Impacts of COVID-19 on Canadians
For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.
Table of Contents
- Behaviours and health impacts (BH)
- Labour market impacts (LM)
- Demographic questions (DEM)
- Sign-up (UCE)
Behaviours and health impacts (BH)
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_Q100
When practicing recommended public health measures, which source of information do you find the most helpful?
- 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 am not practicing recommended public health measures
Behaviours and health impacts (BH) - Question identifier:BH_Q105
Which social media application do you use most often to discuss topics about COVID-19?
- 01: Facebook
- 02: Twitter
- 03: TikTok
- 04: Snapchat
- 05: Instagram
- 06: LinkedIn
- 07: Reddit
- 08: Tumblr
- 09: Sina Weibo
- 10: Other
- 11: None of the above
Behaviours and health impacts (BH) - Question identifier:BH_Q60A
In the last week, 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, 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, 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, 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, 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, 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_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: Extremely
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: Extremely
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: Extremely
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: Extremely
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: Extremely
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: Extremely
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: Extremely
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: Extremely
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: Extremely
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: Extremely
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: Extremely
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: Extremely
Labour market impacts (LM)
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
- 6: Not working at a job or business
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
Demographic questions (DEM)
Demographic questions (DEM) - Question identifier:DEM_Q05
What is your age?
Min = 0; Max = 999
Demographic questions (DEM) - Question identifier:DEM_Q10
What is your gender?
- 1: Male
- 2: Female
- 3: Or please specify
Demographic questions (DEM) - Question identifier:DEM_Q15
To determine which geographic region you live in, please provide your postal code.
Long Answer Length = 6
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_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
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
Sign-up (UCE) - Question identifier:UCE_R10
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