Survey of Safety in Public and Private Spaces

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

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Table of Contents

Telephone details (TEL)

Telephone details (TEL) - Question identifier:TEL_Q02

Does the telephone number ^CMP_Contact1_PhoneNumber1 belong to any member of your household, including yourself?

  • 1: Yes
  • 2: No

Telephone details (TEL) - Question identifier:TEL_Q03

Is ^CMP_Contact1_PhoneNumber1 a cellular phone number?

  • 1: Yes
  • 2: No

Telephone details (TEL) - Question identifier:TEL_Q04

Is this phone number for a private home or personal phone, a business[or an institution/, an institution or secondary (or seasonal) residence]?

  • 1: Private home or personal phone
  • 2: Business
  • 3: Both private home or personal phone and business
  • 4: Institution
  • 5: Secondary (or seasonal) residence
  • 6: Collective dwelling

Telephone details (TEL) - Question identifier:TEL_Q05A

Please specify the type of collective dwelling you live in.

Long Answer Length = 80

Telephone details (TEL) - Question identifier:TEL_Q05B

What is the total number of people living in this collective dwelling?

Min = 0; Max = 999

Telephone details (TEL) - Question identifier:TEL_Q06

Does anyone use this telephone number as a private home or personal phone number?

  • 1: Yes
  • 2: No

Telephone details (TEL) - Question identifier:TEL_Q07

Excluding all numbers used for computer, fax or business use only, how many different phone numbers are there in your household?

  • 01: 1
  • 02: 2
  • 03: 3
  • 04: 4
  • 05: 5
  • 06: 6
  • 07: 7
  • 08: 8
  • 09: 9 or more

Telephone details (TEL) - Question identifier:TEL_Q08

How many of these are cellular phone numbers?

  • 01: 1
  • 02: 2
  • 03: 3
  • 04: 4
  • 05: 5
  • 06: 6
  • 07: 7
  • 08: 8
  • 09: 9 or more
  • 10: None

Address confirmation (LAC)

Address confirmation (LAC) - Question identifier:LAC_Q01

Is this your address?


#{CMP_AddressLine1}
#{CMP_AddressLine2}
#{CMP_City}, #{CMP_Province}
#{CMP_PostalCode}

  • 1: Yes
  • 2: No

Postal Code (RPC)

Postal Code (RPC) - Question identifier:RPC_Q01A

In which province or territory do you live?

  • 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
  • 77: Outside of Canada

Postal Code (RPC) - Question identifier:RPC_Q01B

To determine which geographic region you live in, please provide your postal code.

Long Answer Length = 6

Postal Code (RPC) - Question identifier:RPC_Q03

Please confirm your postal code. Is it ^RPC_Q01B?

  • 1: Yes
  • 2: No

Postal Code (RPC) - Question identifier:RPC_Q04

What is your correct postal code?

Long Answer Length = 6

Age-order selection (AOS)

Age-order selection (AOS) - Question identifier:AOS_Q01

Including yourself, how many people 15 years of age or older live in your household?

  • 1: 1 person
  • 2: 2 people
  • 3: 3 or more people

Age-order selection (AOS) - Question identifier:AOS_R03A

The [older/younger] member has been selected to participate in the survey.

Age-order selection (AOS) - Question identifier:AOS_Q03A

What is their first and last name?
First name

Long Answer Length = 80

Age-order selection (AOS) - Question identifier:AOS_Q03B

What is their first and last name?
Last name

Long Answer Length = 80

Age-order selection (AOS) - Question identifier:AOS_R05A

The [oldest/youngest] member among those has been selected to participate in the survey

Age-order selection (AOS) - Question identifier:AOS_Q05A

What is their first and last name?
First name

Long Answer Length = 80

Age-order selection (AOS) - Question identifier:AOS_Q05B

What is their first and last name?
Last name

Long Answer Length = 80

Age-order selection (AOS) - Question identifier:AOS_Q10AA

What are the names of the household members in order of [oldest to youngest/youngest to oldest].
First name

Long Answer Length = 80

Age-order selection (AOS) - Question identifier:AOS_Q10AB

What are the names of the household members in order of [oldest to youngest/youngest to oldest].
Last name

Long Answer Length = 80

Age-order selection (AOS) - Question identifier:AOS_Q10BA

What are the names of the household members in order of [oldest to youngest/youngest to oldest].
First name

Long Answer Length = 80

Age-order selection (AOS) - Question identifier:AOS_Q10BB

What are the names of the household members in order of [oldest to youngest/youngest to oldest].
Last name

Long Answer Length = 80

Age-order selection (AOS) - Question identifier:AOS_Q10CA

What are the names of the household members in order of [oldest to youngest/youngest to oldest].
First name

Long Answer Length = 80

Age-order selection (AOS) - Question identifier:AOS_Q10CB

What are the names of the household members in order of [oldest to youngest/youngest to oldest].
Last name

Long Answer Length = 80

Age-order selection (AOS) - Question identifier:AOS_R15

[^AOS_Q10BA ^AOS_Q10BB/^AOS_Q10CA ^AOS_Q10CB] has been selected to participate in the survey.

Age-order selection (AOS) - Question identifier:AOS_R16A

You have been selected to participate in the survey.

Age-order selection (AOS) - Question identifier:AOS_Q16A

What is your first and last name?
First name

Long Answer Length = 80

Age-order selection (AOS) - Question identifier:AOS_Q16B

What is your first and last name?
Last name

Long Answer Length = 80

Target Respondent (TR)

Target Respondent (TR) - Question identifier:TR_Q01

May I speak to ^CMP_Contact1_GivenName ^CMP_Contact1_FamilyName?

  • 1: Yes, speaking to respondent
  • 2: Yes, respondent available
  • 3: No, respondent unable to complete this survey
  • 4: No, respondent not available at this time

Submit module for Out-of-Scope (OOS)

Submit module for Out-of-Scope (OOS) - Question identifier:OOS_R01

You indicated that ^CMP_Contact1_PhoneNumber1 does not belong to anyone in the household. A Statistics Canada representative may contact you to collect more details.

If you are ready to submit the questionnaire, press the Submit button.

Submit module for Out-of-Scope (OOS) - Question identifier:OOS_R02

You indicated that ^CMP_Contact1_PhoneNumber1 is not a personal or private number. A Statistics Canada representative may contact you to collect more details.

If you are ready to submit the questionnaire, press the Submit button.

Submit module for Out-of-Scope (OOS) - Question identifier:OOS_R03

You indicated that this address does not belong to this household. A Statistics Canada representative may contact you to collect more details.

If you are ready to submit the questionnaire, press the Submit button.

Alternate Telephone Contact (ATC)

Alternate Telephone Contact (ATC) - Question identifier:ATC_Q01

Is there a better telephone number at which I can reach ^CMP_Contact1_GivenName ^CMP_Contact1_FamilyName?

  • 1: Yes
  • 2: No

Alternate Telephone Contact (ATC) - Question identifier:ATC_Q02

Could you provide the telephone number?

Long Answer Length = 10

Roster (RRS)

Roster (RRS) - Question identifier:RRS_R01

The next few questions ask for important information about the people in your household.

Roster (RRS) - Question identifier:RRS_Q12

Including yourself, how many persons are staying at this address?

  • 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

Roster (continued-extended) (RRS3)

Roster (continued-extended) (RRS3) - Question identifier:RRS3_Q15A

[Please provide your first name, last name, and age./Beginning with yourself, please provide the first name, last name, and age of all the people usually living at this address.]
*First name

Long Answer Length = 25

Roster (continued-extended) (RRS3) - Question identifier:RRS3_Q15B

[Please provide your first name, last name, and age./Beginning with yourself, please provide the first name, last name, and age of all the people usually living at this address.]
*Last name

Long Answer Length = 30

Roster (continued-extended) (RRS3) - Question identifier:RRS3_Q15C

[Please provide your first name, last name, and age./Beginning with yourself, please provide the first name, last name, and age of all the people usually living at this address.]
*Age

Min = 0; Max = 999

Roster (continued-extended) (RRS3) - Question identifier:RRS3_R20

Please verify that you are listed first and all of the information is correct.

Roster (continued-extended) (RRS3) - Question identifier:RRS3_R20B

Person ^DT_INSTANCEROSTER

Roster (continued-extended) (RRS3) - Question identifier:RRS3_R20C

First name: ^RRS3_Q15A
Last name: ^RRS3_Q15B
Age: ^RRS3_Q15C

Relationship to Selected Respondent (RSR2)

Relationship to Selected Respondent (RSR2) - Question identifier:RSR2_R30

What is the relationship of the following [people/person] to you?

Relationship to Selected Respondent (RSR2) - Question identifier:RSR2_Q30

^RRS3_Q15A (age RRS3_Q15C) is

  • 01: your husband or wife
  • 02: your common-law partner
  • 03: your father or mother
  • 04: your son or daughter (birth, adopted or step)
  • 05: your brother or sister
  • 06: your foster father or mother
  • 07: your foster son or daughter
  • 08: your grandfather or grandmother
  • 09: your grandson or granddaughter
  • 10: your in-law
  • 11: other related
  • 12: unrelated

Sex at birth and gender (RRS4)

Sex at birth and gender (RRS4) - Question identifier:RRS4_R40

The following questions are about sex at birth and gender.

Sex at birth and gender (RRS4) - Question identifier:RRS4_Q40

What was your sex at birth?

  • 1: Male
  • 2: Female

Sex at birth and gender (RRS4) - Question identifier:RRS4_Q50

What is your gender?

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

Sex at birth and gender (RRS4) - Question identifier:RRS4_Q60

What was your [spouse/partner]'s sex at birth?

  • 1: Male
  • 2: Female

Sex at birth and gender (RRS4) - Question identifier:RRS4_Q70

What is your [spouse/partner]'s gender?

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

Sex at birth and gender (RRS4) - Question identifier:RRS4_R80

Please verify that all of the information is correct.

Sex at birth and gender (RRS4) - Question identifier:RRS4_R80B

You

Sex assigned at birth : [Male/Female/Information not provided]
Gender: ^DT_RGEN_E


Your [spouse/partner]

Sex assigned at birth: ^DT_PSEX_E
Gender: ^DT_PGEN_E

Age without Confirmation (ANCQ)

Age without Confirmation (ANCQ) - Question identifier:ANCQ_Q01A

What is your date of birth?
Day

Min = 0; Max = 99

Age without Confirmation (ANCQ) - Question identifier:ANCQ_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

Age without Confirmation (ANCQ) - Question identifier:ANCQ_Q01C

Year

Min = 0; Max = 9999

Age without Confirmation (ANCQ) - Question identifier:ANCQ_Q02

As of today ([THISDATE]), your age is [Age calculated based on the entered date of birth][years/year//months/month/months].
Is that correct?

  • 1: Yes
  • 2: No

Age without Confirmation (ANCQ) - Question identifier:ANCQ_Q03

What is your age?

Min = 0; Max = 999

Sexual Orientation of Respondent (SOR)

Sexual Orientation of Respondent (SOR) - Question identifier:SOR_Q110

What is your sexual orientation?

  • 1: Heterosexual
  • 2: Homosexual (e.g., lesbian or gay)
  • 3: Bisexual
  • 4: Please specify

Marital Status (MSNC)

Marital Status (MSNC) - Question identifier:MSNC_Q01

What is your marital status?

  • 1: Married
  • 2: Living common law (Two people who live together as a couple but who are not legally married to each other.)
  • 3: Widowed
  • 4: Separated
  • 5: Divorced
  • 6: Single, never married

Previous Marriage or Common-law relationship (PMC)

Previous Marriage or Common-law relationship (PMC) - Question identifier:PMC_Q15

Have you ever been in an intimate partner relationship, including being married, living common-law, or dating someone?

  • 1: Yes
  • 2: No

Previous Marriage or Common-law relationship (PMC) - Question identifier:PMC_Q20

Have you had contact with any former spouse, common-law partner, or dating partner in the past 12 months?

  • 1: Yes
  • 2: No

Labour Market Activities Minimal (LMAM)

Labour Market Activities Minimal (LMAM) - Question identifier:LMAM_Q01

The following questions concern your activities last week, meaning the week beginning on Sunday and ending Saturday.
Last week, did you work at a job or business?

  • 1: Yes
  • 2: No

Labour Market Activities Minimal (LMAM) - Question identifier:LMAM_Q02

Last week, did you have a job or business from which you were absent?

  • 1: Yes
  • 2: No

Labour Market Activities Minimal (LMAM) - Question identifier:LMAM_Q03

What was the main reason you were absent from work last week?

  • 01: Your illness or disability
  • 02: Caring for your children
  • 03: Caring for elder relative ((60 years of age or older))
  • 04: Maternity or parental leave
  • 05: Other personal or family responsibilities
  • 06: Vacation
  • 07: Labour dispute, strike or lockout
  • 08: Temporary layoff due to business conditions
  • 09: Seasonal layoff
  • 10: You have a casual job and no work was available
  • 11: Your work schedule (e.g., You work shift work)
  • 12: You are self-employed and no work was available
  • 13: Seasonal business (Include self-employed only)
  • 14: Other

Labour market past year (LPY)

Labour market past year (LPY) - Question identifier:LPY_Q01

In the past 12 months, did you work at a job or business?

  • 1: Yes
  • 2: No

Labour market past year (LPY) - Question identifier:LPY_Q02

During the past 12 months, what was your main activity?

  • 01: Looking for paid work
  • 02: Going to school
  • 03: Caring for your children
  • 04: Household work
  • 05: Retired
  • 06: Maternity, paternity or parental leave
  • 07: Long-term illness
  • 08: Volunteering or caregiving other than for your children
  • 09: Other

Class of worker (COW)

Class of worker (COW) - Question identifier:COW_R10

The next questions ask about the job or business at which you last worked.

Class of worker (COW) - Question identifier:COW_Q10

Were you an employee or self-employed?

  • 1: Employee
  • 2: Self-employed
  • 3: Working in a family business without pay

Industry (IND)

Industry (IND) - Question identifier:IND_Q11

What was the name of your business?

Long Answer Length = 80

Industry (IND) - Question identifier:IND_Q12

For whom did you work?

Long Answer Length = 80

Industry (IND) - Question identifier:IND_Q13

What kind of business, industry or service was this?

Long Answer Length = 80

Occupation (OCP)

Occupation (OCP) - Question identifier:OCP_Q14

What was your work or occupation?

Long Answer Length = 80

Occupation (OCP) - Question identifier:OCP_Q15

In this work, what were your main activities?

Long Answer Length = 80

Number of weeks employed (NWE)

Number of weeks employed (NWE) - Question identifier:NWE_Q110

For how many weeks during the past 12 months were you employed?

  • 01: 52
  • 02: 51
  • 03: 50
  • 04: 49
  • 05: 48
  • 06: 47
  • 07: 46
  • 08: 45
  • 09: 44
  • 10: 43
  • 11: 42
  • 12: 41
  • 13: 40
  • 14: 39
  • 15: 38
  • 16: 37
  • 17: 36
  • 18: 35
  • 19: 34
  • 20: 33
  • 21: 32
  • 22: 31
  • 23: 30
  • 24: 29
  • 25: 28
  • 26: 27
  • 27: 26
  • 28: 25
  • 29: 24
  • 30: 23
  • 31: 22
  • 32: 21
  • 33: 20
  • 34: 19
  • 35: 18
  • 36: 17
  • 37: 16
  • 38: 15
  • 39: 14
  • 40: 13
  • 41: 12
  • 42: 11
  • 43: 10
  • 44: 9
  • 45: 8
  • 46: 7
  • 47: 6
  • 48: 5
  • 49: 4
  • 50: 3
  • 51: 2
  • 52: 1

Usual Hours Worked (UHW)

Usual Hours Worked (UHW) - Question identifier:UHW_Q16

[Excluding overtime, on average, how many paid hours did you usually work per week?/On average, how many hours did you usually work per week?/On average, how many paid hours do you usually work per week?/On average, how many hours do you usually work per week?]

Min = 0.0; Max = 999.9

Work activities - Hours Worked (UWS)

Work activities - Hours Worked (UWS) - Question identifier:UWS_Q230

Which of the following best describes your usual work schedule?

  • 01: A regular daytime schedule or shift
  • 02: A regular evening shift
  • 03: A regular night shift
  • 04: A rotating shift (One that changes periodically from days to evenings or to nights)
  • 05: A split shift (One consisting of two or more distinct periods each day)
  • 06: On call
  • 07: An irregular schedule
  • 08: Other

Terms of employment (TOE)

Terms of employment (TOE) - Question identifier:TOE_Q240

[Was/Is] your job permanent, or is there some way that it [was/is] not permanent?

  • 1: Permanent
  • 2: Not permanent (e.g., seasonal, temporary, term, casual)

Terms of employment (TOE) - Question identifier:TOE_Q241

In what way [was/is] your job not permanent?

  • 1: Seasonal (A job that ends with the off-season, e.g., an employee who works in farming, fishing or tourism.)
  • 2: Temporary, term or contract (A non-seasonal job that has a fixed end date.)
  • 3: Casual job (Work when needed by your employer, e.g., a substitute teacher, "spare" or "fill-in".)
  • 4: Other

Education - School Attendance (ESC1)

Education - School Attendance (ESC1) - Question identifier:ESC1_Q01

Are you currently attending school, college, CEGEP or university?

  • 1: Yes
  • 2: No

Education - Minimum block (EDM)

Education - Minimum block (EDM) - Question identifier:EDM_Q01

What type of educational institution are you attending?

  • 1: Elementary, junior high school or high school
  • 2: Trade school, business school, community college, technical institue, CEGEP or other non-university institution
  • 3: University

Education - Minimum block (EDM) - Question identifier:EDM_Q02

Are you enrolled as a full-time student or part-time student?

  • 1: Full-time student
  • 2: Part-time student

Highest level of education (EHG1)

Highest level of education (EHG1) - Question identifier:EHG1_Q01

What is the highest certificate, diploma or degree that you have completed?

  • 1: Less than high school diploma or its equivalent
  • 2: High school diploma or a high school equivalency certificate
  • 3: Trades certificate or diploma
  • 4: College, CEGEP or other non-university certificate or diploma (other than trades certificates or diplomas)
  • 5: University certificate or diploma below the bachelor's level
  • 6: Bachelor's degree (e.g., B.A., B.A. (Hons), B.Sc., LL.B.)
  • 7: University certificate, diploma or degree above the bachelor's level

Main Activity of respondent's spouse/Partner (MAP)

Main Activity of respondent's spouse/Partner (MAP) - Question identifier:MAP_Q110

During the past 12 months, what was your [spouse/partner]'s main activity?

  • 01: Working at a paid job or self-employed
  • 02: Looking for paid work
  • 03: Going to school
  • 04: Caring for [his/her/his or her] children
  • 05: Household work
  • 06: Retired
  • 07: Maternity, paternity or parental leave
  • 08: Long-term illness
  • 09: Volunteering or caregiving other than for [his/her/his or her] children
  • 10: Other

Main Activity of respondent's spouse/Partner (MAP) - Question identifier:MAP_Q120

Was your [spouse/partner] enrolled as a full-time student or part-time student?

  • 1: Full-time student
  • 2: Part-time student

Main Activity of respondent's spouse/Partner (MAP) - Question identifier:MAP_Q130

Did your [spouse/partner] have a paid job or was [he/she/he or she] self-employed at any time during the past 12 months?

  • 1: Yes
  • 2: No

Education Of respondent's Partner (EOP)

Education Of respondent's Partner (EOP) - Question identifier:EOP_Q200

What is the highest certificate, diploma or degree that your [spouse/partner] has completed?

  • 1: Less than high school diploma or its equivalent
  • 2: High school diploma or a high school equivalency certificate
  • 3: Trades certificate or diploma
  • 4: College, CEGEP or other non-university certificate or diploma (other than trades certificates or diplomas)
  • 5: University certificate or diploma below the bachelor's level
  • 6: Bachelor's degree (e.g., B.A., B.A. (Hons), B.Sc., LL.B.)
  • 7: University certificate, diploma or degree above the bachelor's level

Unexpected Expense (EWB)

Unexpected Expense (EWB) - Question identifier:EWB_Q110

The next questions are about any unforeseen expenditures [you/your household] may encounter.
Could [you/your household] handle an unforeseen expenditure of $5,000, today?

  • 1: Yes, easily
  • 2: Yes, but with some difficulty
  • 3: No, could not handle the expenditure

Unexpected Expense (EWB) - Question identifier:EWB_Q115

Could [you/your household] handle an unforeseen expenditure of $500, today?

  • 1: Yes, easily
  • 2: Yes, but with some difficulty
  • 3: No, could not handle the expenditure

Unexpected Expense (EWB) - Question identifier:EWB_Q120

In the past 12 months, how difficult or easy was it for [you/you and your household] to meet your needs in terms of transportation, housing, food, clothing, participation in some social activities and other necessary expenses?

  • 1: Very difficult
  • 2: Difficult
  • 3: Easy
  • 4: Very easy

Perceptions (PA)

Perceptions (PA) - Question identifier:PA_R010A

The next statements are opinions that may be held by members of Canadian society when it comes to gender roles for women and men and violence in relationships.

Perceptions (PA) - Question identifier:PA_R010B

Indicate if you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree with each of the following statements. Remember that these are personal opinions and there are no right or wrong answers.

Perceptions (PA) - Question identifier:PA_Q010

People should be able to express their gender however they choose

  • 1: Strongly agree
  • 2: Agree
  • 3: Neither agree nor disagree
  • 4: Disagree
  • 5: Strongly disagree

Perceptions (PA) - Question identifier:PA_Q020

There are significant obstacles that make it harder for women to get ahead than men

  • 1: Strongly agree
  • 2: Agree
  • 3: Neither agree nor disagree
  • 4: Disagree
  • 5: Strongly disagree

Perceptions (PA) - Question identifier:PA_Q030

People who report sexual assault are almost always telling the truth

  • 1: Strongly agree
  • 2: Agree
  • 3: Neither agree nor disagree
  • 4: Disagree
  • 5: Strongly disagree

Perceptions (PA) - Question identifier:PA_Q040

Violence between partners can be excused if people get so angry they lose control

  • 1: Strongly agree
  • 2: Agree
  • 3: Neither agree nor disagree
  • 4: Disagree
  • 5: Strongly disagree

Perceptions (PA) - Question identifier:PA_Q050

It is understandable that someone would react violently if they suspect their partner of having an affair

  • 1: Strongly agree
  • 2: Agree
  • 3: Neither agree nor disagree
  • 4: Disagree
  • 5: Strongly disagree

Perceptions (PA) - Question identifier:PA_Q060

If a family member of mine came out as transgender, I would not be able to support them

  • 1: Strongly agree
  • 2: Agree
  • 3: Neither agree nor disagree
  • 4: Disagree
  • 5: Strongly disagree

Perceptions (PA) - Question identifier:PA_Q070

People have the right to check who their partner has been calling or texting at all times

  • 1: Strongly agree
  • 2: Agree
  • 3: Neither agree nor disagree
  • 4: Disagree
  • 5: Strongly disagree

Perceptions (PA) - Question identifier:PA_Q080

Same-sex and opposite-sex couples should have the same rights to adopt children

  • 1: Strongly agree
  • 2: Agree
  • 3: Neither agree nor disagree
  • 4: Disagree
  • 5: Strongly disagree

Inappropriate behaviours experienced in the workplace (SMW)

Inappropriate behaviours experienced in the workplace (SMW) - Question identifier:SMW_R005

The next questions are about behaviours you may have observed or experienced in your workplace in the past 12 months.

Inappropriate behaviours experienced in the workplace (SMW) - Question identifier:SMW_Q005

Would you say that most of your workplace colleagues are male or female?

  • 1: All or mostly male
  • 2: All or mostly female
  • 3: About evenly divided

Inappropriate behaviours experienced in the workplace (SMW) - Question identifier:SMW_R010

Indicate how many times in the past 12 months you personally experienced, saw or heard each of the following behaviours while in the workplace or at work-sanctioned events, such as office parties or training outside of the workplace.

Inappropriate behaviours experienced in the workplace (SMW) - Question identifier:SMW_Q010

Inappropriate sexual jokes

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Inappropriate behaviours experienced in the workplace (SMW) - Question identifier:SMW_Q020

Unwanted sexual attention, such as whistles, calls, suggestive looks, gestures, or body language

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Inappropriate behaviours experienced in the workplace (SMW) - Question identifier:SMW_Q030

Unwanted physical contact, such as hugs or shoulder rubs or getting too close

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Inappropriate behaviours experienced in the workplace (SMW) - Question identifier:SMW_Q040

Suggestions that specific people do not act like a man or woman is supposed to act

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Inappropriate behaviours experienced in the workplace (SMW) - Question identifier:SMW_Q050

Someone being insulted, mistreated, ignored, or excluded because they are a man or a woman

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Inappropriate behaviours experienced in the workplace (SMW) - Question identifier:SMW_Q060

Someone being insulted, mistreated, ignored, or excluded because of their sexual orientation or assumed sexual orientation

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Inappropriate behaviours experienced in the workplace (SMW) - Question identifier:SMW_Q070

Someone being insulted, mistreated, ignored, or excluded because they are (or are assumed to be) transgender

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Inappropriate behaviours experienced in the workplace (SMW) - Question identifier:SMW_R080

Indicate how many times in the past 12 months these behaviours were directed at you personally, while in the workplace or at work-sanctioned events.

Inappropriate behaviours experienced in the workplace (SMW) - Question identifier:SMW_Q080

Inappropriate sexual jokes

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Inappropriate behaviours experienced in the workplace (SMW) - Question identifier:SMW_Q090

Unwanted sexual attention, such as whistles, calls, suggestive looks, gestures, or body language

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Inappropriate behaviours experienced in the workplace (SMW) - Question identifier:SMW_Q100

Unwanted physical contact, such as hugs or shoulder rubs or getting too close

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Inappropriate behaviours experienced in the workplace (SMW) - Question identifier:SMW_Q110

Suggestions that you do not act like a ^DT_MANWOMAN is supposed to act

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Inappropriate behaviours experienced in the workplace (SMW) - Question identifier:SMW_Q120

Someone insulting, mistreating, ignoring, or excluding you because you are a ^DT_MANWOMAN

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Inappropriate behaviours experienced in the workplace (SMW) - Question identifier:SMW_Q130

Someone insulting, mistreating, ignoring, or excluding you because of your sexual orientation or assumed sexual orientation

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Inappropriate behaviours experienced in the workplace (SMW) - Question identifier:SMW_Q140

Someone insulting, mistreating, ignoring, or excluding you because you are (or are assumed to be) transgender

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Inappropriate behaviours experienced in a public space (SMP)

Inappropriate behaviours experienced in a public space (SMP) - Question identifier:SMP_R110A

All members of our society should feel free to access public spaces, but sometimes the behaviour of others can impact our experiences. The next questions ask about behaviours you might have encountered while you were in a public space.

A public space is anywhere the public is able to access with little or no restrictions.

e.g., coffee shops, the street, shopping malls, public transportation, bars, restaurants

Exclude behaviours that occurred in your workplace, home or apartment.

Inappropriate behaviours experienced in a public space (SMP) - Question identifier:SMP_R110B

Thinking about time you spent in public spaces in the past 12 months, how many times has anyone made you feel unsafe or uncomfortable by doing any of the following?

Inappropriate behaviours experienced in a public space (SMP) - Question identifier:SMP_Q110

Making unwanted physical contact, such as hugs or shoulder rubs or getting too close to you in a sexual manner

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Inappropriate behaviours experienced in a public space (SMP) - Question identifier:SMP_Q120

Indecently exposing themselves to you or inappropriately displaying any body parts to you in a sexual manner

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Inappropriate behaviours experienced in a public space (SMP) - Question identifier:SMP_Q130

Making unwanted comments that you do not look or act like a [man/woman/man or woman] is supposed to look or act

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Inappropriate behaviours experienced in a public space (SMP) - Question identifier:SMP_Q140

Making unwanted comments about your sexual orientation or assumed sexual orientation

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Inappropriate behaviours experienced in a public space (SMP) - Question identifier:SMP_Q150

Giving you unwanted sexual attention, such as inappropriate comments, whistles, calls, suggestive looks, gestures, or body language

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Most serious behaviour experienced in a public space (SMD)

Most serious behaviour experienced in a public space (SMD) - Question identifier:SMD_R100

The following questions will refer to the most serious incident experienced in a public space in the past 12 months. If you are unable to think of one incident as the most serious, please think of the incident that affected you the most. Exclude incidents that occurred in your workplace, home or apartment.

Most serious behaviour experienced in a public space (SMD) - Question identifier:SMD_Q102

Thinking about the most serious incident experienced in a public space in the past 12 months, where did this occur?

  • 01: In a restaurant or bar
  • 02: Inside a school or on school grounds
  • 03: In a commercial or office building, a factory, a store, or a shopping mall
  • 04: In a hospital, prison or rehabilitation centre
  • 05: On public transportation
  • 06: In a parking garage or parking lot
  • 07: On a sidewalk, street or highway in your neighbourhood
  • 08: On any other sidewalk, street or highway
  • 09: In a rural area or park (Include national, provincial, and local parks, or conservation areas)
  • 10: In a private residence
  • 11: Other

Most serious behaviour experienced in a public space (SMD) - Question identifier:SMD_Q110

In your opinion, was this incident related to the person's alcohol or drug use?

  • 1: Yes
  • 2: No
  • 9: DK

Most serious behaviour experienced in a public space (SMD) - Question identifier:SMD_Q120

Was only one person involved in committing the act?

  • 1: Yes
  • 2: No

Most serious behaviour experienced in a public space (SMD) - Question identifier:SMD_Q130

Was this person male or female?

  • 1: Male
  • 2: Female

Most serious behaviour experienced in a public space (SMD) - Question identifier:SMD_Q140

What was this person's relationship to you?

  • 01: Your current spouse or common-law partner
  • 02: Your former spouse or common-law partner
  • 03: Your current dating partner
  • 04: Your former dating partner
  • 05: A member of your family
  • 06: Your neighbour
  • 07: Your friend
  • 08: An acquaintance
  • 09: An online friend
  • 10: Your teacher or professor
  • 11: Your supervisor, manager or boss
  • 12: Your co-worker
  • 13: Your classmate
  • 14: Known by sight only
  • 15: A stranger
  • 17: Other

Most serious behaviour experienced in a public space (SMD) - Question identifier:SMD_Q150

How many people were involved in committing the act?

Min = 0; Max = 99

Most serious behaviour experienced in a public space (SMD) - Question identifier:SMD_Q160

Were they male or female?

  • 1: All male
  • 2: All female
  • 3: Both male and female

Most serious behaviour experienced in a public space (SMD) - Question identifier:SMD_Q165

Were they mostly male or mostly female?

  • 1: Mostly male
  • 2: Mostly female
  • 3: About evenly divided

Most serious behaviour experienced in a public space - offender (SMD2)

Most serious behaviour experienced in a public space - offender (SMD2) - Question identifier:SMD2_Q170

What is the relationship of the [1st/2nd/3rd/^DT_SMD_INSTANCEROSTERth] offender to you?

  • 01: Your current spouse or common-law partner
  • 02: Your former spouse or common-law partner
  • 03: Your current dating partner
  • 04: Your former dating partner
  • 05: A member of your family
  • 06: Your neighbour
  • 07: Your friend
  • 08: An acquaintance
  • 09: An online friend
  • 10: Your teacher or professor
  • 11: Your supervisor, manager or boss
  • 12: Your co-worker
  • 13: Your classmate
  • 14: Known by sight only
  • 15: A stranger
  • 16: Other

Most serious behaviour experienced in a public space - consequences (SMD3)

Most serious behaviour experienced in a public space - consequences (SMD3) - Question identifier:SMD3_Q180B

At the time of the most serious incident experienced in a public space in the past 12 months, how did this experience affect you emotionally?

  • 12: Not much
  • 13: Angry
  • 14: Upset, confused or frustrated
  • 15: Fearful
  • 16: More cautious or aware
  • 17: Shock or disbelief
  • 18: Hurt or disappointment
  • 19: Victimized
  • 20: Sleeping problems
  • 21: Depression or anxiety attacks
  • 22: Ashamed or guilty
  • 23: Afraid for your children
  • 24: Annoyed
  • 25: Lowered self esteem
  • 26: Lack of trust in others
  • 27: Problems relating to men or women
  • 28: Other

Most serious behaviour experienced in a public space - consequences (SMD3) - Question identifier:SMD3_Q180A

OR

  • 1: Not at all

Most serious behaviour experienced in a public space - consequences (SMD3) - Question identifier:SMD3_Q190B

Did this experience cause you to change your behaviour in any of the following ways?

  • 12: Avoiding certain places
  • 13: Avoiding certain people or situations
  • 14: Changing the way you present yourself in public (e.g., changing the way you dress or act)
  • 15: Carrying something to defend yourself or alert others
  • 16: Becoming withdrawn from social events or activities you typically enjoy
  • 17: Staying home in order to avoid similar experiences
  • 18: Other

Most serious behaviour experienced in a public space - consequences (SMD3) - Question identifier:SMD3_Q190A

OR

  • 1: Not at all

Inappropriate behaviours experienced online (SMC)

Inappropriate behaviours experienced online (SMC) - Question identifier:SMC_R050

The following questions are about incidents which may have happened online or while using a cell phone or smartphone.

Inappropriate behaviours experienced online (SMC) - Question identifier:SMC_Q050

In the past 12 months, did you change your username or block certain people from interacting with you online because of messages you received or harassment you experienced through that account?

  • 1: Yes
  • 2: No
  • 3: Did not use the Internet

Inappropriate behaviours experienced online (SMC) - Question identifier:SMC_Q060

In the past 12 months, did you restrict your own Internet access or participation on social media in order to protect yourself?

  • 1: Yes
  • 2: No

Inappropriate behaviours experienced online (SMC) - Question identifier:SMC_Q070

In the past 12 months, did you shut down or delete an online account you had because of messages you received or harassment you experienced through that account?

  • 1: Yes
  • 2: No

Inappropriate behaviours experienced online (SMC) - Question identifier:SMC_R110

Indicate how many times in the past 12 months you have experienced each of the following behaviours while online.

Inappropriate behaviours experienced online (SMC) - Question identifier:SMC_Q110

You received any threatening or aggressive emails, social media messages, or text messages where you were the only recipient

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Inappropriate behaviours experienced online (SMC) - Question identifier:SMC_Q115

You were the target of threatening or aggressive comments spread through group emails, group text messages or postings on social media

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Inappropriate behaviours experienced online (SMC) - Question identifier:SMC_Q120

Someone posted or distributed, or threatened to post or distribute, intimate or sexually explicit videos or images of you without your consent

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Inappropriate behaviours experienced online (SMC) - Question identifier:SMC_Q130

Someone pressured you to send, share, or post sexually suggestive or explicit images or messages

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Inappropriate behaviours experienced online (SMC) - Question identifier:SMC_Q140

Someone sent you sexually suggestive or explicit images or messages when you did not want to receive them

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Most serious behaviour experienced online (CVD)

Most serious behaviour experienced online (CVD) - Question identifier:CVD_R050

The following questions will refer to the most serious incident experienced while online or while using a cell phone or smartphone in the past 12 months.

If you are unable to think of one incident as the most serious, please think of the incident that affected you the most.

Most serious behaviour experienced online (CVD) - Question identifier:CVD_Q120

Was only one person involved in the most serious incident experienced while online in the past 12 months?

  • 1: Yes
  • 2: No
  • 9: DK

Most serious behaviour experienced online (CVD) - Question identifier:CVD_Q130

Was this person male or female?

  • 1: Male
  • 2: Female
  • 9: DK

Most serious behaviour experienced online (CVD) - Question identifier:CVD_Q140

What was this person's relationship to you?

  • 01: Your current spouse or common-law partner
  • 02: Your former spouse or common-law partner
  • 03: Your current dating partner
  • 04: Your former dating partner
  • 05: A member of your family
  • 06: Your neighbour
  • 07: Your friend
  • 08: An acquaintance
  • 09: An online friend
  • 10: Your teacher or professor
  • 11: Your supervisor, manager or boss
  • 12: Your co-worker
  • 13: Your classmate
  • 14: Known by sight only
  • 15: A stranger
  • 17: Other

Most serious behaviour experienced online (CVD) - Question identifier:CVD_Q150A

How many people were involved in committing the act?
Number of people

Min = 0; Max = 99

Most serious behaviour experienced online (CVD) - Question identifier:CVD_Q150B

OR

  • 09: Don't know

Most serious behaviour experienced online (CVD) - Question identifier:CVD_Q160

Were they male or female?

  • 1: All male
  • 2: All female
  • 3: Both male and female
  • 9: DK

Most serious behaviour experienced online (CVD) - Question identifier:CVD_Q165

Were they mostly male or mostly female?

  • 1: Mostly male
  • 2: Mostly female
  • 3: About evenly divided
  • 9: DK

Most serious behaviour experienced online - offender (CVD2)

Most serious behaviour experienced online - offender (CVD2) - Question identifier:CVD2_Q170

What is the relationship of the [1st/2nd/3rd/^DT_CVD_INSTANCEROSTERth'] offender to you?

  • 01: Your current spouse or common-law partner
  • 02: Your former spouse or common-law partner
  • 03: Your current dating partner
  • 04: Your former dating partner
  • 05: A member of your family
  • 06: Your neighbour
  • 07: Your friend
  • 08: An acquaintance
  • 09: An online friend
  • 10: Your teacher or professor
  • 11: Your supervisor, manager or boss
  • 12: Your co-worker
  • 13: Your classmate
  • 14: Known by sight only
  • 15: A stranger
  • 17: Other

Most serious behaviour experienced online - consequences (CVD3)

Most serious behaviour experienced online - consequences (CVD3) - Question identifier:CVD3_Q180B

At the time of the most serious incident experienced while online in the past 12 months, how did this experience affect you emotionally?

  • 12: Not much
  • 13: Angry
  • 14: Upset, confused or frustrated
  • 15: Fearful
  • 16: More cautious or aware
  • 17: Shock or disbelief
  • 18: Hurt or disappointment
  • 19: Victimized
  • 20: Sleeping problems
  • 21: Depression or anxiety attacks
  • 22: Ashamed or guilty
  • 23: Afraid for your children
  • 24: Annoyed
  • 25: Lowered self esteem
  • 26: Lack of trust in others
  • 27: Problems relating to men or women
  • 28: Other

Most serious behaviour experienced online - consequences (CVD3) - Question identifier:CVD3_Q180A

OR

  • 1: Not at all

Most serious behaviour experienced online - consequences (CVD3) - Question identifier:CVD3_Q200B

Did you ever talk to any of the following people about the most serious incident?

  • 12: The police
  • 13: Your friends
  • 14: Your family members
  • 15: Your neighbours
  • 16: Your co-workers
  • 17: Your online friends
  • 18: A lawyer
  • 19: A counsellor, psychologist, or social worker
  • 20: Your Internet service provider
  • 21: The administrators of the service (e.g., reported directly to Facebook, Twitter or the chat room)
  • 22: Other

Most serious behaviour experienced online - consequences (CVD3) - Question identifier:CVD3_Q200A

OR

  • 11: Did not talk to anyone

Physical and sexual assault - Screening questions (PSA)

Physical and sexual assault - Screening questions (PSA) - Question identifier:PSA_R110

Remember that your answers are strictly confidential.

Physical and sexual assault - Screening questions (PSA) - Question identifier:PSA_Q110

Since you were 15, have you been attacked by anyone; that is anything from being threatened, hit, slapped, pushed or grabbed, to being shot or beaten? Exclude acts that may have been committed by a current or previous spouse, common-law partner, or dating partner.

  • 1: Yes
  • 2: No

Physical and sexual assault - Screening questions (PSA) - Question identifier:PSA_Q115

Did this happen during the past 12 months?

  • 1: Yes
  • 2: No

Physical and sexual assault - Screening questions (PSA) - Question identifier:PSA_R120

Remember that your answers are strictly confidential.

Physical and sexual assault - Screening questions (PSA) - Question identifier:PSA_Q120

Since you were 15, has anyone threatened to hit or attack you, or threatened you with a weapon? Exclude acts that may have been committed by a current or previous spouse, common-law partner, or dating partner.

  • 1: Yes
  • 2: No

Physical and sexual assault - Screening questions (PSA) - Question identifier:PSA_Q125

Did this happen during the past 12 months?

  • 1: Yes
  • 2: No

Physical and sexual assault - Screening questions (PSA) - Question identifier:PSA_R130

Remember that your answers are strictly confidential.

Physical and sexual assault - Screening questions (PSA) - Question identifier:PSA_Q130

Since you were 15, has anyone ever touched you against your will in any sexual way; that is, anything from unwanted touching or grabbing, to kissing or fondling? Exclude acts that may have been committed by a current or previous spouse, common-law partner, or dating partner.

  • 1: Yes
  • 2: No

Physical and sexual assault - Screening questions (PSA) - Question identifier:PSA_Q135

Did this happen during the past 12 months?

  • 1: Yes
  • 2: No

Physical and sexual assault - Screening questions (PSA) - Question identifier:PSA_R140

Remember that your answers are strictly confidential.

Physical and sexual assault - Screening questions (PSA) - Question identifier:PSA_Q140

Since you were 15, has anyone, including family and non-family, forced you or attempted to force you into any unwanted sexual activity by threatening you, holding you down or hurting you in some way? Exclude acts that may have been committed by a current or previous spouse, common-law partner, or dating partner.

  • 1: Yes
  • 2: No

Physical and sexual assault - Screening questions (PSA) - Question identifier:PSA_Q145

Did this happen during the past 12 months?

  • 1: Yes
  • 2: No

Physical and sexual assault - Screening questions (PSA) - Question identifier:PSA_R150

Remember that your answers are strictly confidential.

Physical and sexual assault - Screening questions (PSA) - Question identifier:PSA_Q150

Since you were 15, has anyone subjected you to a sexual activity to which you were not able to consent; that is, were you drugged, intoxicated, manipulated or forced in other ways than physically? Exclude acts that may have been committed by a current or previous spouse, common-law partner, or dating partner.

  • 1: Yes
  • 2: No

Physical and sexual assault - Screening questions (PSA) - Question identifier:PSA_Q155

Did this happen during the past 12 months?

  • 1: Yes
  • 2: No

Physical and sexual assault - Screening questions (PSA) - Question identifier:PSA_R160

You indicated that you have experienced the following [behaviours/behaviour] during the past 12 months.
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Physical and sexual assault - Screening questions (PSA) - Question identifier:PSA_Q160

Did you experience [these behaviours/this behaviour] in one incident or more than one incident?

  • 1: All in one incident
  • 2: Over multiple incidents

Physical and sexual assault - Screening questions (PSA) - Question identifier:PSA_Q170

How many separate incidents?

  • 1: 2 incidents
  • 2: 3 to 5 incidents
  • 3: 6 to 10 incidents
  • 4: More than 10 incidents

Stalking - Criminal Harassment (SCH)

Stalking - Criminal Harassment (SCH) - Question identifier:SCH_R010

Remember that your answers are strictly confidential.

Stalking - Criminal Harassment (SCH) - Question identifier:SCH_Q010

In the past 12 months, have you been stalked, that is, have you been the subject of repeated and unwanted attention? Exclude acts that may have been committed by a current or previous spouse, common-law partner, or dating partner.

  • 1: Yes
  • 2: No

Stalking - Criminal Harassment (SCH) - Question identifier:SCH_Q015

Did this cause you to fear for your safety or the safety of someone you know?

  • 1: Yes
  • 2: No

Most serious incident of physical assault (PAD)

Most serious incident of physical assault (PAD) - Question identifier:PAD_R100

You indicated that you were a victim of [physical/physical and sexual] assault in the past 12 months.

The following questions will refer to the most serious incident of [physical and sexual/Physical] assault experienced in the past 12 months.

If you are unable to think of one incident as the most serious, please think of the incident that affected you the most.

Most serious incident of physical assault (PAD) - Question identifier:PAD_Q110

Did the person who committed the act have a weapon, such as a gun or knife, or something they were using as a weapon, such as a rock or bottle?

  • 1: Yes
  • 2: No
  • 9: DK

Most serious incident of physical assault (PAD) - Question identifier:PAD_Q115A

What type of weapon?

  • 1: Gun
  • 2: Knife
  • 3: Bottle
  • 4: Bat or stick
  • 5: Rock
  • 6: Other

Most serious incident of physical assault (PAD) - Question identifier:PAD_Q115B

OR

  • 099: DK

Most serious incident of physical assault (PAD) - Question identifier:PAD_Q135

Were you physically injured in any way?

  • 1: Yes
  • 2: No

Most serious incident of physical assault (PAD) - Question identifier:PAD_Q200

Where did the most serious incident of [physical and sexual/Physical] assault take place?

  • 1: Your home, property or surrounding area
  • 2: Other private residence or property
  • 3: Commercial or institutional establishment (e.g., restaurant, bar, school, office building, store, shopping mall, hospital)
  • 4: Street or other public place
  • 5: Other

Most serious incident of physical assault (PAD) - Question identifier:PAD_Q210

Where in your home, property or surrounding area did the most serious incident of [physical and sexual/Physical] assault take place?

  • 1: Inside your own home or apartment
  • 2: Inside your vacation property (Include surrounding areas.)
  • 3: Inside a garage or other building on your property
  • 4: Outside your home or apartment (e.g., yard, farm field, driveway, parking lot, in a shared area related to your home such as an apartment hallway or laundry room.)

Most serious incident of physical assault (PAD) - Question identifier:PAD_Q220

In which other private residence or property did the most serious incident of [physical and sexual/Physical] assault take place?

  • 1: In or around the offender's home
  • 2: In or around another private residence or farm

Most serious incident of physical assault (PAD) - Question identifier:PAD_Q230

In which commercial or institutional establishment did the most serious incident of [physical and sexual/Physical] assault take place?

  • 1: In a restaurant or bar
  • 2: Inside a school or on school grounds
  • 3: In a commercial or office building, a factory, a store, or a shopping mall
  • 4: In a hospital, prison or rehabilitation centre

Most serious incident of physical assault (PAD) - Question identifier:PAD_Q240

Where on a street or other public place did the most serious incident of [physical and sexual/Physical] assault take place?

  • 1: On public transportation
  • 2: In a parking garage or parking lot other than your own
  • 3: On a sidewalk, street or highway in your neighbourhood
  • 4: On any other sidewalk, street or highway
  • 5: In a rural area or park (Include national, provincial, and local parks, or conservation areas.)

Most serious incident of physical assault (PAD) - Question identifier:PAD_Q250

Was this your place of work?

  • 1: Yes
  • 2: No

Most serious incident of physical assault (PAD) - Question identifier:PAD_Q310

In your opinion, was the most serious incident of [physical and sexual/Physical] assault related to the person's alcohol or drug use?

  • 1: Yes
  • 2: No
  • 9: DK

Most serious incident of physical assault (PAD) - Question identifier:PAD_Q320

Was only one person involved in committing the act?

  • 1: Yes
  • 2: No
  • 9: DK

Most serious incident of physical assault (PAD) - Question identifier:PAD_Q330

Was this person male or female?

  • 1: Male
  • 2: Female

Most serious incident of physical assault (PAD) - Question identifier:PAD_Q340

What was this person's relationship to you?

  • 01: Your current spouse or common-law partner
  • 02: Your former spouse or common-law partner
  • 03: Your current dating partner
  • 04: Your former dating partner
  • 05: A member of your family
  • 06: Your neighbour
  • 07: Your friend
  • 08: An acquaintance
  • 09: An online friend
  • 10: Your teacher or professor
  • 11: Your supervisor, manager or boss
  • 12: Your co-worker
  • 13: Your classmate
  • 14: Known by sight only
  • 15: A stranger
  • 16: Your caregiver
  • 17: Other

Most serious incident of physical assault (PAD) - Question identifier:PAD_Q350

How many people were involved in committing the act?

Min = 0; Max = 99

Most serious incident of physical assault (PAD) - Question identifier:PAD_Q360

Were they male or female?

  • 1: All male
  • 2: All female
  • 3: Both male and female

Most serious incident of physical assault (PAD) - Question identifier:PAD_Q365

Were they mostly male or mostly female?

  • 1: Mostly male
  • 2: Mostly female
  • 3: About evenly divided

Most serious incident of physical assault - offender (PAD2)

Most serious incident of physical assault - offender (PAD2) - Question identifier:PAD2_Q370

What is the relationship of the [1st/2nd/3rd/^DT_PAD_INSTANCEROSTERth] offender to you?

  • 01: Your current spouse or common-law partner
  • 02: Your former spouse or common-law partner
  • 03: Your current dating partner
  • 04: Your former dating partner
  • 05: A member of your family
  • 06: Your neighbour
  • 07: Your friend
  • 08: An acquaintance
  • 09: An online friend
  • 10: Your teacher or professor
  • 11: Your supervisor, manager or boss
  • 12: Your co-worker
  • 13: Your classmate
  • 14: Known by sight only
  • 15: A stranger
  • 16: Your caregiver
  • 17: Other

Most serious incident of physical assault - details (PAD3)

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q380

At the time of the most serious incident of ^DT_PHYSSEX_E assault, did the person who committed the act live with you?

  • 1: Yes
  • 2: No

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q400

Did the police find out about the most serious incident of ^DT_PHYSSEX_E assault in any way?

  • 1: Yes
  • 2: No

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q405

How did they learn about it?

  • 1: From you
  • 2: Some other way

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_R420

You indicated that police became aware of the most serious incident of ^DT_PHYSSEX_E assault, but that you did not personally report it.

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q420

Did you speak with the police about the most serious incident of ^DT_PHYSSEX_E assault at any point?

  • 1: Yes
  • 2: No

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_R430

The next questions are about experiences you may have had when you spoke to police about the most serious incident of ^DT_PHYSSEX_E assault.

You may have spoken with more than one officer, so answer each question thinking about your overall experience.

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q430

Were you informed about services, programs or resources available to you?

  • 1: Yes
  • 2: No

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q435

In general, were you treated with respect?

  • 1: Yes
  • 2: No

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q440

In general, did you feel as though your report was believed?

  • 1: Yes
  • 2: No

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q445

Overall, did you feel that speaking to police was worth your time or effort?

  • 1: Yes
  • 2: No

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q450

Overall, how satisfied were you with the way you were treated by police?

  • 1: Very satisfied
  • 2: Satisfied
  • 3: Neither satisfied nor dissatisfied
  • 4: Dissatisfied
  • 5: Very dissatisfied

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q455

After you spoke with police, did anyone from the criminal justice system, such as police, courts personnel, or victim's services, ever contact you again for any reason related to the most serious incident of ^DT_PHYSSEX_E assault?

  • 1: Yes
  • 2: No

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q460

Did you feel as though this follow-up contact was necessary or helpful?

  • 1: Yes
  • 2: No

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q465

Would follow-up contact have been something you wanted or needed?

  • 1: Yes
  • 2: No

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q470A

What action did police take?

  • 11: Visit the scene
  • 12: Make a report or conduct an investigation
  • 13: Give a warning to the offender
  • 14: Give you a warning
  • 15: Take the offender away
  • 16: Take you away
  • 17: Arrest the offender
  • 18: Arrest you
  • 19: Lay charges against the offender
  • 20: Lay charges against you
  • 21: Take any other action

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q470B

OR

  • 22: Take no action

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q480

Overall, how satisfied were you with the actions that the police took?

  • 1: Very satisfied
  • 2: Satisfied
  • 3: Neither satisfied nor dissatisfied
  • 4: Dissatisfied
  • 5: Very dissatisfied

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q500A

[Other than the police, who else did you talk to/Who did you talk to] about the most serious incident of ^DT_PHYSSEX_E assault?

  • 1: A family member
  • 2: A friend or neighbour
  • 3: A co-worker
  • 4: A doctor or nurse
  • 5: A lawyer
  • 6: A priest, rabbi, imam, elder, or other spiritual advisor
  • 7: Other

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q500B

OR

  • 18: Did not talk to anyone

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q510

During the past 12 months, did you ever contact or use any services for help because of the incident?

  • 1: Yes
  • 2: No

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q515B

Did your use of these services have any of the following outcomes?

  • 12: Helped you financially or helped you ensure your financial security
  • 13: Helped with your physical or mental health and well-being
  • 14: Helped you with the criminal justice system process
  • 15: Ensured your safety or ensured the safety of your children
  • 16: Made you feel responsible for the violence you experienced
  • 17: Made you feel revictimized
  • 18: Other

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q515A

OR

  • 1: No outcome

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q520

Is there any reason why you didn't use any of these services?

  • 01: Didn't know of any services
  • 02: None available
  • 03: Waiting list
  • 04: Incident too minor
  • 05: Shame or embarrassment
  • 06: Wouldn't be believed
  • 07: The offender or your family prevented you
  • 08: Distance from service
  • 09: Didn't want or need help
  • 10: None available in my language
  • 11: Other

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q525

Thinking of the most serious incident of ^DT_PHYSSEX_E assault in the past 12 months, did anyone make you feel as though you were responsible or to blame for this incident?

  • 1: Yes
  • 2: No

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q530

Who made you feel as though you were responsible or to blame for the most serious incident of ^DT_PHYSSEX_E assault experienced in the past 12 months?

  • 1: The [person/persons/person or persons] who committed the violence
  • 2: Your friends or family
  • 3: The police
  • 4: Victim services (e.g., a crisis centre or help line, a counsellor, psychologist, or social worker, a community, family, ethnic, or cultural centre, a shelter or transition house, a women's or men's centre, a senior's centre, a support group)
  • 5: Other

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q540B

At the time of the most serious incident of ^DT_PHYSSEX_E assault experienced in the past 12 months, how did this experience affect you emotionally?

  • 12: Not much
  • 13: Angry
  • 14: Upset, confused or frustrated
  • 15: Fearful
  • 16: More cautious or aware
  • 17: Shock or disbelief
  • 18: Hurt or disappointment
  • 19: Victimized
  • 20: Sleeping problems
  • 21: Depression or anxiety attacks
  • 22: Ashamed or guilty
  • 23: Afraid for your children
  • 24: Annoyed
  • 25: Lowered self esteem
  • 26: Lack of trust in others
  • 27: Problems relating to men or women
  • 28: Other

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q540A

OR

  • 1: Not at all

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_R550

Now, some questions about longer-term effects of the most serious incident of ^DT_PHYSSEX_E assault.

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q550

In the past month, have you had nightmares about the incident or thought about it when you did not want to?

  • 1: Yes
  • 2: No

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q560

In the past month, have you tried hard not to think about the incident or went out of your way to avoid situations that reminded you of it?

  • 1: Yes
  • 2: No

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q570

In the past month, have you felt constantly on guard, watchful, or easily startled?

  • 1: Yes
  • 2: No

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q580

In the past month, have you felt numb or detached from others, activities, or your surroundings?

  • 1: Yes
  • 2: No

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q590B

Did the most serious incident of ^DT_PHYSSEX_E assault cause you to change your behaviour in any of the following ways?

  • 1: Avoiding certain places
  • 2: Changing your routine to avoid certain people or situations
  • 3: Changing the way you present yourself in public (e.g., changing the way you dress or act)
  • 4: Carrying something to defend yourself or alert others
  • 5: Becoming withdrawn from social events or activities you typically enjoy
  • 6: Staying home in order to avoid similar experiences
  • 7: Other

Most serious incident of physical assault - details (PAD3) - Question identifier:PAD3_Q590A

OR

  • 1: Not at all

Most serious incident of sexual assault (SAD)

Most serious incident of sexual assault (SAD) - Question identifier:SAD_R100

You indicated that you were a victim of sexual assault in the past 12 months.

The following questions will refer to the most serious incident of sexual assault experienced in the past 12 months.

If you are unable to think of one incident as the most serious, please think of the incident that affected you the most.

Most serious incident of sexual assault (SAD) - Question identifier:SAD_Q105

Thinking of the most serious incident of sexual assault in the past 12 months, did this occur at the same time as the incident of physical assault that you just reported?

  • 1: Yes
  • 2: No

Most serious incident of sexual assault (SAD) - Question identifier:SAD_Q110

Did the person who committed the act have a weapon, such as a gun or knife, or something they were using as a weapon, such as a rock or bottle?

  • 1: Yes
  • 2: No
  • 9: DK

Most serious incident of sexual assault (SAD) - Question identifier:SAD_Q115A

What type of weapon?

  • 1: Gun
  • 2: Knife
  • 3: Bottle
  • 4: Bat or stick
  • 5: Rock
  • 6: Other

Most serious incident of sexual assault (SAD) - Question identifier:SAD_Q115B

OR

  • 099: DK

Most serious incident of sexual assault (SAD) - Question identifier:SAD_Q135

Were you physically injured in any way?

  • 1: Yes
  • 2: No

Most serious incident of sexual assault (SAD) - Question identifier:SAD_Q200

Where did the most serious incident of sexual assault take place?

  • 1: Your home, property or surrounding area
  • 2: Other private residence or property
  • 3: Commercial or institutional establishment (e.g., restaurant, bar, school, office building, store, shopping mall, hospital)
  • 4: Street or other public place
  • 5: Other

Most serious incident of sexual assault (SAD) - Question identifier:SAD_Q210

Where in your home, property or surrounding area did the most serious incident of sexual assault take place?

  • 1: Inside your own home or apartment
  • 2: Inside your vacation property (Include surrounding areas.)
  • 3: Inside a garage or other building on your property
  • 4: Outside your home or apartment (e.g., yard, farm field, driveway, parking lot, in a shared area related to your home such as an apartment hallway or laundry room.)

Most serious incident of sexual assault (SAD) - Question identifier:SAD_Q220

In which other private residence or property did the most serious incident of sexual assault take place?

  • 1: In or around the offender's home
  • 2: In or around another private residence or farm

Most serious incident of sexual assault (SAD) - Question identifier:SAD_Q230

In which commercial or institutional establishment did the most serious incident of sexual assault take place?

  • 1: In a restaurant or bar
  • 2: Inside a school or on school grounds
  • 3: In a commercial or office building, a factory, a store, or a shopping mall
  • 4: In a hospital, prison or rehabilitation centre

Most serious incident of sexual assault (SAD) - Question identifier:SAD_Q240

Where on a street or other public place did the most serious incident of sexual assault take place?

  • 1: On public transportation
  • 2: In a parking garage or parking lot other than your own
  • 3: On a sidewalk, street or highway in your neighbourhood
  • 4: On any other sidewalk, street or highway
  • 5: In a rural area or park (Include national, provincial, and local parks, or conservation areas.)

Most serious incident of sexual assault (SAD) - Question identifier:SAD_Q250

Was this your place of work?

  • 1: Yes
  • 2: No

Most serious incident of sexual assault (SAD) - Question identifier:SAD_Q310

In your opinion, was the most serious incident of sexual assault related to the person's alcohol or drug use?

  • 1: Yes
  • 2: No
  • 9: DK

Most serious incident of sexual assault (SAD) - Question identifier:SAD_Q320

Was only one person involved in committing the act?

  • 1: Yes
  • 2: No
  • 9: DK

Most serious incident of sexual assault (SAD) - Question identifier:SAD_Q330

Was this person male or female?

  • 1: Male
  • 2: Female

Most serious incident of sexual assault (SAD) - Question identifier:SAD_Q340

What was this person's relationship to you?

  • 01: Your current spouse or common-law partner
  • 02: Your former spouse or common-law partner
  • 03: Your current dating partner
  • 04: Your former dating partner
  • 05: A member of your family
  • 06: Your neighbour
  • 07: Your friend
  • 08: An acquaintance
  • 09: An online friend
  • 10: Your teacher or professor
  • 11: Your supervisor, manager or boss
  • 12: Your co-worker
  • 13: Your classmate
  • 14: Known by sight only
  • 15: A stranger
  • 16: Your caregiver
  • 17: Other

Most serious incident of sexual assault (SAD) - Question identifier:SAD_Q350

How many people were involved in committing the act?

Min = 0; Max = 99

Most serious incident of sexual assault (SAD) - Question identifier:SAD_Q360

Were they male or female?

  • 1: All male
  • 2: All female
  • 3: Both male and female

Most serious incident of sexual assault (SAD) - Question identifier:SAD_Q365

Were they mostly male or mostly female?

  • 1: Mostly male
  • 2: Mostly female
  • 3: About evenly divided

Most serious incident of sexual assault - offender (SAD2)

Most serious incident of sexual assault - offender (SAD2) - Question identifier:SAD2_Q370

What is the relationship of the [1st/2nd/3rd/^DT_INSTANCEROSTERth] offender to you?

  • 01: Your current spouse or common-law partner
  • 02: Your former spouse or common-law partner
  • 03: Your current dating partner
  • 04: Your former dating partner
  • 05: A member of your family
  • 06: Your neighbour
  • 07: Your friend
  • 08: An acquaintance
  • 09: An online friend
  • 10: Your teacher or professor
  • 11: Your supervisor, manager or boss
  • 12: Your co-worker
  • 13: Your classmate
  • 14: Known by sight only
  • 15: A stranger
  • 16: Your caregiver
  • 17: Other

Most serious incident of sexual assault - details (SAD3)

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q380

At the time of the most serious incident of sexual assault, did the person who committed the act live with you?

  • 1: Yes
  • 2: No

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q400

Did the police find out about the most serious incident of sexual assault in any way?

  • 1: Yes
  • 2: No

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q405

How did they learn about it?

  • 1: From you
  • 2: Some other way

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_R420

You indicated that police became aware of the most serious incident of sexual assault, but that you did not personally report it.

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q420

Did you speak with the police about the most serious incident of sexual assault at any point?

  • 1: Yes
  • 2: No

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_R430

The next questions are about experiences you may have had when you spoke to police about the most serious incident of sexual assault.

You may have spoken with more than one officer, so answer each question thinking about your overall experience.

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q430

Were you informed about services, programs or resources available to you?

  • 1: Yes
  • 2: No

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q435

In general, were you treated with respect?

  • 1: Yes
  • 2: No

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q440

In general, did you feel as though your report was believed?

  • 1: Yes
  • 2: No

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q445

Overall, did you feel that speaking to police was worth your time or effort?

  • 1: Yes
  • 2: No

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q450

Overall, how satisfied were you with the way you were treated by police?

  • 1: Very satisfied
  • 2: Satisfied
  • 3: Neither satisfied nor dissatisfied
  • 4: Dissatisfied
  • 5: Very dissatisfied

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q455

After you spoke with police, did anyone from the criminal justice system, such as police, courts personnel, or victim's services, ever contact you again for any reason related to the most serious incident of sexual assault?

  • 1: Yes
  • 2: No

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q460

Did you feel as though this follow-up contact was necessary or helpful?

  • 1: Yes
  • 2: No

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q465

Would follow-up contact have been something you wanted or needed?

  • 1: Yes
  • 2: No

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q470A

What action did police take?

  • 11: Visit the scene
  • 12: Make a report or conduct an investigation
  • 13: Give a warning to the offender
  • 14: Give you a warning
  • 15: Take the offender away
  • 16: Take you away
  • 17: Arrest the offender
  • 18: Arrest you
  • 19: Lay charges against the offender
  • 20: Lay charges against you
  • 21: Take any other action

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q470B

OR

  • 22: Take no action

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q480

Overall, how satisfied were you with the actions that the police took?

  • 1: Very satisfied
  • 2: Satisfied
  • 3: Neither satisfied nor dissatisfied
  • 4: Dissatisfied
  • 5: Very dissatisfied

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q500A

^DT_PAD500_E about the most serious incident of sexual assault?

  • 1: A family member
  • 2: A friend or neighbour
  • 3: A co-worker
  • 4: A doctor or nurse
  • 5: A lawyer
  • 6: A priest, rabbi, imam, elder, or other spiritual advisor
  • 7: Other

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q500B

OR

  • 18: Did not talk to anyone

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q510

During the past 12 months, did you ever contact or use any services for help because of the incident?

  • 1: Yes
  • 2: No

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q515B

Did your use of these services have any of the following outcomes?

  • 12: Helped you financially or helped you ensure your financial security
  • 13: Helped with your physical or mental health and well-being
  • 14: Helped you with the criminal justice system process
  • 15: Ensured your safety or ensured the safety of your children
  • 16: Made you feel responsible for the violence you experienced
  • 17: Made you feel revictimized
  • 18: Other

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q515A

OR

  • 1: No outcome

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q520

Is there any reason why you didn't use any of these services?

  • 01: Didn't know of any services
  • 02: None available
  • 03: Waiting list
  • 04: Incident too minor
  • 05: Shame or embarrassment
  • 06: Wouldn't be believed
  • 07: The offender or your family prevented you
  • 08: Distance from service
  • 09: Didn't want or need help
  • 10: None available in my language
  • 11: Other

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q525

Thinking of the most serious incident of sexual assault in the past 12 months, did anyone make you feel as though you were responsible or to blame for this incident?

  • 1: Yes
  • 2: No

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q530

Who made you feel as though you were responsible or to blame for the most serious incident of sexual assault experienced in the past 12 months?

  • 1: The [person/persons/person or persons] who committed the violence
  • 2: Your friends or family
  • 3: The police
  • 4: Victim services (e.g., a crisis centre or help line, a counsellor, psychologist, or social worker, a community, family, ethnic, or cultural centre, a shelter or transition house, a women's or men's centre, a senior's centre, a support group)
  • 5: Other

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q540B

At the time of the most serious incident of sexual assault experienced in the past 12 months, how did this experience affect you emotionally?

  • 12: Not much
  • 13: Angry
  • 14: Upset, confused or frustrated
  • 15: Fearful
  • 16: More cautious or aware
  • 17: Shock or disbelief
  • 18: Hurt or disappointment
  • 19: Victimized
  • 20: Sleeping problems
  • 21: Depression or anxiety attacks
  • 22: Ashamed or guilty
  • 23: Afraid for your children
  • 24: Annoyed
  • 25: Lowered self esteem
  • 26: Lack of trust in others
  • 27: Problems relating to men or women
  • 28: Other

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q540A

OR

  • 1: Not at all

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_R550

Now, some questions about longer-term effects of the most serious incident of sexual assault.

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q550

In the past month, have you had nightmares about the incident or thought about it when you did not want to?

  • 1: Yes
  • 2: No

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q560

In the past month, have you tried hard not to think about the incident or went out of your way to avoid situations that reminded you of it?

  • 1: Yes
  • 2: No

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q570

In the past month, have you felt constantly on guard, watchful, or easily startled?

  • 1: Yes
  • 2: No

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q580

In the past month, have you felt numb or detached from others, activities, or your surroundings?

  • 1: Yes
  • 2: No

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q590B

Did the most serious incident of sexual assault cause you to change your behaviour in any of the following ways?

  • 1: Avoiding certain places
  • 2: Changing your routine to avoid certain people or situations
  • 3: Changing the way you present yourself in public (e.g., changing the way you dress or act)
  • 4: Carrying something to defend yourself or alert others
  • 5: Becoming withdrawn from social events or activities you typically enjoy
  • 6: Staying home in order to avoid similar experiences
  • 7: Other

Most serious incident of sexual assault - details (SAD3) - Question identifier:SAD3_Q590A

OR

  • 1: Not at all

Experiences in intimate partner relationships (IPV)

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_R100A

The following set of questions asks about abusive and violent behaviours in relationships. Your answers are very important, regardless of whether or not you have experienced any of these behaviours. Remember that all the information you provide is strictly confidential.

Due to the sensitive nature of the questions, this section has been designed with important security safeguards.

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Experiences in intimate partner relationships (IPV) - Question identifier:IPV_R100B

Indicate if you have ever experienced the following behaviours from any intimate partners you have had.

Include current or former spouses, common-law partners, or dating partners.

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q100

Has an intimate partner ever done any of the following?
Been jealous and didn't want you to talk to other men or women

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q105

Has an intimate partner ever done any of the following?
Harmed, or threatened to harm your pets

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q110

Has an intimate partner ever done any of the following?
Demanded to know who you were with and where you were at all times

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q115

Has an intimate partner ever done any of the following?
Put you down or called you names to make you feel bad

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q120

Has an intimate partner ever done any of the following?
Forced you to give them money or possessions

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q125

Has an intimate partner ever done any of the following?
Told you you were crazy, stupid, or not good enough

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q130

Has an intimate partner ever done any of the following?
Tried to convince your family, children, or friends that you are crazy or tried to turn them against you

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q135

Has an intimate partner ever done any of the following?
Followed you or hung around outside your home or work

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q140

Has an intimate partner ever done any of the following?
Kept you from seeing or talking to your family or friends

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q145

Has an intimate partner ever done any of the following?
Harassed you by phone, text, email, or using social media

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q150

Has an intimate partner ever done any of the following?
Made you perform sex acts that you did not want to perform

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q155

Has an intimate partner ever done any of the following?
Shook, pushed, grabbed, or threw you

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q160

Has an intimate partner ever done any of the following?
Kept you from having access to a job, money, or financial resources

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_R165A

Indicate if you have ever experienced the following behaviours from any intimate partners you have had.

Include current or former spouses, common-law partners, or dating partners.

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q165

Has an intimate partner ever done any of the following?
Hit you with a fist or object, kicked or bit you

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q170

Confined or locked you in a room or other space

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q175

Has an intimate partner ever done any of the following?
Forced or tried to force you to have sex

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q180

Has an intimate partner ever done any of the following?
Threatened to harm or kill you or someone close to you

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q185

Has an intimate partner ever done any of the following?
Choked you

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q190

Has an intimate partner ever done any of the following?
Used or threatened to use a knife or gun or other weapon to harm you

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q195

Has an intimate partner ever done any of the following?
Threatened to hit you with their fist or anything that could hurt you

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q200

Has an intimate partner ever done any of the following?
Damaged or destroyed your possessions or property

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q205

Has an intimate partner ever done any of the following?
Thrown anything at you that could have hurt you

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q210

Has an intimate partner ever done any of the following?
Slapped you

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q215

Has an intimate partner ever done any of the following?
Beaten you

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q220

Has an intimate partner ever done any of the following?
Made comments about your sexual past or your sexual performance that made you feel ashamed, inadequate, or humiliated

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q225

Has an intimate partner ever done any of the following?
Revealed, or threatened to reveal, your sexual orientation or your relationship to anyone who you did not want to know about your sexuality or sexual orientation

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q230

Has an intimate partner ever blamed you for causing their abusive or violent behaviour?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_R235A

You indicated that you experienced the following behaviours committed by an intimate partner.

Remember that all information provided is strictly confidential.

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q235

How often did these behaviours occur in the past 12 months?
Been jealous and didn't want you to talk to other men or women

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q240

How often did these behaviours occur in the past 12 months?
Harmed, or threatened to harm, your pets

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q245

How often did these behaviours occur in the past 12 months?
Demanded to know who you were with and where you were at all times

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q250

How often did these behaviours occur in the past 12 months?
Put you down or called you names to make you feel bad

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q255

How often did these behaviours occur in the past 12 months?
Forced you to give them money or possessions

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q260

How often did these behaviours occur in the past 12 months?
Told you you were crazy, stupid, or not good enough

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q265

How often did these behaviours occur in the past 12 months?
Tried to convince your family, children, or friends that you are crazy or tried to turn them against you

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q270

How often did these behaviours occur in the past 12 months?
Followed you or hung around outside your home or work

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q275

How often did these behaviours occur in the past 12 months?
Kept you from seeing or talking to your family or friends

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q280

How often did these behaviours occur in the past 12 months?
Harassed you by phone, text, email, or using social media

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q285

How often did these behaviours occur in the past 12 months?
Made you perform sex acts that you did not want to perform

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q290

How often did these behaviours occur in the past 12 months?
Shook, pushed, grabbed, or threw you

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q295

How often did these behaviours occur in the past 12 months?
Kept you from having access to a job, money, or financial resources

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q300

How often did these behaviours occur in the past 12 months?
Hit you with a fist or object, kicked or bit you

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q305

How often did these behaviours occur in the past 12 months?
Confined or locked you in a room or other space

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q310

How often did these behaviours occur in the past 12 months?
Forced or tried to force you to have sex

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q315

How often did these behaviours occur in the past 12 months?
Threatened to harm or kill you or someone close to you

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q320

How often did these behaviours occur in the past 12 months?
Choked you

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q325

Used or threatened to use a knife or gun or other weapon to harm you

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q330

How often did these behaviours occur in the past 12 months?
Threatened to hit you with their fist or anything that could hurt you

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q335

How often did these behaviours occur in the past 12 months?
Damaged or destroyed your possessions or property

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q340

How often did these behaviours occur in the past 12 months?
Thrown anything at you that could have hurt you

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q345

How often did these behaviours occur in the past 12 months?
Slapped you

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q350

How often did these behaviours occur in the past 12 months?
Beaten you

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q355

How often did these behaviours occur in the past 12 months?
Made comments about your sexual past or your sexual performance that made you feel ashamed, inadequate, or humiliated

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q360

How often did these behaviours occur in the past 12 months?
Revealed, or threatened to reveal, your sexual orientation or your relationship to anyone who you did not want to know about your sexuality or sexual orientation

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships (IPV) - Question identifier:IPV_Q365

How often did these behaviours occur in the past 12 months?
Blamed you for causing their violent behaviour

  • 1: Not in the past 12 months
  • 2: Once
  • 3: A few times
  • 4: Monthly
  • 5: Weekly
  • 6: Daily or almost daily

Experiences in intimate partner relationships - Lifetime (LTV)

Experiences in intimate partner relationships - Lifetime (LTV) - Question identifier:LTV_R010

You indicated that, in your lifetime, you have experienced some form of emotionally abusive or violent behaviours committed by an intimate partner.

Remember that all information provided is strictly confidential.

Experiences in intimate partner relationships - Lifetime (LTV) - Question identifier:LTV_Q010

How many partners have been responsible for any of these behaviours you have ever experienced?

Min = 0; Max = 99

Experiences in intimate partner relationships - Lifetime (LTV) - Question identifier:LTV_Q020

As a result of these experiences, have you ever been afraid of any partner?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - Lifetime (LTV) - Question identifier:LTV_Q030

Are you currently afraid of any partner?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - Lifetime (LTV) - Question identifier:LTV_Q040

As a result of these experiences, have you ever felt controlled or trapped by any partner?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - Lifetime (LTV) - Question identifier:LTV_Q050

Do you currently feel controlled or trapped by any partner?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - Lifetime (LTV) - Question identifier:LTV_Q060

As a result of these experiences, have you ever felt anxious or on edge because of any partner?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - Lifetime (LTV) - Question identifier:LTV_Q070

Do you currently feel anxious or on edge because of any partner?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - past 12 months (IPD)

Experiences in intimate partner relationships - past 12 months (IPD) - Question identifier:IPD_R010

You indicated that during the past 12 months, you experienced some form of emotionally abusive, physically violent or sexually violent behaviour committed by an intimate partner. The next questions are about the abusive or violent behaviour you experienced.

Remember that all information provided is strictly confidential.

Experiences in intimate partner relationships - past 12 months (IPD) - Question identifier:IPD_Q010

How many partners have been responsible for any of these emotionally abusive or physically violent behaviours you have experienced in the past 12 months?

Min = 0; Max = 99

Experiences in intimate partner relationships - past 12 months (IPD) - Question identifier:IPD_Q015

What is this person's current relationship to you?

  • 1: Current spouse or common-law partner
  • 2: Former spouse or common-law partner
  • 3: Current dating partner
  • 4: Former dating partner

Experiences in intimate partner relationships - past 12 months (IPD) - Question identifier:IPD_Q017

Was this person emotionally abusive or violent towards you on more than one occasion?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - past 12 months (IPD) - Question identifier:IPD_Q020

What was this person's relationship to you at the time of the behaviour?

  • 1: Current spouse or common-law partner
  • 2: Former spouse or common-law partner
  • 3: Current dating partner
  • 4: Former dating partner

Experiences in intimate partner relationships - past 12 months (IPD) - Question identifier:IPD_Q025

Thinking of the first time these behaviours occurred in the past 12 months, what was this person's relationship to you at that time?

  • 1: Current spouse or common-law partner
  • 2: Former spouse or common-law partner
  • 3: Current dating partner
  • 4: Former dating partner

Experiences in intimate partner relationships - past 12 months (IPD) - Question identifier:IPD_Q030

Thinking of the most recent time these behaviours occurred, what was this person's relationship to you at that time?

  • 1: Current spouse or common-law partner
  • 2: Former spouse or common-law partner
  • 3: Current dating partner
  • 4: Former dating partner

Experiences in intimate partner relationships - offender (IPD2)

Experiences in intimate partner relationships - offender (IPD2) - Question identifier:IPD2_Q035

What is the [1st/2nd/3rd/^DT_INSTANCEROSTERth] person's current relationship to you?

  • 1: Current spouse or common-law partner
  • 2: Former spouse or common-law partner
  • 3: Current dating partner
  • 4: Former dating partner

Experiences in intimate partner relationships - offender (IPD2) - Question identifier:IPD2_Q040

Was the [1st/2nd/3rd/^DT_INSTANCEROSTERth] person abusive or violent towards you on more than one occasion?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - offender (IPD2) - Question identifier:IPD2_Q045

What was the [1st/2nd/3rd/^DT_INSTANCEROSTERth] person's relationship to you at the time of the behaviour?

  • 1: Current spouse or common-law partner
  • 2: Former spouse or common-law partner
  • 3: Current dating partner
  • 4: Former dating partner

Experiences in intimate partner relationships - offender (IPD2) - Question identifier:IPD2_Q050

The first time the [1st/2nd/3rd/^DT_INSTANCEROSTERth] person was violent or abusive towards you in the past 12 months, what was their relationship to you?

  • 1: Current spouse or common-law partner
  • 2: Former spouse or common-law partner
  • 3: Current dating partner
  • 4: Former dating partner

Experiences in intimate partner relationships - offender (IPD2) - Question identifier:IPD2_Q055

The most recent time the ^DT_IPDREL_F person was violent or abusive towards you in the past 12 months, what was their relationship to you?

  • 1: Current spouse or common-law partner
  • 2: Former spouse or common-law partner
  • 3: Current dating partner
  • 4: Former dating partner

Experiences in intimate partner relationships - consequences (IPD3)

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q060

As a result of the violence you experienced by an intimate partner in the past 12 months, were you physically injured in any way?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q065

What were your injuries?

  • 11: Bruises
  • 12: Cuts, scratches or burns
  • 13: Fractures or broken bones
  • 14: A miscarriage
  • 15: Internal injuries
  • 16: A concussion or other head injury
  • 17: Other

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q070

As a result of the violence you experienced in the past 12 months, did you ever lose consciousness or almost lose consciousness?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q075

Did any of the abusive or violent behaviour in the past 12 months occur while your partner was drinking?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q080

Did any of the abusive or violent behaviour in the past 12 months happen while you were pregnant?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q085

During the past 12 months, were you ever separated because of your partner's abusive or violent behaviour?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q090

As a result of this separation, did you have to leave a shared home or accommodation you had with your partner, even if only temporarily?

  • 1: Yes
  • 2: No
  • 3: Did not have a shared home or accommodation

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q095

During this time, where did you stay?

  • 11: Purchased or rented new accommodations (e.g., home or apartment)
  • 12: With friends or family
  • 13: At a hotel, motel or other paid accommodation
  • 14: In a shelter
  • 15: In a car, on the street, or in a public park
  • 16: Other

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q100

Did the police find out about the abusive or violent behaviour in any way?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q105

How did they learn about it?

  • 1: From you
  • 2: Some other way

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q115

After the police learned about the abusive or violent behaviour, would you say it increased, decreased, stopped entirely, or stayed about the same?

  • 1: Increased
  • 2: Decreased
  • 3: Stopped entirely
  • 4: Stayed about the same

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q120

You indicated that police became aware of the abusive or violent behaviour, but that you did not personally report it.
Did you speak with the police about the abusive or violent behaviour at any point?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q130

The next questions are about experiences you may have had when you spoke to police about the abusive or violent behaviour.

You may have spoken with more than one officer or spoken with police about more than one incident, so answer each question thinking about your overall experience.
Were you informed about services, programs or resources available to you?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q140

The next questions are about experiences you may have had when you spoke to police about the abusive or violent behaviour.

You may have spoken with more than one officer or spoken with police about more than one incident, so answer each question thinking about your overall experience.
In general, were you treated with respect?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q150

The next questions are about experiences you may have had when you spoke to police about the abusive or violent behaviour.

You may have spoken with more than one officer or spoken with police about more than one incident, so answer each question thinking about your overall experience.
In general, did you feel as though your report was believed?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q160

The next questions are about experiences you may have had when you spoke to police about the abusive or violent behaviour.

You may have spoken with more than one officer or spoken with police about more than one incident, so answer each question thinking about your overall experience.
Overall, did you feel that speaking to police was worth your time or effort?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q170

The next questions are about experiences you may have had when you spoke to police about the abusive or violent behaviour.

You may have spoken with more than one officer or spoken with police about more than one incident, so answer each question thinking about your overall experience.
Overall, how satisfied were you with the way you were treated by police?

  • 1: Very satisfied
  • 2: Somewhat satisfied
  • 3: Neither satisfied nor dissatisfied
  • 4: Somewhat dissatisfied
  • 5: Very dissatisfied

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q180

The next questions are about experiences you may have had when you spoke to police about the abusive or violent behaviour.

You may have spoken with more than one officer or spoken with police about more than one incident, so answer each question thinking about your overall experience.
After you spoke with police, did anyone from the criminal justice system, such as police, courts personnel, or victim's services, ever contact you again for any reason related to the abusive or violent behaviour?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q185

The next questions are about experiences you may have had when you spoke to police about the abusive or violent behaviour.

You may have spoken with more than one officer or spoken with police about more than one incident, so answer each question thinking about your overall experience.
Did you feel as though this follow-up contact was necessary or helpful?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q190

The next questions are about experiences you may have had when you spoke to police about the abusive or violent behaviour.

You may have spoken with more than one officer or spoken with police about more than one incident, so answer each question thinking about your overall experience.
Would follow-up contact have been something you wanted or needed?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q195A

The next questions are about experiences you may have had when you spoke to police about the abusive or violent behaviour.

You may have spoken with more than one officer or spoken with police about more than one incident, so answer each question thinking about your overall experience.
What action did police take?

  • 11: Visit the scene
  • 12: Make a report or conduct an investigation
  • 13: Give a warning to your partner
  • 14: Give you a warning
  • 15: Take your partner away
  • 16: Take you away
  • 17: Arrest your partner
  • 18: Arrest you
  • 19: Lay charges against your partner
  • 20: Lay charges against you
  • 21: Take any other action

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q195B

The next questions are about experiences you may have had when you spoke to police about the abusive or violent behaviour.

You may have spoken with more than one officer or spoken with police about more than one incident, so answer each question thinking about your overall experience.
OR

  • 22: Take no action

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q200

The next questions are about experiences you may have had when you spoke to police about the abusive or violent behaviour.

You may have spoken with more than one officer or spoken with police about more than one incident, so answer each question thinking about your overall experience.
Overall, how satisfied were you with the actions that the police took?

  • 1: Very satisfied
  • 2: Somewhat satisfied
  • 3: Neither satisfied nor dissatisfied
  • 4: Somewhat dissatisfied
  • 5: Very dissatisfied

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q205A

[Other than the police, who else did you talk to/Who did you talk to] about the abusive or violent behaviour?

  • 11: A family member
  • 12: A friend or neighbour
  • 13: A co-worker
  • 14: A doctor or nurse
  • 15: A lawyer
  • 16: A priest, rabbi, imam, elder, or other spiritual advisor
  • 17: Other

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q205B

[Other than the police, who else did you talk to/Who did you talk to] about the abusive or violent behaviour?
OR

  • 18: Did not talk to anyone

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q210

During the past 12 months, did you ever contact or use any services for help because of the abusive or violent behaviour?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q215B

Did your use of these services have any of the following outcomes?

  • 12: Helped you financially or helped you ensure your financial security
  • 13: Helped with your physical or mental health and well-being
  • 14: Helped you with the criminal justice system process
  • 15: Ensured your safety or ensured the safety of your children
  • 16: Helped you leave your relationship
  • 17: Helped your partner
  • 18: Made you feel responsible for the violence you experienced
  • 19: Made you feel revictimized
  • 20: Other

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q215A

OR

  • 11: No outcome

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q220

Is there any reason why you didn't use any of these services?

  • 11: Didn't know of any services
  • 12: None available
  • 13: Waiting list
  • 14: Abusive or violent behaviour too minor
  • 15: Shame or embarrassment
  • 16: Wouldn't be believed
  • 17: Spouse or partner prevented you
  • 18: Distance from service
  • 19: Fear of losing financial support
  • 20: Fear of losing children
  • 21: Didn't want the relationship to end
  • 22: Didn't want or need help
  • 23: None available in my language
  • 24: Other

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q230B

At the time of the abusive or violent behaviour, how did this experience affect you emotionally?

  • 12: Not much
  • 13: Angry
  • 14: Upset, confused or frustrated
  • 15: Fearful
  • 16: More cautious or aware
  • 17: Shock or disbelief
  • 18: Hurt or disappointment
  • 19: Victimized
  • 20: Sleeping problems
  • 21: Depression or anxiety attacks
  • 22: Ashamed or guilty
  • 23: Afraid for your children
  • 24: Annoyed
  • 25: Lowered self esteem
  • 26: Lack of trust in others
  • 27: Problems relating to men or women
  • 28: Other

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q230A

OR

  • 11: Not at all

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q240

Now, some questions about longer-term effects of the abusive or violent behaviour you experienced.
In the past month, have you had nightmares about the abusive or violent behaviour or thought about it when you did not want to?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q250

Now, some questions about longer-term effects of the abusive or violent behaviour you experienced.
In the past month, have you tried hard not to think about the abusive or violent behaviour or went out of your way to avoid situations that reminded you of it?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q260

Now, some questions about longer-term effects of the abusive or violent behaviour you experienced.
In the past month, have you felt constantly on guard, watchful, or easily startled?

  • 1: Yes
  • 2: No

Experiences in intimate partner relationships - consequences (IPD3) - Question identifier:IPD3_Q270

Now, some questions about longer-term effects of the abusive or violent behaviour you experienced.
In the past month, have you felt numb or detached from others, activities, or your surroundings?

  • 1: Yes
  • 2: No

Harsh parenting (AYH)

Harsh parenting (AYH) - Question identifier:AYH_R010A

The next few questions are about events that may have happened before you were 15. Remember that all information provided is strictly confidential.

Harsh parenting (AYH) - Question identifier:AYH_R010B

Before age 15, how many times did your parents or other caregivers do any of the following?

Harsh parenting (AYH) - Question identifier:AYH_Q010

Spank you with their hand or slap you on your hand

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Harsh parenting (AYH) - Question identifier:AYH_Q020

Say things that really hurt your feelings

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Harsh parenting (AYH) - Question identifier:AYH_Q025

Made you feel like you were not wanted or loved

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Harsh parenting (AYH) - Question identifier:AYH_Q030

Did not take care of your basic needs, such as keeping you clean or providing food or clothing

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Harsh parenting (AYH) - Question identifier:AYH_Q040

Before age 15, how many times did you see or hear any of your parents or caregivers say hurtful or mean things to each other or to another adult in your home?

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Childhood experiences (CEX)

Childhood experiences (CEX) - Question identifier:CEX_Q010

Before age 15, how many times did any adult do any of the following to you?
a. Slap you on the face, head or ears, or hit you with something hard to hurt you

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Childhood experiences (CEX) - Question identifier:CEX_Q020

Before age 15, how many times did any adult do any of the following to you?
b. Push, grab, shove or throw something at you to hurt you

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Childhood experiences (CEX) - Question identifier:CEX_Q030

Before age 15, how many times did any adult do any of the following to you?
c. Kick, bite, punch, choke, burn you, or physically attack you in some way

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Childhood experiences (CEX) - Question identifier:CEX_Q040

Thinking about the most serious incident of physical assault before age 15, what was the adult's relationship to you?

  • 01: Your mother
  • 02: Your father
  • 03: Your step-mother
  • 04: Your step-father
  • 05: Your grandmother
  • 06: Your grandfather
  • 07: Your brother
  • 08: Your sister
  • 09: Other member of your family
  • 10: Your boyfriend or girlfriend
  • 11: Your ex-boyfriend or ex-girlfriend
  • 12: Your neighbour
  • 13: Your friend
  • 14: A family friend
  • 15: An acquaintance
  • 16: Your teacher, professor or tutor
  • 17: Your baby-sitter or nanny
  • 18: Your classmate
  • 19: Known by sight only
  • 20: A stranger
  • 21: Other

Childhood experiences (CEX) - Question identifier:CEX_Q045

Was this adult male or female?

  • 1: Male
  • 2: Female

Childhood experiences (CEX) - Question identifier:CEX_Q050

Before age 15, how many times did any adult do any of the following to you?
Force you or attempt to force you into any unwanted sexual activity, by threatening you, holding you down or hurting you in some way

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Childhood experiences (CEX) - Question identifier:CEX_Q060

Touch you against your will in any sexual way, meaning anything from unwanted touching or grabbing, to kissing or fondling

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Childhood experiences (CEX) - Question identifier:CEX_Q065

Thinking about the most serious incident of sexual assault before age 15, what was that adult's relationship to you?

  • 01: Your mother
  • 02: Your father
  • 03: Your step-mother
  • 04: Your step-father
  • 05: Your grandmother
  • 06: Your grandfather
  • 07: Your brother
  • 08: Your sister
  • 09: Other member of your family
  • 10: Your boyfriend or girlfriend
  • 11: Your ex-boyfriend or ex-girlfriend
  • 12: Your neighbour
  • 13: Your friend
  • 14: A family friend
  • 15: An acquaintance
  • 16: Your teacher, professor or tutor
  • 17: Your baby-sitter or nanny
  • 18: Your classmate
  • 19: Known by sight only
  • 20: A stranger
  • 21: Other

Childhood experiences (CEX) - Question identifier:CEX_Q068

Was this adult male or female?

  • 1: Male
  • 2: Female

Childhood experiences (CEX) - Question identifier:CEX_Q070A

Before age 15, did you ever see or talk to the police about any of the incidents you experienced?

  • 1: Yes
  • 2: No

Childhood experiences (CEX) - Question identifier:CEX_Q070B

Before age 15, did you ever see or talk to anyone from child protective services about any of the incidents you experienced?

  • 1: Yes
  • 2: No

Childhood experiences (CEX) - Question identifier:CEX_Q080

Before age 15, how many times did you see or hear any one of your parents, step-parents or guardians hit each other or another adult?

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Respondent was once the Legal Responsibility of the Government (LRG)

Respondent was once the Legal Responsibility of the Government (LRG) - Question identifier:LRG_Q10

As a child, were you ever under the legal responsibility of the government?

  • 1: Yes
  • 2: No

Homelessness (HOM)

Homelessness (HOM) - Question identifier:HOM_Q10

Have you ever been homeless; that is, having to live in a shelter, on the street, or in an abandoned building?

  • 1: Yes
  • 2: No

Homelessness (HOM) - Question identifier:HOM_Q17

Was this because you were leaving an emotionally abusive or physically violent situation?

  • 1: Yes
  • 2: No

Homelessness (HOM) - Question identifier:HOM_Q30

Have you ever had to temporarily live with family or friends, or anywhere else because you had nowhere else to live?

  • 1: Yes
  • 2: No

Homelessness (HOM) - Question identifier:HOM_Q37

Was this because you were leaving an emotionally abusive or physically violent situation?

  • 1: Yes
  • 2: No

Homelessness (HOM) - Question identifier:HOM_Q50

Have you ever temporarily lived somewhere other than your home because you were leaving an abusive or violent situation?

  • 1: Yes
  • 2: No

Self Rated Health (SRH)

Self Rated Health (SRH) - Question identifier:SRH_R110A

The following set of questions asks about your day-to-day health. By health, we mean not only the absence of disease or injury but also physical, mental and social well-being.

Self Rated Health (SRH) - Question identifier:SRH_Q110

In general, how would you rate your health?

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

Self Rated Health (SRH) - Question identifier:SRH_Q115

In general, how would you rate your mental health?

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

Life satisfaction of respondent (LSR)

Life satisfaction of respondent (LSR) - Question identifier:LSR_Q110

Using a scale of 0 to 10, where 0 means "Very dissatisfied" and 10 means "Very satisfied", how do you feel about your life as a whole right now?

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

Suicidal thoughts and attempts (SUI)

Suicidal thoughts and attempts (SUI) - Question identifier:SUI_R005

The following questions may be sensitive to some people, but the same questions have to be asked of everyone.

Suicidal thoughts and attempts (SUI) - Question identifier:SUI_Q005

Have you ever seriously contemplated suicide?

  • 1: Yes
  • 2: No

Disability screening questions (DSQ)

Disability screening questions (DSQ) - Question identifier:DSQ_R01

The following questions are about difficulties you may have doing certain activities. Only difficulties or long-term conditions that have lasted or are expected to last for six months or more should be considered.

Disability screening questions (DSQ) - Question identifier:DSQ_Q01

Do you have any difficulty seeing?

  • 1: No
  • 2: Sometimes
  • 3: Often
  • 4: Always
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q02

Do you wear glasses or contact lenses to improve your vision?

  • 1: Yes
  • 2: No
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q03

[With your glasses or contact lenses, which/Which] of the following best describes your ability to see?

  • 1: No difficulty seeing
  • 2: Some difficulty seeing
  • 3: A lot of difficulty seeing
  • 4: You are legally blind
  • 5: You are blind
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q04

How often does this [difficulty seeing/seeing condition] limit your daily activities?

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

Disability screening questions (DSQ) - Question identifier:DSQ_Q05

Do you have any difficulty hearing?

  • 1: No
  • 2: Sometimes
  • 3: Often
  • 4: Always
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q06

Do you use a hearing aid or cochlear implant?

  • 1: Yes
  • 2: No
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q07

[With your hearing aid or cochlear implant, which/Which] of the following best describes your ability to hear?

  • 1: No difficulty hearing
  • 2: Some difficulty hearing
  • 3: A lot of difficulty hearing
  • 4: You cannot hear at all
  • 5: You are Deaf
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q08

How often does this [difficulty hearing/hearing condition] limit your daily activities?

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

Disability screening questions (DSQ) - Question identifier:DSQ_Q09

Do you have any difficulty walking, using stairs, using your hands or fingers or doing other physical activities?

  • 1: No
  • 2: Sometimes
  • 3: Often
  • 4: Always
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_R10

The following questions are about your ability to move around, even when using an aid such as a cane.

Disability screening questions (DSQ) - Question identifier:DSQ_Q10

How much difficulty do you have walking on a flat surface for 15 minutes without resting?

  • 1: No difficulty
  • 2: Some difficulty
  • 3: A lot of difficulty
  • 4: You cannot do at all
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q11

How much difficulty do you have walking up or down a flight of stairs, about 12 steps without resting?

  • 1: No difficulty
  • 2: Some difficulty
  • 3: A lot of difficulty
  • 4: You cannot do at all
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q12

How often [does this difficulty walking/does this difficulty using stairs/do these difficulties] limit your daily activities?

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

Disability screening questions (DSQ) - Question identifier:DSQ_Q13

How much difficulty do you have bending down and picking up an object from the floor?

  • 1: No difficulty
  • 2: Some difficulty
  • 3: A lot of difficulty
  • 4: You cannot do at all
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q14

How much difficulty do you have reaching in any direction, for example, above your head?

  • 1: No difficulty
  • 2: Some difficulty
  • 3: A lot of difficulty
  • 4: You cannot do at all
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q15

How often [does this difficulty bending down and picking up an object/does this difficulty reaching/do these difficulties] limit your daily activities?

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

Disability screening questions (DSQ) - Question identifier:DSQ_Q16

How much difficulty do you have using your fingers to grasp small objects like a pencil or scissors?

  • 1: No difficulty
  • 2: Some difficulty
  • 3: A lot of difficulty
  • 4: You cannot do at all
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q17

How often does this difficulty using your fingers limit your daily activities?

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

Disability screening questions (DSQ) - Question identifier:DSQ_R18

The following questions are about pain due to a long-term condition that has lasted or is expected to last for six months or more.

Disability screening questions (DSQ) - Question identifier:DSQ_Q18

Do you have pain that is always present?

  • 1: Yes
  • 2: No
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q19

Do you [also/null] have periods of pain that reoccur from time to time?

  • 1: Yes
  • 2: No
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q20

How often does this pain limit your daily activities?

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

Disability screening questions (DSQ) - Question identifier:DSQ_Q21

When you are experiencing this pain, how much difficulty do you have with your daily activities?

  • 1: No difficulty
  • 2: Some difficulty
  • 3: A lot of difficulty
  • 4: You cannot do most activities
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_R22

Please answer only for difficulties or long-term conditions that have lasted or are expected to last for six months or more.

Disability screening questions (DSQ) - Question identifier:DSQ_Q22

Do you have any difficulty learning, remembering or concentrating?

  • 1: No
  • 2: Sometimes
  • 3: Often
  • 4: Always
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q23

Do you think you have a condition that makes it difficult in general for you to learn? This may include learning disabilities such as dyslexia, hyperactivity, attention problems, etc.

  • 1: Yes
  • 2: No
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q24

Has a teacher, doctor or other health care professional ever said that you had a learning disability?

  • 1: Yes
  • 2: No
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q25

How often are your daily activities limited by this condition?

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

Disability screening questions (DSQ) - Question identifier:DSQ_Q26

How much difficulty do you have with your daily activities because of this condition?

  • 1: No difficulty
  • 2: Some difficulty
  • 3: A lot of difficulty
  • 4: You cannot do most activities
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q27

Has a doctor, psychologist or other health care professional ever said that you had a developmental disability or disorder? This may include Down syndrome, autism, Asperger syndrome, mental impairment due to lack of oxygen at birth, etc.

  • 1: Yes
  • 2: No
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q28

How often are your daily activities limited by this condition?

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

Disability screening questions (DSQ) - Question identifier:DSQ_Q29

How much difficulty do you have with your daily activities because of this condition?

  • 1: No difficulty
  • 2: Some difficulty
  • 3: A lot of difficulty
  • 4: You cannot do most activities
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q30

Do you have any ongoing memory problems or periods of confusion?

  • 1: Yes
  • 2: No
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q31

How often are your daily activities limited by this problem?

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

Disability screening questions (DSQ) - Question identifier:DSQ_Q32

How much difficulty do you have with your daily activities because of this problem?

  • 1: No difficulty
  • 2: Some difficulty
  • 3: A lot of difficulty
  • 4: ^DT_DSQ_YOU_C cannot do most activities
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_R33

Please remember that your answers will be kept strictly confidential.

Disability screening questions (DSQ) - Question identifier:DSQ_Q33

Do you have any emotional, psychological or mental health conditions?

  • 1: No
  • 2: Sometimes
  • 3: Often
  • 4: Always
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q34

How often are your daily activities limited by this condition?

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

Disability screening questions (DSQ) - Question identifier:DSQ_Q35

When you are experiencing this condition, how much difficulty do you have with your daily activities?

  • 1: No difficulty
  • 2: Some difficulty
  • 3: A lot of difficulty
  • 4: You cannot do most activities
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q36

Do you have any other health problem or long-term condition that has lasted or is expected to last for six months or more?

  • 1: Yes
  • 2: No
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q37

How often does this health problem or long-term condition limit your daily activities?

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

Disability screening questions (DSQ) - Question identifier:DSQ_R38

The following questions are about pain due to a long-term condition that has lasted or is expected to last for six months or more.

Disability screening questions (DSQ) - Question identifier:DSQ_Q38

Do you have pain that is always present?

  • 1: Yes
  • 2: No
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q39

Do you [also/null] have periods of pain that reoccur from time to time?

  • 1: Yes
  • 2: No
  • 9: DK

Disability screening questions (DSQ) - Question identifier:DSQ_Q40

How often does this pain limit your daily activities?

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

Disability screening questions (DSQ) - Question identifier:DSQ_Q41

When you are experiencing this pain, how much difficulty do you have with your daily activities?

  • 1: No difficulty
  • 2: Some difficulty
  • 3: A lot of difficulty
  • 4: You cannot do most activities
  • 9: DK

Chronic Conditions (CCC)

Chronic Conditions (CCC) - Question identifier:CCC_R110A

The next questions are about certain long-term health conditions which you may have.

Long-term conditions are conditions which are expected to last or have already lasted 6 months or more and that have been diagnosed by a health professional.

Chronic Conditions (CCC) - Question identifier:CCC_R110B

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

Chronic Conditions (CCC) - Question identifier:CCC_Q110

Arthritis

  • 1: Yes
  • 2: No

Chronic Conditions (CCC) - Question identifier:CCC_Q120

Back problems

  • 1: Yes
  • 2: No

Chronic Conditions (CCC) - Question identifier:CCC_Q130

A mood disorder

  • 1: Yes
  • 2: No

Chronic Conditions (CCC) - Question identifier:CCC_Q140

An anxiety disorder

  • 1: Yes
  • 2: No

Chronic Conditions (CCC) - Question identifier:CCC_Q150

Post-traumatic stress disorder

  • 1: Yes
  • 2: No

Chronic Conditions (CCC) - Question identifier:CCC_Q160

Any other long-term physical or mental health condition that has been diagnosed by a health professional

  • 1: Yes
  • 2: No

Medication of Respondent (MED)

Medication of Respondent (MED) - Question identifier:MED_Q110

During the past month, have you used any medications that were prescribed or bought over-the-counter for any of the following reasons?

a. Help you sleep

  • 1: Yes
  • 2: No

Medication of Respondent (MED) - Question identifier:MED_Q120

B. Help you calm down

  • 1: Yes
  • 2: No

Medication of Respondent (MED) - Question identifier:MED_Q130

C. Help you get out of depression

  • 1: Yes
  • 2: No

Alcohol use and dependency (AUD)

Alcohol use and dependency (AUD) - Question identifier:AUD_Q100

During the past 12 months, how often did you drink alcoholic beverages?

  • 01: Never
  • 02: Less than once a month
  • 03: Once a month
  • 04: 2 to 3 times a month
  • 05: Once a week
  • 06: 2 to 3 times a week
  • 07: 4 to 6 times a week
  • 08: Every day

Alcohol use and dependency (AUD) - Question identifier:AUD_Q110

How often in the past 12 months have you had [4/5] or more drinks on one occasion?

  • 1: Never
  • 2: Less than once a month
  • 3: Once a month
  • 4: 2 to 3 times a month
  • 5: Once a week
  • 6: More than once a week

Alcohol use and dependency (AUD) - Question identifier:AUD_Q120

Was there ever a time in your life when your drinking caused arguments or other serious or repeated problems with your family, friends, neighbours, or co-workers?

  • 1: Yes
  • 2: No

Drug use of respondent (DUR)

Drug use of respondent (DUR) - Question identifier:DUR_R010

The following questions ask about the use of drugs. Please do not include medications that are taken on a doctor's prescription or bought over-the-counter.

Remember that all information provided is strictly confidential.

Drug use of respondent (DUR) - Question identifier:DUR_Q010

During the past 12 months, how often did you use marijuana, hashish, hash oil or other cannabis derivatives?

  • 01: Never
  • 02: Less than once a month
  • 03: Once a month
  • 04: 2 to 3 times a month
  • 05: Once a week
  • 06: 2 to 3 times a week
  • 07: 4 to 6 times a week
  • 08: Every day

Drug use of respondent (DUR) - Question identifier:DUR_Q020

During the past 12 months, how often did you use any other non prescribed drugs, for example: magic mushrooms, cocaine, speed, methamphetamine, ecstasy, PCP, mescaline, heroin or fentanyl?

  • 01: Never
  • 02: Less than once a month
  • 03: Once a month
  • 04: 2 to 3 times a month
  • 05: Once a week
  • 06: 2 to 3 times a week
  • 07: 4 to 6 times a week
  • 08: Every day

Drug use of respondent (DUR) - Question identifier:DUR_Q030

Have you ever used drugs or alcohol in order to help you cope with any emotional abuse or physical violence you have experienced in your lifetime?

  • 1: Yes
  • 2: No

Drug use of respondent (DUR) - Question identifier:DUR_Q040

Have you ever used drugs or alcohol in order to help you cope with any emotional abuse or physical violence you have experienced in the past 12 months?

  • 1: Yes
  • 2: No

Immigration extended block (BPR)

Immigration extended block (BPR) - Question identifier:BPR_Q01

In what country were you born?

Long Answer Length = 80

Immigration extended block (BPR) - Question identifier:BPR_Q02

In which province or territory were you born?

  • 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

Immigration extended block (BPR) - Question identifier:BPR_Q15

In what year did you first come to Canada to live?

Min = 0; Max = 9999

Immigration extended block (BPR) - Question identifier:BPR_Q16

Are you now, or have you ever been a landed immigrant in Canada?

  • 1: Yes
  • 2: No

Immigration extended block (BPR) - Question identifier:BPR_Q17

In what year did you first become a landed immigrant in Canada?

Min = 0; Max = 9999

Immigration extended block (BPR) - Question identifier:BPR_Q18

Of what country are you a citizen?
First citizenship

Long Answer Length = 80

Immigration extended block (BPR) - Question identifier:BPR_Q19

Of what country are you a citizen?
Second citizenship (if applicable)

Long Answer Length = 80

Immigration extended block (BPR) - Question identifier:BPR_Q20

Of what country are you a citizen?
Third citizenship (if applicable)

Long Answer Length = 80

Birthplace of spouse/Partner (BPP)

Birthplace of spouse/Partner (BPP) - Question identifier:BPP_Q10

In what country was your [spouse/partner] born?

Long Answer Length = 80

Aboriginal Extended (AEB)

Aboriginal Extended (AEB) - Question identifier:AEB_Q01

Are you an Aboriginal person, that is, First Nations, Métis or Inuk (Inuit)?

  • 1: Yes
  • 2: No

Aboriginal Extended (AEB) - Question identifier:AEB_Q02

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

  • 1: First Nations (North American Indian)
  • 2: Métis
  • 3: Inuk (Inuit)

Aboriginal Extended (AEB) - Question identifier:AEB_Q03

Are you a Status Indian, that is, a Registered or Treaty Indian as defined by the Indian Act of Canada?

  • 1: Yes, Status Indian (Registered or Treaty)
  • 2: No

Aboriginal Extended (AEB) - Question identifier:AEB_Q04

Are you a member of a First Nation or Indian band?

  • 1: Yes
  • 2: No

Aboriginal Identity of spouse/Partner (AIP)

Aboriginal Identity of spouse/Partner (AIP) - Question identifier:AIP_Q01

Is your [spouse/partner] an Aboriginal person that is, First Nations, Métis or Inuk [Inuit]?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Aboriginal Identity of spouse/Partner (AIP) - Question identifier:AIP_Q02

Is your DT_MSTATUS_E First Nations, Métis or Inuk (Inuit)?

  • 1: First Nations (North American Indian)
  • 2: Métis
  • 3: Inuk (Inuit)

Population Group (PG)

Population Group (PG) - Question identifier:PG_Q01

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: Latin American
  • 07: Arab
  • 08: Southeast Asian (e.g., Vietnamese, Cambodian, Laotian, Thai)
  • 09: West Asian (e.g., Iranian, Afghan)
  • 10: Korean
  • 11: Japanese
  • 12: Other

Visible Minority status of respondent's spouse/Partner (VMP)

Visible Minority status of respondent's spouse/Partner (VMP) - Question identifier:VMP_Q01

Is your [spouse/partner]
Select up to 4 responses

  • 01: White
  • 02: South Asian (e.g., East Indian, Pakistani, Sri Lankan)
  • 03: Chinese
  • 04: Black
  • 05: Filipino
  • 06: Latin American
  • 07: Arab
  • 08: Southeast Asian (e.g., Vietnamese, Cambodian, Laotian, Thai)
  • 09: West Asian (e.g., Iranian, Afghan)
  • 10: Korean
  • 11: Japanese
  • 12: Other

Religion extended (REM)

Religion extended (REM) - Question identifier:REM_Q01A

What is your religion?
Religion

  • 1: Use the Religion.xlsx list to display a searchable dropdown in the provided order

Religion extended (REM) - Question identifier:REM_Q01B

What is your religion?
Specify your religion

Long Answer Length = 80

Importance of Religion (RLR)

Importance of Religion (RLR) - Question identifier:RLR_Q110

How important are your religious or spiritual beliefs to the way you live your life?

  • 1: Very important
  • 2: Somewhat important
  • 3: Not very important
  • 4: Not important at all

Language Minimum (LAN)

Language Minimum (LAN) - Question identifier:LAN_Q01

Of English or French, which language(s) do you speak well enough to conduct a conversation?

  • 1: English only
  • 2: French only
  • 3: Both English and French
  • 4: Neither English nor French

Language Minimum (LAN) - Question identifier:LAN_Q10A

What language do you speak most often at home?
First language

  • 1: Use the Language.xlsx list to display a searchable dropdown in alphabetical order

Language Minimum (LAN) - Question identifier:LAN_Q10B

What language do you speak most often at home?
Specify the language

Long Answer Length = 80

Language Minimum (LAN) - Question identifier:LAN_Q11A

What language do you speak most often at home?
Second language (if applicable)

  • 1: Use the Language.xlsx list to display a searchable dropdown in alphabetical order

Language Minimum (LAN) - Question identifier:LAN_Q11B

What language do you speak most often at home?
Specify the language

Long Answer Length = 80

Language Minimum (LAN) - Question identifier:LAN_Q12A

What language do you speak most often at home?
Third language (if applicable)

  • 1: Use the Language.xlsx list to display a searchable dropdown in alphabetical order

Language Minimum (LAN) - Question identifier:LAN_Q12B

What language do you speak most often at home?
Specify the language

Long Answer Length = 80

Language Minimum (LAN) - Question identifier:LAN_Q15A

What is the language that you first learned at home in childhood and still understand?
First language

  • 1: Use the Language.xlsx list to display a searchable dropdown in alphabetical order

Language Minimum (LAN) - Question identifier:LAN_Q15B

What is the language that you first learned at home in childhood and still understand?
Specify the language

Long Answer Length = 80

Language Minimum (LAN) - Question identifier:LAN_Q16A

What is the language that you first learned at home in childhood and still understand?
Second language (if applicable)

  • 1: Use the Language.xlsx list to display a searchable dropdown in alphabetical order

Language Minimum (LAN) - Question identifier:LAN_Q16B

What is the language that you first learned at home in childhood and still understand?
Specify the language

Long Answer Length = 80

Language Minimum (LAN) - Question identifier:LAN_Q17A

What is the language that you first learned at home in childhood and still understand?
Third language (if applicable)

  • 1: Use the Language.xlsx list to display a searchable dropdown in alphabetical order

Language Minimum (LAN) - Question identifier:LAN_Q17B

What is the language that you first learned at home in childhood and still understand?
Specify the language

Long Answer Length = 80

Personal and household income (INR)

Personal and household income (INR) - Question identifier:INR_Q025

What was your main source of income during the year ending December 31, 2017?

  • 01: No income
  • 02: Employment (Include wages, salaries, commissions and tips)
  • 03: Self-employment (e.g., unincorporated business, professional practice or farm)
  • 04: Investment income (e.g., dividends, interest, net rents from real estate)
  • 05: RRSPs or RRIFs
  • 06: Employment Insurance or Quebec Parental Insurance Plan
  • 07: Workers' Compensation
  • 08: Benefits from Canada or Quebec Pension Plan
  • 09: Retirement pensions, superannuation and annuities
  • 10: Basic Old Age Security
  • 11: Guaranteed Income Supplement or Survivor's Allowance (Include from federal government only)
  • 12: Child Tax Benefit or family allowances
  • 13: Provincial, territorial or municipal social assistance or welfare
  • 14: Child Support or alimony
  • 15: Other

Personal and household income (INR) - Question identifier:INR_Q032A

What is your best estimate of your total personal income, before taxes and deductions, from all sources during the year ending December 31, 2017?

Min = -9999999; Max = 9999999

Personal and household income (INR) - Question identifier:INR_Q032B

OR

  • 09: Don't know

Personal and household income (INR) - Question identifier:INR_Q033

In which of the following groups did your total personal income fall for the year ending December 31, 2017?

  • 1: Less than $30,000 including income loss
  • 2: $30,000 or more

Personal and household income (INR) - Question identifier:INR_Q034

In which of the following groups did your total personal income fall for the year ending December 31, 2017?

  • 1: Less than $5,000
  • 2: $5,000 to less than $10,000
  • 3: $10,000 to less than $15,000
  • 4: $15,000 to less than $20,000
  • 5: $20,000 to less than $25,000
  • 6: $25,000 to less than $30,000

Personal and household income (INR) - Question identifier:INR_Q035

In which of the following groups did your total personal income fall for the year ending December 31, 2017?

  • 1: $30,000 to less than $40,000
  • 2: $40,000 to less than $50,000
  • 3: $50,000 to less than $60,000
  • 4: $60,000 to less than $80,000
  • 5: $80,000 to less than $100,000
  • 6: $100,000 to less than $150,000
  • 7: $150,000 or more

Personal and household income (INR) - Question identifier:INR_Q040

Not including you, how many other household members received income from any source during the year ending December 31, 2017?

  • 01: 0
  • 02: 1
  • 03: 2
  • 04: 3
  • 05: 4
  • 06: 5
  • 07: 6
  • 08: 7
  • 09: 8
  • 10: 9
  • 11: 10
  • 12: 11
  • 13: 12
  • 14: 13
  • 15: 14
  • 16: 15
  • 17: 16
  • 18: 17
  • 19: 18
  • 20: 19

Personal and household income (INR) - Question identifier:INR_Q110A

What is your best estimate of your total household income, received by all household members, from all sources, before taxes and deductions, during the year ending December 31, 2017?

Min = -9999999; Max = 9999999

Personal and household income (INR) - Question identifier:INR_Q110B

OR

  • 09: Don't know

Personal and household income (INR) - Question identifier:INR_Q120

In which of the following groups did your total household income fall for the year ending December 31, 2017?

  • 1: Less than $50,000 including income loss
  • 2: $50,000 or more

Personal and household income (INR) - Question identifier:INR_Q130

In which of the following groups did your total household income fall for the year ending December 31, 2017?

  • 1: Less than $5,000
  • 2: $5,000 to less than $10,000
  • 3: $10,000 to less than $15,000
  • 4: $15,000 to less than $20,000
  • 5: $20,000 to less than $30,000
  • 6: $30,000 to less than $40,000
  • 7: $40,000 to less than $50,000

Personal and household income (INR) - Question identifier:INR_Q140

In which of the following groups did your total household income fall for the year ending December 31, 2017?

  • 1: $50,000 to less than $60,000
  • 2: $60,000 to less than $70,000
  • 3: $70,000 to less than $80,000
  • 4: $80,000 to less than $90,000
  • 5: $90,000 to less than $100,000
  • 6: $100,000 to less than $150,000
  • 7: $150,000 and over

Record linkage statement (RLS)

Record linkage statement (RLS) - Question identifier:RLS_Q01

To enhance the data from this survey and to reduce the reporting burden, Statistics Canada will combine the information you provide with information from the tax data of all members of your household. Statistics Canada may also combine the information you provide with other survey or administrative data sources.

  • 1: Continue
  • 2: Respondent does not want his/her responses combined with other sources
  • 3: Other (e.g., respondent hung up, interview suspended / interrupted)

Record linkage statement (RLS) - Question identifier:RLS_Q02

To enhance the data from this survey and to reduce the reporting burden, Statistics Canada may combine the information you provide with other survey or administrative data sources.

  • 1: Continue
  • 2: Respondent does not want his/her responses combined with other sources
  • 3: Other (e.g., respondent hung up, interview suspended / interrupted)

Exit questions (XQ)

Exit questions (XQ) - Question identifier:XQ_R01B

Telephone number

Exit questions (XQ) - Question identifier:XQ_R01C

Telephone type

Exit questions (XQ) - Question identifier:XQ_R01D

A. Telephone number 1

Exit questions (XQ) - Question identifier:XQ_Q01AA

And finally, in order to prevent [you/your household] from being selected more than once for this survey, please list all [your telephone numbers/the telephone numbers in your household]:
Pre-fill with ^CMP_Contact1_PhoneNumber1

Long Answer Length = 10

Exit questions (XQ) - Question identifier:XQ_Q01AB

And finally, in order to prevent [you/your household] from being selected more than once for this survey, please list all [your telephone numbers/the telephone numbers in your household]:
Default Display for the answer type is <<< Select >>>

  • 1: Cellular telephone
  • 2: Landline telephone

Exit questions (XQ) - Question identifier:XQ_R01E

B. Telephone number 2

Exit questions (XQ) - Question identifier:XQ_Q01BA

And finally, in order to prevent [you/your household] from being selected more than once for this survey, please list all [your telephone numbers/the telephone numbers in your household]:
Pre-fill with ^CMP_Contact1_PhoneNumber2

Long Answer Length = 10

Exit questions (XQ) - Question identifier:XQ_Q01BB

And finally, in order to prevent [you/your household] from being selected more than once for this survey, please list all [your telephone numbers/the telephone numbers in your household]:
Default Display for the answer type is <<< Select >>>

  • 1: Cellular telephone
  • 2: Landline telephone

Exit questions (XQ) - Question identifier:XQ_R01F

C. Telephone number 3

Exit questions (XQ) - Question identifier:XQ_Q01CA

And finally, in order to prevent [you/your household] from being selected more than once for this survey, please list all [your telephone numbers/the telephone numbers in your household]:
Pre-fill with ^CMP_Contact1_PhoneNumber3

Long Answer Length = 10

Exit questions (XQ) - Question identifier:XQ_Q01CB

And finally, in order to prevent [you/your household] from being selected more than once for this survey, please list all [your telephone numbers/the telephone numbers in your household]:
Default Display for the answer type is <<< Select >>>

  • 1: Cellular telephone
  • 2: Landline telephone

Exit questions (XQ) - Question identifier:XQ_R01G

D. Telephone number 4

Exit questions (XQ) - Question identifier:XQ_Q01DA

And finally, in order to prevent [you/your household] from being selected more than once for this survey, please list all [your telephone numbers/the telephone numbers in your household]:
Pre-fill with ^CMP_Contact1_PhoneNumber4

Long Answer Length = 10

Exit questions (XQ) - Question identifier:XQ_Q01DB

And finally, in order to prevent [you/your household] from being selected more than once for this survey, please list all [your telephone numbers/the telephone numbers in your household]:
Default Display for the answer type is <<< Select >>>

  • 1: Cellular telephone
  • 2: Landline telephone

Exit questions (XQ) - Question identifier:XQ_R01H

E. Telephone number 5

Exit questions (XQ) - Question identifier:XQ_Q01EA

And finally, in order to prevent [you/your household] from being selected more than once for this survey, please list all [your telephone numbers/the telephone numbers in your household]:
Pre-fill with ^CMP_Contact1_PhoneNumber5

Long Answer Length = 10

Exit questions (XQ) - Question identifier:XQ_Q01EB

And finally, in order to prevent [you/your household] from being selected more than once for this survey, please list all [your telephone numbers/the telephone numbers in your household]:
Default Display for the answer type is <<< Select >>>

  • 1: Cellular telephone
  • 2: Landline telephone

Exit questions (XQ) - Question identifier:XQ_R01I

F. Telephone number 6

Exit questions (XQ) - Question identifier:XQ_Q01FA

And finally, in order to prevent [you/your household] from being selected more than once for this survey, please list all [your telephone numbers/the telephone numbers in your household]:
Pre-fill with ^CMP_Contact1_PhoneNumber6

Long Answer Length = 10

Exit questions (XQ) - Question identifier:XQ_Q01FB

And finally, in order to prevent [you/your household] from being selected more than once for this survey, please list all [your telephone numbers/the telephone numbers in your household]:
Default Display for the answer type is <<< Select >>>

  • 1: Cellular telephone
  • 2: Landline telephone

Exit questions (XQ) - Question identifier:XQ_R01J

G. Telephone number 7

Exit questions (XQ) - Question identifier:XQ_Q01GA

And finally, in order to prevent [you/your household] from being selected more than once for this survey, please list all [your telephone numbers/the telephone numbers in your household]:
Pre-fill with ^CMP_Contact1_PhoneNumber7

Long Answer Length = 10

Exit questions (XQ) - Question identifier:XQ_Q01GB

And finally, in order to prevent [you/your household] from being selected more than once for this survey, please list all [your telephone numbers/the telephone numbers in your household]:
Default Display for the answer type is <<< Select >>>

  • 1: Cellular telephone
  • 2: Landline telephone

Exit questions (XQ) - Question identifier:XQ_R01K

H. Telephone number 8

Exit questions (XQ) - Question identifier:XQ_Q01HA

And finally, in order to prevent [you/your household] from being selected more than once for this survey, please list all [your telephone numbers/the telephone numbers in your household]:
Pre-fill with ^CMP_Contact1_PhoneNumber8

Long Answer Length = 10

Exit questions (XQ) - Question identifier:XQ_Q01HB

And finally, in order to prevent [you/your household] from being selected more than once for this survey, please list all [your telephone numbers/the telephone numbers in your household]:
Default Display for the answer type is <<< Select >>>

  • 1: Cellular telephone
  • 2: Landline telephone

Exit questions (XQ) - Question identifier:XQ_R01L

I. Telephone number 9

Exit questions (XQ) - Question identifier:XQ_Q01IA

And finally, in order to prevent [you/your household] from being selected more than once for this survey, please list all [your telephone numbers/the telephone numbers in your household]:
Pre-fill with ^CMP_Contact1_PhoneNumber9

Long Answer Length = 10

Exit questions (XQ) - Question identifier:XQ_Q01IB

And finally, in order to prevent [you/your household] from being selected more than once for this survey, please list all [your telephone numbers/the telephone numbers in your household]:
Default Display for the answer type is <<< Select >>>

  • 1: Cellular telephone
  • 2: Landline telephone
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