Survey Series on People and their Communities - Social Cohesion and Experiences with Discrimination
For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.
Table of Contents
- Respondent confirmation (RC)
- General health (GEN)
- Financial well-being (EHA)
- Satisfaction with time use (DOS)
- Future outlook in Canada (FOC)
- Feelings towards others (FTO)
- Experiences of discrimination (ERD)
Respondent confirmation (RC)
Respondent confirmation (RC) - Question identifier:RC_R01
The following questions are for [NAME_OR_EMAIL].
General health (GEN)
General health (GEN) - Question identifier:GEN_R01
The following questions are about health. By health, we mean not only the absence of disease or injury but also physical, mental and social well-being.
General health (GEN) - Question identifier:GEN_Q01
In general, how is your health?
- 1: Excellent
- 2: Very good
- 3: Good
- 4: Fair
- 5: Poor
General health (GEN) - Question identifier:GEN_Q02
In general, how is your mental health?
- 1: Excellent
- 2: Very good
- 3: Good
- 4: Fair
- 5: Poor
Financial well-being (EHA)
Financial well-being (EHA) - Question identifier:EHA_Q10
In the past 12 months, how difficult or easy was it for your household to meet its financial needs in terms of transportation, housing, food, clothing and other necessary expenses?
- 1: Very difficult
- 2: Difficult
- 3: Neither difficult nor easy
- 4: Easy
- 5: Very easy
Satisfaction with time use (DOS)
Satisfaction with time use (DOS) - Question identifier:DOS_Q08
On a scale from 0 to 10, where 0 means you feel "Not at all satisfied" and 10 means you are "Completely satisfied", how satisfied are you with the amount of time you have to do the things that you like doing?
- 00: 0 - Not at all satisfied
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10 - Completely satisfied
Satisfaction with time use (DOS) - Question identifier:DOS_Q09
On a scale from 0 to 10, where 0 means you feel "Not at all satisfied" and 10 means you are "Completely satisfied", how satisfied are you with the quality of your local environment such as access to green space, and air or water quality?
- 00: 0 - Not at all satisfied
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10 - Completely satisfied
Future outlook in Canada (FOC)
Future outlook in Canada (FOC) - Question identifier:FOC_R05
The following question asks about how hopeful you are about the future in Canada.
Future outlook in Canada (FOC) - Question identifier:FOC_Q05
Thinking about the future in Canada, how hopeful are you about each of the following topics?
The way democracy works in Canada
- 1: Very hopeful
- 2: Somewhat hopeful
- 3: A little hopeful
- 4: Not at all hopeful
Future outlook in Canada (FOC) - Question identifier:FOC_Q10
Thinking about the future in Canada, how hopeful are you about each of the following topics?
Economic opportunities in Canada
- 1: Very hopeful
- 2: Somewhat hopeful
- 3: A little hopeful
- 4: Not at all hopeful
Future outlook in Canada (FOC) - Question identifier:FOC_Q15
Thinking about the future in Canada, how hopeful are you about each of the following topics?
Unity among Canadians
- 1: Very hopeful
- 2: Somewhat hopeful
- 3: A little hopeful
- 4: Not at all hopeful
Feelings towards others (FTO)
Feelings towards others (FTO) - Question identifier:FTO_R05
The following questions are about your feelings towards groups of people. On a scale of 0 to 10, 0 means you feel "Very cold" or negative towards the group and 10 means you feel "Very warm" or positive towards the group. A rating of 5 means you feel "Neutral" towards the group, which is neither "Very cold" nor "Very warm".
Feelings towards others (FTO) - Question identifier:FTO_Q05
Using this scale, how do you feel towards Canadians in general?
- 00: 0 - Very cold
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5 - Neutral
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10 - Very warm
Feelings towards others (FTO) - Question identifier:FTO_R10
The following questions are about your feelings towards groups of people with views both similar and different to your own. On a scale of 0 to 10, 0 means you feel "Very cold" or negative towards the group and 10 means you feel "Very warm" or positive towards the group. A rating of 5 means you feel "Neutral" towards the group, which is neither "Very cold" nor "Very warm".
Feelings towards others (FTO) - Question identifier:FTO_Q10
Using this scale, how do you feel towards people with political views that are similar to your own?
- 00: 0 - Very cold
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5 - Neutral
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10 - Very warm
Feelings towards others (FTO) - Question identifier:FTO_Q15
Using this scale, how do you feel towards people with political views that are different from your own?
- 00: 0 - Very cold
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5 - Neutral
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10 - Very warm
Feelings towards others (FTO) - Question identifier:FTO_R20
The following questions are about your feelings towards groups of people with views both similar and different to your own. On a scale of 0 to 10, 0 means you feel "Very cold" or negative towards the group and 10 means you feel "Very warm" or positive towards the group. A rating of 5 means you feel "Neutral" towards the group, which is neither "Very cold" nor "Very warm".
Feelings towards others (FTO) - Question identifier:FTO_Q20
Using this scale, how do you feel towards people with views on racism that are similar to your own?
- 00: 0 - Very cold
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5 - Neutral
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10 - Very warm
Feelings towards others (FTO) - Question identifier:FTO_Q25
Using this scale, how do you feel towards people with views on racism that are different from your own?
- 00: 0 - Very cold
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5 - Neutral
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10 - Very warm
Feelings towards others (FTO) - Question identifier:FTO_R30
The following questions are about your feelings towards groups of people with views both similar and different to your own. On a scale of 0 to 10, 0 means you feel "Very cold" or negative towards the group and 10 means you feel "Very warm" or positive towards the group. A rating of 5 means you feel "Neutral" towards the group, which is neither "Very cold" nor "Very warm".
Feelings towards others (FTO) - Question identifier:FTO_Q30
Using this scale, how do you feel towards people with views on gender identity that are similar to your own?
- 00: 0 - Very cold
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5 - Neutral
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10 - Very warm
Feelings towards others (FTO) - Question identifier:FTO_Q35
Using this scale, how do you feel towards people with views on gender identity that are different from your own?
- 00: 0 - Very cold
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5 - Neutral
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10 - Very warm
Experiences of discrimination (ERD)
Experiences of discrimination (ERD) - Question identifier:ERD_R05
The following questions are about unfair treatment, racism or discrimination you may experience in your day-to-day life in Canada because of your race or ethnicity.
These questions may be sensitive to some people. It is important we ask these questions of everyone to understand what people have experienced in their lives.
Some questions may make you feel uncomfortable. Should you need it, a list of support resources can be accessed by pressing the help (?) button.
Experiences of discrimination (ERD) - Question identifier:ERD_Q05
In the past 5 years, have you experienced any of the following situations because of your race or ethnicity?
- 1: You experienced discrimination or were treated unfairly by others (e.g., denied service or employment, treated badly or with suspicion)
- 2: You experienced exclusion (e.g., made to feel like you don't belong, or you are inferior, or people are avoiding you)
- 3: You experienced physical attacks, abuse, intimidation or threats
- 4: You experienced verbal abuse (e.g., name-calling, racial slurs, or ridicule)
- 5: You did not experience any of these situations because of your race or ethnicity
Experiences of discrimination (ERD) - Question identifier:ERD_Q30
In the past 5 years, which of the following types of discrimination or unfair treatment did you experience because of your race or ethnicity?
- 1: You were treated with less courtesy or respect than others
- 2: You were treated with suspicion
- 3: You were treated poorly when seeking a service (e.g., received poorer service than others or was refused the use of a service or was denied entry)
- 4: You were treated as if you are not smart
- 5: People acted as if they were afraid of you
- 6: Other type of discrimination or unfair treatment
Experiences of discrimination (ERD) - Question identifier:ERD_Q35
In the past 5 years, which of the following types of exclusion did you experience because of your race or ethnicity?
- 1: Offensive gestures were directed at you
- 2: You felt excluded or left out of social gatherings
- 3: You felt that people avoided you
- 4: You were told that you did not belong in Canada (e.g., you have been told to "go home" or "get out")
- 5: Other type of exclusion
Experiences of discrimination (ERD) - Question identifier:ERD_Q40
In the past 5 years, which of the following types of physical attacks, abuse, intimidation or threats did you experience because of your race or ethnicity?
- 1: You experienced racially motivated vandalism of your property
- 2: You were spat at
- 3: You had objects such as eggs or bottles thrown at you
- 4: You faced physical threats or assaults
- 5: Other types of physical attacks, abuse, intimidation or threats
Experiences of discrimination (ERD) - Question identifier:ERD_Q45
In the past 5 years, which of the following types of verbal abuse did you experience because of your race or ethnicity?
- 1: You were called an offensive slang name for your ethnic, cultural or racialized group
- 2: You were sworn at, or verbally abused
- 3: You heard talk or read comments that are stereotypical of your group
- 4: You heard talk or read comments that portray your group in a poor light
- 5: You were the target of racist jokes, songs, or teasing
- 6: Other type of verbal abuse
Experiences of discrimination (ERD) - Question identifier:ERD_Q50
In the past 5 years, how often have you experienced unfair treatment, racism or discrimination?
- 1: Once
- 2: Occasionally
- 3: Often
- 4: Daily or almost daily
Experiences of discrimination (ERD) - Question identifier:ERD_Q55
In the past 5 years, in what types of situations have you experienced unfair treatment, racism or discrimination in Canada?
- 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 or by or among friends or family
- 10: While using public areas, such as parks and sidewalks
- 11: While using public transit, such as buses, trains or taxis
- 12: When seeing a medical health professional or in other health care settings (Medical health professionals may include doctors, nurses, and physiotherapists.
In health care settings may include at hospitals, clinics, and dental offices.) - 13: Other situation
Experiences of discrimination (ERD) - Question identifier:ERD_Q65
On a scale of 0 to 10, where 0 means "Much easier to succeed in life" and 10 means "Much harder to succeed in life", how have your race and ethnicity affected your success in life overall?
- 00: 0 - Much easier to succeed in life
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5 - Neither easier nor harder for me to succeed in life
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10 - Much harder to succeed in life
- Date modified: