellent
- 2: Very good
- 3: Good
- 4: Fair
- 5: Poor
Behaviours and Health Impacts (BH) - Question identifier:BH_Q35A
Are you doing any of the following activities for your health?
Communication with friends and family
- 1: Yes, for my mental health
- 2: Yes, for my physical health
- 3: Yes, for both my mental and physical health
- 4: No
Behaviours and Health Impacts (BH) - Question identifier:BH_Q35B
Are you doing any of the following activities for your health?
Meditation
- 1: Yes, for my mental health
- 2: Yes, for my physical health
- 3: Yes, for both my mental and physical health
- 4: No
Behaviours and Health Impacts (BH) - Question identifier:BH_Q35C
Are you doing any of the following activities for your health?
Exercise outdoors
- 1: Yes, for my mental health
- 2: Yes, for my physical health
- 3: Yes, for both my mental and physical health
- 4: No
Behaviours and Health Impacts (BH) - Question identifier:BH_Q35D
Are you doing any of the following activities for your health?
Exercise indoors
- 1: Yes, for my mental health
- 2: Yes, for my physical health
- 3: Yes, for both my mental and physical health
- 4: No
Behaviours and Health Impacts (BH) - Question identifier:BH_Q35E
Are you doing any of the following activities for your health?
Changing my food choices
- 1: Yes, for my mental health
- 2: Yes, for my physical health
- 3: Yes, for both my mental and physical health
- 4: No
Behaviours and Health Impacts (BH) - Question identifier:BH_Q40A
Have your weekly habits changed for any of the following activities?
Consuming alcohol
- 1: Increased
- 2: Decreased
- 3: No change
Behaviours and Health Impacts (BH) - Question identifier:BH_Q40B
Have your weekly habits changed for any of the following activities?
Using tobacco products
- 1: Increased
- 2: Decreased
- 3: No change
Behaviours and Health Impacts (BH) - Question identifier:BH_Q40C
Have your weekly habits changed for any of the following activities?
Consuming cannabis
- 1: Increased
- 2: Decreased
- 3: No change
Behaviours and Health Impacts (BH) - Question identifier:BH_Q40D
Have your weekly habits changed for any of the following activities?
Eating junk food or sweets
- 1: Increased
- 2: Decreased
- 3: No change
Behaviours and Health Impacts (BH) - Question identifier:BH_Q40E
Have your weekly habits changed for any of the following activities?
Watching television
- 1: Increased
- 2: Decreased
- 3: No change
Behaviours and Health Impacts (BH) - Question identifier:BH_Q40F
Have your weekly habits changed for any of the following activities?
Spending time on the internet
- 1: Increased
- 2: Decreased
- 3: No change
Behaviours and Health Impacts (BH) - Question identifier:BH_Q40G
Have your weekly habits changed for any of the following activities?
Playing video games
- 1: Increased
- 2: Decreased
- 3: No change
Behaviours and Health Impacts (BH) - Question identifier:BH_Q40H
Have your weekly habits changed for any of the following activities?
Playing board games
- 1: Increased
- 2: Decreased
- 3: No change
Behaviours and Health Impacts (BH) - Question identifier:BH_Q45
Do you have a compromised immune system?
- 1: Yes
- 2: No
Behaviours and Health Impacts (BH) - Question identifier:BH_Q50
Do you have diabetes or a chronic condition affecting your lungs, heart or kidneys?
- 1: Yes
- 2: No
Behaviours and Health Impacts (BH) - Question identifier:BH_Q55A
How concerned are you about each of the following impacts of COVID-19?
My own health
- 1: Not at all
- 2: Somewhat
- 3: Very
- 4: Extremelly
Behaviours and Health Impacts (BH) - Question identifier:BH_Q55B
How concerned are you about each of the following impacts of COVID-19?
Member of the household's health
- 1: Not at all
- 2: Somewhat
- 3: Very
- 4: Extremelly
Behaviours and Health Impacts (BH) - Question identifier:BH_Q55C
How concerned are you about each of the following impacts of COVID-19?
Vulnerable people's health
- 1: Not at all
- 2: Somewhat
- 3: Very
- 4: Extremelly
Behaviours and Health Impacts (BH) - Question identifier:BH_Q55D
How concerned are you about each of the following impacts of COVID-19?
Canadian population's health
- 1: Not at all
- 2: Somewhat
- 3: Very
- 4: Extremelly
Behaviours and Health Impacts (BH) - Question identifier:BH_Q55E
How concerned are you about each of the following impacts of COVID-19?
World population's health
- 1: Not at all
- 2: Somewhat
- 3: Very
- 4: Extremelly
Behaviours and Health Impacts (BH) - Question identifier:BH_Q55F
How concerned are you about each of the following impacts of COVID-19?
Overloading the health system
- 1: Not at all
- 2: Somewhat
- 3: Very
- 4: Extremelly
Behaviours and Health Impacts (BH) - Question identifier:BH_Q55G
How concerned are you about each of the following impacts of COVID-19?
Civil disorder
- 1: Not at all
- 2: Somewhat
- 3: Very
- 4: Extremelly
Behaviours and Health Impacts (BH) - Question identifier:BH_Q55H
How concerned are you about each of the following impacts of COVID-19?
Maintaining social ties
- 1: Not at all
- 2: Somewhat
- 3: Very
- 4: Extremelly
Behaviours and Health Impacts (BH) - Question identifier:BH_Q55I
How concerned are you about each of the following impacts of COVID-19?
Ability to cooperate and support one another during the crisis
- 1: Not at all
- 2: Somewhat
- 3: Very
- 4: Extremelly
Behaviours and Health Impacts (BH) - Question identifier:BH_Q55J
How concerned are you about each of the following impacts of COVID-19?
Ability to cooperate and support one another after the crisis
- 1: Not at all
- 2: Somewhat
- 3: Very
- 4: Extremelly
Behaviours and Health Impacts (BH) - Question identifier:BH_Q55K
How concerned are you about each of the following impacts of COVID-19?
Family stress from confinement
- 1: Not at all
- 2: Somewhat
- 3: Very
- 4: Extremelly
Behaviours and Health Impacts (BH) - Question identifier:BH_Q55L
How concerned are you about each of the following impacts of COVID-19?
Violence in the home
- 1: Not at all
- 2: Somewhat
- 3: Very
- 4: Extremelly
Behaviours and Health Impacts (BH) - Question identifier:BH_Q60A
In the last week, that is ^REFDATE_E, how often did you do each of the following activities?
Went shopping at the grocery store or drugstore
- 1: Daily or more
- 2: 4 or 5 times
- 3: 1 to 3 times
- 4: Never
Behaviours and Health Impacts (BH) - Question identifier:BH_Q60B
In the last week, that is ^REFDATE_E, how often did you do each of the following activities?
Used a delivery service for groceries or for a drugstore
- 1: Daily or more
- 2: 4 or 5 times
- 3: 1 to 3 times
- 4: Never
Behaviours and Health Impacts (BH) - Question identifier:BH_Q60C
In the last week, that is ^REFDATE_E, how often did you do each of the following activities?
Used a food delivery service for prepared food
- 1: Daily or more
- 2: 4 or 5 times
- 3: 1 to 3 times
- 4: Never
Behaviours and Health Impacts (BH) - Question identifier:BH_Q60D
In the last week, that is ^REFDATE_E, how often did you do each of the following activities?
Ate at a restaurant
- 1: Daily or more
- 2: 4 or 5 times
- 3: 1 to 3 times
- 4: Never
Behaviours and Health Impacts (BH) - Question identifier:BH_Q60E
In the last week, that is ^REFDATE_E, how often did you do each of the following activities?
Attended a public event
- 1: Daily or more
- 2: 4 or 5 times
- 3: 1 to 3 times
- 4: Never
Behaviours and Health Impacts (BH) - Question identifier:BH_Q60F
In the last week, that is ^REFDATE_E, how often did you do each of the following activities?
Travelled for work
- 1: Daily or more
- 2: 4 or 5 times
- 3: 1 to 3 times
- 4: Never
Behaviours and Health Impacts (BH) - Question identifier:BH_Q65
Did you travel outside of Canada or were you exposed to someone who travelled outside of Canada in the last 4 weeks?
- 1: Yes, I traveled outside of Canada
- 2: Yes, I was exposed to someone who travelled outside of Canada
- 3: No
Behaviours and Health Impacts (BH) - Question identifier:BH_Q70
Did you self-isolate after travelling or after being exposed?
- 1: Yes, with symptoms (e.g., cough, fever, difficulty breathing, pneumonia in both lungs)
- 2: Yes, without symptoms
- 3: No
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