The balance sheet is derived, for the most part, using data already produced by the Agriculture Division. Since the capital value series uses reference data at July 1 while the balance sheet uses data at December 31, estimates for the two series are not the same. Also, the capital value series includes the personal share of assets while the balance sheet (set 2) excludes it.

In this series, data are provided only for the Balance Sheet of the Agricultural Sector (set 2). This is because set 2 most closely reflects the assets employed in the production of agricultural products. The other sets of balance sheet accounts are available on request. The four sets of aggregate balance sheets produced for Canadian agriculture are described in the attached document: Description of assets, liabilities, equity, and financial ratios.

Although not published in the capital value series, the components of farm real estate, machinery and livestock are available as a result of the estimation process used to derive the capital value and depreciation series. The business share of homes, autos and trucks are estimated using the same assumptions used in the depreciation series.

The value of assets obtained from the capital value and depreciation series represents roughly 90% of the total value of assets in the balance sheet. These estimates are considered to be of good quality. Further data quality is available by referring to the Value of farm capital (record number 3471) and Farm operating expenses and depreciation charges (record number 5214).

The other long-term assets, which include long-term investments as well as AgriInvest balances, represent roughly 1%.

The year-end value of crops, obtained from the Farm Prices Unit, represents roughly 3% of the total values of assets, and is considered to be of good quality.

The other four components of assets (cash, bonds and savings; accounts receivable; inputs; and quota) represent roughly 7% of the value of total assets. They are derived using Farm Credit Canada (FCC) survey data for the years 1980, 1983, 1987, 1989 and 1991 and the Farm Financial Survey (FFS) since 1993. In intervening years, interpolations are made.

Total liabilities are derived from the debt outstanding series of the Farm debt outstanding (record number 3472). Total debt outstanding is split between current and long-term liabilities using ratios derived from the FCC or FFS survey data. These sources are considered to be of good quality.

The personal share of long-term debt is excluded using the ratio of farm real estate excluding the personal share to farm real estate including it. It is assumed that none of the current liabilities are for personal use. These assumptions are considered reasonable.

Estimates of the balance sheet components are calculated for each province and year. Canada level estimates are derived by summing provincial estimates. Annual financial ratios are calculated separately for each province and Canada.

As the balance sheet is essentially an integrated account, incorporating data from other data series, the revision process is determined by the various sources (farm debt outstanding, farm capital value, and value added account). For a better understanding of this process, users should refer to the section of the concepts and methods of these bulletins.

Current assets are the sum of cash, bonds, and savings; accounts receivable; and inventories.

Cash, bonds, and savings estimates for sets 1 and 3 are based on FCC or FFS survey data. For sets 2 and 4, adjustments are made to exclude the personal share of farm household cash, bonds and savings. It is assumed that two-thirds of the total cash, bonds, and savings relate to the personal share of farm households. This assumption is based on U.S. farm balance sheet data. Thus, two-thirds of the estimate is deducted to exclude the personal share of farm households.

Accounts receivable estimates are based on FCC or FFS survey data. There is no adjustment between sets.

Inventory estimates are based on several sources including the Production of Poultry and Eggs survey (record number 5039) and the  Biannual Livestock Survey (record number 3460)  There are three components of inventories: poultry and market livestock; crops; and inputs. All of the value of inventories is assumed to pertain to farm businesses. Estimates for sets 2, 3 and 4 are the same as those for set 1.

The year-end value of poultry and market livestock is the sum of year-end values for poultry plus market livestock. These are derived by multiplying inventory figures by value per head data (from administrative sources). Market livestock include beef slaughter heifers, steers, calves, pigs other than boars or sows, and market lambs. The value of fur animals intended for pelting is not calculated separately as most fur animals are pelted in the fall.

The value of crops is derived by adding year-end values for wheat excluding durum, durum wheat, oats, barley, rye, corn, flaxseed, canola, soybeans, mustard seed, canary seed, sunflower seed, dry peas, chickpeas, lentils, tobacco, and potatoes. These year-end values are derived by multiplying averages of December and January prices by year-end stocks estimates.

Estimates of the value of inputs are based on FCC or FFS survey data.

Prior to 1991, the value of household contents is derived from the value of homes. Household contents are assumed to be 60% of the value of homes. This assumption is based on the structure of home insurance policy packages where coverage on contents is generally insured at 60% of the dwelling value. For each set, the value of household contents is calculated to be 60% of the corresponding value of homes. As described later, the value of homes estimate varies from set to set as adjustments are made to exclude the personal share and the portion leased from non-operator landlords.

Quota estimates for all sets are based on FCC or FFS survey data.

For all sets the year-end value of breeding livestock is the sum of year-end values for bulls, dairy cows, beef cows, dairy heifers, beef replacement heifers, boars, sows, rams, ewes, replacement lambs and breeding stock on fur farms. These are derived by multiplying inventory values by value per head data (from administrative sources). The value of animals on fur farms is derived by multiplying the number of animals on farms at year end by a value per head which is based on changes in pelt prices. Data for animals on fur farms are obtained from the Livestock Section of Agriculture Division and may include some animals which were not pelted during the normal fall pelting season.

There are three components of machinery: autos, trucks, and other machinery.

Auto and truck estimates for sets 1 and 3, as well as other machinery estimates for all sets, are derived from Agriculture Division's capital value series (included in this publication). July 1 values are averaged to estimate year-end values. For the most current year, the July 1 value is used as a proxy for the year-end value. Auto and truck estimates for sets 2 and 4 exclude the personal share of farm operator households.

There are three components of farm real estate: land, service buildings and homes. Estimates of these values for set 1 are derived from Agriculture Division's capital value of land and buildings series. July 1 values are averaged to estimate year-end values. For the most current year, the July 1 value is used as a proxy for the year-end value.

For set 2, the values of land and service buildings are the same as those in set 1. The farm business portion of homes is derived by multiplying the value of homes in set 1 by 15%. It is assumed that 15% of the farm operator's home is used for farm business purposes. This approach is consistent with that used in related series.

For set 3, the value of farm real estate owned by nonoperator landlords is excluded by multiplying estimates of land, service buildings and homes from set 1 by annual provincial ratios. These ratios are based on land tenure data from the FCC or FFS surveys.

For set 4, both the personal household share of the value of homes and the value of real estate leased from nonoperator landlords need to be excluded. Estimates of the value of land and service buildings are the same as those for set 3, but the value of homes from set 3 is multiplied by 15% to obtain the business share.

Other long-term assets include long-term investments based on the Farm Financial Survey, as well as AgriInvest balances (beginning in 2008). Prior to the end of the programs in 2007, and the subsequent closure of all the producer accounts in 2009, Net Income Stabilization Account (NISA) balances and, in Québec, balances in the "Compte de stabilisation du revenu agricole" (CSRA), were also included. AgriInvest, CSRA and NISA balances are all from administrative data. This series starts in 1991.

Total assets are the sum of current assets, quota, breeding livestock, machinery, farm real estate and other long-term assets.

Current liabilities are based on Agriculture Division's total debt outstanding series. Estimates of total debt outstanding for each province are multiplied by ratios of current debt to total debt which are derived from FCC or FFS survey data. No adjustments are made.

For set 1, long-term liabilities are calculated as total debt outstanding less current liabilities. Long-term liabilities are then adjusted to exclude the portions for non-operator landlords and farm operator households.

For set 2, the value of long-term liabilities (excluding the farm household) is calculated by multiplying estimates of long-term liabilities from set 1, by the ratio of the total value of farm real estate from set 2 (which excludes households), to the total value of farm real estate including households from set 1.

For set 3, the value of long-term liabilities (excluding the non-operator landlord's share) is calculated by multiplying estimates of long-term liabilities from set 1, by the ratio of the total value of farm real estate from set 3 (which excludes the non-operator landlord's share), to the total value of farm real-estate including the non-operator landlord's share from set 1.

For set 4, the non-operator landlord's share and the personal household share of long-term liabilities are both excluded. Values of long-term liabilities from set 3 (which exclude the non-operator landlord's share), are multiplied by the ratio of the total value of farm real estate from set 4 (which excludes the farm household), to the total value of farm real estate including the farm households from set 3.

Total liabilities are the sum of current and long term liabilities.

Equity equals total assets less total liabilities.

The balance sheet is used to derive all of the liquidity and solvency ratios.

To calculate the profitability and financial efficiency ratios, the balance sheet and the value added account are both used.

The current ratio (CA/CL) is calculated as current assets (CA) divided by current liabilities (CL).

The acid-test (quick) ratio [(C+AR)/CL] is cash and marketable securities plus accounts receivable, divided by current liabilities. To calculate this ratio, the value of cash, bonds and savings (C) is used as a proxy for cash plus marketable securities. The acid-test ratio is calculated as cash, bonds and savings (C) plus accounts receivable (AR), divided by current liabilities (CL).

The debt structure ratio (CL/TL) is the current liabilities (CL) divided by total liabilities (TL).

The leverage ratio (TL/E) is calculated as total liabilities (TL) divided by equity (E).

The equity ratio (E/TA) equals equity (E) divided by total assets (TA).

The debt ratio (TL/TA) is calculated as total liabilities (TL) divided by total assets (TA).

The capital turnover ratio (R/TA) is calculated as revenue divided by total assets. For our purposes, revenue (R) is derived from the value added account by summing: sales of agricultural products, sales of non-agricultural products, and other sources of the value of production. The value used for total assets (TA) is the value of total assets at the beginning of the period in which revenues were earned (i.e. the value of total assets at December 31 of the previous year).

Return on assets equals net income before taxes (NIBT) plus interest (I) expense divided by average total assets (ATA). For set 1, net income before taxes plus interest expense is derived from the value added series by adding rent to non-operators, corporate profits, wages to family, unincorporated operator returns and interest. For sets 2 and 4, wages to family are not included. Rent to nonoperators is not included for sets 3 and 4. Average total assets (ATA) are calculated as the average of total assets at the beginning and end of the year. Thus, return on assets is calculated as [(NIBT+I)/ATA].

Return on equity consists of net income divided by average equity. Because of the difficulty involved in separating the value of income taxes attributable to farm income from that attributable to non-farm income, income tax expense cannot be estimated for the agricultural sector. Thus, net income after taxes cannot be estimated for the agricultural sector, so net income before taxes (NIBT) is used a proxy for net income. For set 1, net income before taxes is derived from the value added series by adding rent to non-operators, corporate profits, wages to family, and unincorporated operator returns. For sets 2 and 4, wages to family are not included. Rent to nonoperators is not included for sets 3 and 4. Average equity (AE) is calculated as the average of equity at the beginning and end of the year. Thus, return on equity is calculated as (NIBT/AE).

The interest coverage ratio [(NIBT+I)/I] is defined as net income before taxes plus interest expense, divided by interest expense. The method for deriving the numerator (NIBT+I) is described in the earlier paragraph on the return on assets. The denominator (interest expense) is also from the value added account.

Center for Energy and Transportation Statistics (CETS)
Energy Section

I. Who should complete this questionnaire?

An engineer, a production manager, an operation manager or someone knowledgeable about the energy consumption and production process of this establishment should complete this questionnaire.

II. Reporting instructions

Please report all quantities of energy commodities consumed from the 1st of January to the 31st of December, be they purchased or self-generated by the industrial establishment. Exclude energy used by contractors, common carriers and suppliers. Round all data to the nearest whole number. If you need assistance, please contact Statistics Canada at the telephone number indicated on your questionnaire.

III. Retention

Please keep a copy of the completed questionnaire with your secure records.

IV. Definitions

Type of energy use

Amount consumed as fuel: The quantity of the energy commodity used to power the production process of the plant, which includes heating and transportation at the establishment.

Amount consumed to produce steam for sale: The quantity of the energy commodity used in the production of steam that is delivered to another establishment, as per a sales contract or other understanding. Energy used in the production of steam that is then used internally in the production process is reported in the "amount consumed as fuel" column.

Amount consumed to produce electricity: The quantity of the energy commodity used to generate electricity either for the plant's own use or for delivery to another establishment, as per a sales contract or other understanding.

Amount consumed for non-energy use: The quantity of the energy commodity used for other purposes than As Fuel in the plant production process or to Produce Electricity or Steam. Some examples of energy commodities used for non-energy use are:

• Natural gas used as a reducing agent to produce direct reduced iron (DRI)
• Petroleum coke used as feed to reduce lead oxide in lead production
• Natural gas used as feed to produce hydrogen and ammonia
• Anthracite used as feed (as a reducing agent) to produce ferrosilicon and silicon metal
• Heavy fuel oil consumed as feed to produce other products.
• Refuse consumed as feed to produce other products.
• Diesel consumed as feed to produce other products.
• Propane consumed as feed to produce other products.

Electricity Generated

Please report the total amount of electricity generated, whether used within the plant or sold.

Type of energy consumed

Please report your energy use according to the following commodity definitions.

Section 1

Electricity: A form of energy generated by friction, induction or chemical change that is caused by the presence and motion of elementary-charged particles. The electricity that is consumed can either be received by the establishment (purchased) or produced by the establishment (self-generated).

Natural gas: A mixture of hydrocarbons, comprised principally of methane (CH4), originating in the gaseous phase or in solution with crude oil in porous geologic formations beneath the earth's surface.

Propane: A gaseous, straight-chained hydrocarbon. A colourless, paraffinic gas extracted from natural gas or refinery gas streams, consisting of molecules composed of three atoms of carbon and eight atoms of hydrogen (C3H8). Used primarily in residential and commercial heating and cooling, as transportation fuel and petrochemical feedstock.

Middle distillates (diesel, light fuel oil, kerosene)

Heavy fuel oil (Canadian/Foreign): All grades of residual type fuels including those with low sulphur content. Usually used for steam and electric power generation and diesel motors. Includes heavy fuel oil nos. 4, 5, 6 and bunker C.

Wood and wood waste: Wood and wood energy used as fuel, including round wood (cord wood), lignin, wood scraps from furniture and window frame manufacturing, wood chips, bark, sawdust, shavings, lumber rejects, forest residues, charcoal and pulp waste from the operation of pulp mills, sawmills and plywood mills.

Spent pulping liquor (Black liquor): A recycled by-product formed during the pulping of wood in the paper-making process. It is primarily made up of lignin and other wood constituents and chemicals that are by-products of the manufacture of chemical pulp. It is burned As Fuel or in a recovery boiler which produces steam which can be used to produce electricity.

Refuse: Solid or liquid waste materials used as a combustible energy source. This would include the burning of wastepaper, packing materials, garbage and other industrial, agricultural and urban refuse and is often used to generate electricity. Please specify type.

Steam: A gas resulting from the vaporization of a liquid or the sublimation of a solid, generated by condensing or non-condensing turbines. The steam that is consumed can either be produced by the establishment (self-generated) or received by the establishment (purchased). Report steam used as fuel for the production process, and steam used for atomization or as feed in process application as non energy use. However, steam consumed for own use should not be.

Special note: the fuels used to generate steam within the establishment should be reported under "as fuel" for those fuels. For example, if 100 cubic metres of heavy fuel oil was used to produce steam, the heavy fuel oil consumption should be reported under "as fuel". The consumption of the self-generated steam should be reported under the steam consumption section.

Amount consumed as fuel: The quantity of the energy commodity used to power production processes, heating, on-site transportation.

Amount consumed to produce electricity: The quantity of the energy commodity used to generate electricity either for the plant's own use or for delivery to another establishment, as per a sales contract or other understanding.

Amount consumed for non-energy use: The quantity of the energy commodity used for other purposes than as fuel in the plant production process or to produce electricity or steam. For example, steam used as feed to produce other products.

Section 2

Coal: A readily combustible, black or brownish-black rock-like substance, whose composition, including inherent moisture, consists of more than 50% by weight and 70% by volume of carbonaceous material. It is formed from plant remains that have been compacted, hardened, chemically altered and metamorphosed by heat and pressure over geologic time without access to air.

Bituminous coal (Canadian / Foreign): A dense, black coal, often with well-defined bands of bright and dull material with a moisture content usually less than 20 per cent. It has a higher heating value and higher volatile matter and ash content than sub-bituminous coal; the heating value of bituminous coal typically ranges from 23.3 to 30.2 terajoules per kilotonne. Used in making coke, in steam and electricity production, as well as in the production of steel. Metallurgical coal is typically bituminous coal.

Sub-bituminous coal (Canadian / Foreign): A black coal used primarily for thermal generation. It has a high moisture content, between 15 and 40 percent by weight. Its sulphur content is typically quite low; its ash content is also usually low but volatile matter is usually high and can exceed 40% of the weight. Heating value varies from 16.3 terajoules per kilotonne to slightly over 20.9 terajoules per kilotonne.

Lignite: Low-rank, brown coals which are distinctly brown and woody or claylike in appearance, and which contain relatively high moisture contents (between 30 and 70 percent of the fuel by weight). Used almost exclusively for electric power generation.

Anthracite: A hard, black, lustrous coal containing a high percentage of fixed carbon, a low percentage of volatile matter, little moisture content, low sulfur, low ash and a high heating value at or above 27.7 terajoules per kilotonne that burns with a nearly smokeless flame. Generally used in the production of steel.

Coal coke (Canadian/Foreign): A hard, porous product made from the carbonization (baking) of bituminous coal in ovens in substoichiometric atmosphere at high temperatures to the extent that the volatile matter of the coal is released and the coal passes through a "plastic stage" to become metallurgical coke. Often used as a fuel and a carbon input (reducing agent) in smelting iron ore in an integrated steel mill (blast furnace). Coke breeze and foundry coke are included in this category.

Coal by-products

Section 3

Petroleum coke (Canadian/Foreign): A final product, often called a "waste product", of the petroleum refining process, which is the output of the refinery after all of the distillates and oils have been distilled from crude oil, leaving a product that has the appearance of coal. There are various types, e.g. "sponge", "shot", and "fluid" coke, which are differentiated according to size. Petroleum coke is a residue high in carbon content and low in hydrogen that is the final product of thermal decomposition in the condensation process in cracking. It is typically high in sulfur, low in volatile matter, low in ash and low in moisture. It may be sold as is or further purified by calcining for specialty uses, including anode production. It may also be burned as fuel in various processes, ranging from power plants to cement kilns. Heating value is typically around 40 terajoules per kilotonne.

Refinery fuel gas: Any un-separated mixture of gases produced in refineries by distillation, cracking, reforming and other processes. The principal constituents are methane, ethane, ethylene, normal butane, butylenes, propane, propylene, etc. Also known as still gas. Still gas is used as a refinery fuel and a petrochemical feedstock.

Coke on catalyst (Catalyst coke): In many catalytic operations (e.g. catalytic cracking), carbon is deposited on the catalyst, thus deactivating the catalyst. The catalyst is reactivated by burning off the carbon, which is used as a fuel in the refining process. This carbon or coke is not recoverable in a concentrated form.

Bitumen emulsion (Orimulsion) and Bitumen AC: A thick oil and water emulsion. It is made by mixing bitumen with about 30% water and a small amount of surfactant. Behaves similarly to fuel oil and was developed for industrial use. Bitumen AC is a viscosity grade bitumen mainly used in the manufacture of hot mix asphalt for base and wearing courses.

Ethane: A normally gaseous, straight-chain hydrocarbon. A colourless, paraffinic gas extracted from natural gas or refinery gas streams, consisting of molecules composed of two atoms of carbon and six atoms of hydrogen (C2H6), used as petrochemical feedstock in production of chemicals and plastics and as a solvent in enhanced oil recovery process.

Butane: A normally gaseous hydrocarbon. A colourless, paraffinic gas extracted from natural gas or refinery gas streams, consisting of molecules composed of four atoms of carbon and ten atoms of hydrogen (C4H10), used primarily for blending in high-octane gasoline, for residential and commercial heating, and in the manufacture of chemicals and synthetic rubber.

Naphtha: A feedstock destined primarily for the petrochemical industry (e.g. ethylene manufacture or aromatics production). Naphtha specialties comprise all finished products within the naphtha boiling range of 70-200°C that are used as paint thinners, cleaners or solvents. This also includes gas oil used as petrochemical feedstocks.

By-product gas: A mixture of hydrocarbons and hydrogen produced from chemical processes such as ethane cracking.

Flared gas: Gas that is being burned as a means of disposal to the environment usually when it contains odorous or toxic components. Flared gas should be reported as non-energy use.

Other: Any energy commodity consumed not otherwise identified on the questionnaire. Specify in the space provided along with the unit of measure.

Section 4

Steam sales

If an energy commodity is used to generate steam for sale, please report, in gigajoules, the amount sold to external clients.

Section 5

Reasons for changes in energy consumption

This section aims to reduce the necessity for further inquiries. Statistics Canada compares responses to this questionnaire with those from previous years. Please indicate the reason(s) that best describe significant changes in your energy consumption from the previous year along with an explanation.

From October-December 2024, the following questions measuring the Labour Market and Socio-economic Indicators were added to the Labour Force Survey as a supplement.

The purpose of this survey is to identify changing dynamics within the Canadian labour market, and measure important socio-economic indicators by gathering data on topics such as type of employment, quality of employment, support payments and unmet health care needs.

Questionnaire flow within the collection application is controlled dynamically based on responses provided throughout the survey. Therefore, some respondents will not receive all questions, and there is a small chance that some households will not receive any questions at all. This is based on their answers to certain LFS questions.

Labour Market and Socio-economic Indicators

ENTRY_Q01 / EQ 1 - From the following list, please select the household member that will be completing this questionnaire on behalf of the entire household.

Employee block

The following questions test a new way of measuring temporary employment. Some questions address topics that were previously covered by the Labour Force Survey, but in a slightly different way.

LMI_Q01 / EQ 2 - What type of contract or agreement, [do/does] [you/Respondent name/this person] have in [your/his/her/their] main job?

Is it:

1. Permanent or until retirement
2. Ongoing with no specified end date
   Exclude temporary or seasonal contracts that are regularly renewed.
3. For a specific duration
   e.g., seasonal, term Include temporary or seasonal contracts that are regularly renewed.
4. Until a task or project is completed

LMI_Q02 / EQ 3 - Which of the following applies to [your/Respondent's name/this person's] main job?

1. It is a seasonal job
   e.g., [you/Respondent name/this person] only work[s]during a specific season
2. It covers a period of training
   e.g., apprentice, trainee, etc.

OR

3. None of the above

LMI_Q03 / EQ 4 - In [your/his/her/their] main job, [are/is] [you/Respondent's name/this person] paid by a private employment or placement agency that is different from the company or organization [you/he/she/this person] work[s] for?

1. Yes, paid by a private placement agency
2. No

LMI_Q04 / EQ 5 - What is the total duration of [your/Respondent's name/this person's] contract or agreement in [your/his/her/their] main job?

1. Less than 3 months
2. From 3 months to less than 6 months
3. From 6 months to less than 12 months
4. 12 months or longer

OR

5. Casual job with no specific end date

LMI_Q05 / EQ 6 - In [your/Respondent's name/this person's] main job, [do/does] [you/he/she/they] have a specific number of hours [you/he/she/they] [are/is] supposed to work?

1. Yes
2. No

HRS_Q01 / EQ 7 - [Are/Is] [you/Respondent name/this person] at least guaranteed that [you/he/she/they] will get some work or hours in [your/his/her/their] main job?

Would you say:

1. Yes
2. No minimum number of hours guaranteed, contacted when needed

LMI_Q06 / EQ 8 - What would you say best describes [your/Respondent's name/this person's] current situation in [your/his/her/their] main job?

[you/Respondent name/this person]:

1. Work[s] based on a series of successive contracts with the same employer
   e.g., [your/his/her/their] employer renews [your/his/her/their] contract Include situations with short breaks between contracts
2. [Have/Has] a casual job with an employer that lets [your/his/her/their] choose when [you/he/she/they] work[s]
   e.g., can decide which days or shifts [you/he/she/this person] work[s].
3. Only work[s] when called-in or assigned a shift by [your/his/her/their] employer
4. Work[s] based on a series of successive contracts with different employers
   Include situations with short breaks between contracts
5. Work[s] as a day labourer
   e.g., hired and paid by the day or for a single shift
6. [Have/Has] received a permanent job offer
7. Will return to school or do something else at the end of [your/his/her/their] contract
8. [Are/Is] uncertain about [your/his/her/their] future contract situation
9. None of these

REAT_Q01 / EQ 9 - [Do/Does] [you/Respondent name/this person] want a permanent job at this time?

1. Yes
2. No

REAT_Q02 / EQ 10 - What is the main reason why [you/Respondent name/this person] [do/does] not want a permanent job?

Would you say:

1. To combine employment with education
2. To combine employment with a pension
3. To combine employment with caring for children
4. To combine employment with other family or care responsibilities
5. Other reason

Self-employed block

You mentioned earlier that [you/Respondent name/this person] [are/is] self-employed in [your/his/her/their] [main/other] job. The following section of the survey will refer to this as [your/ respondent name's/this person's] [main/other] business.

LMI_Q07 / EQ 11 - What is the main reason why [you/Respondent name/this person] [are/is] self-employed in [your/his/her/their] [main/other] job?

Is it:

1. To have autonomy and control over work hours, wage rate or location
2. Unable to find work as an employee
3. [To earn more money than [you/Respondent name/this person] would as an employee]/ To earn extra money]
4. To engage in work that [you/he/she/this person] [are/is] passionate about
5. Lost job as an employee
6. To practice or master a new skill
7. To work in [your/his/her/their] field of expertise
8. To join or take over a family business
9. To achieve a better work-life balance
10. To experience less stress or for health reasons
11. Other

LMI_Q08 / EQ 12 - [Do/Does] [you/Respondent name/this person] have any partners or co-owners in [your/his/her/their] [main/side] business?

1. Yes
2. No

LMI_Q09 / EQ 13 - [Do/Does] [you/Respondent name/this person] [or your partners/or your company/, your partners or company/your company] own or lease a building or space dedicated to [your/his/her/their] [main/side] business?

1. Yes
2. No

LMI_Q10 / EQ 14 - In [your/Respondent's name/this person's] [main/side] business, [are/is] [you/he/she/they] required to belong to a professional association or regulatory college to do [your/his/her/their] job?

1. Yes
2. No

LMI_Q11 / EQ 15 - Does [your/Respondent's name/this person's] [main/side] business operate…?

1. All year round
2. During most of the year
3. During a specific season
4. Intermittently

EMP_Q01 / EQ 16 - How many employees in total work at [your/Respondent's name/this person's] business?

1. 5 or less
2. 6 to 20
3. 20 to 99
4. 100 to 500
5. Over 500

LMI_Q12 / EQ 17 - What is the current mix of clients in [your/Respondent's name/this person's] main business?

Is [your/Respondent's name/this person's] main business:

1. Mostly based on getting new clients
2. Based on an equal mix of new and returning clients
3. Mostly based on returning clients
4. Based on a single client

OR

5. [Your/Respondent's name/This person's] main business has not had any clients yet

LMI_Q13 / EQ 18 - Would [you/Respondent name/this person] be able to continue operating [your/his/her/their] main business for the next five years based on returning or existing clients alone?

1. Yes
2. No

LMI_Q14 / EQ 19 - To what extent do you agree or disagree with the following statement? In normal times, it is easy for [you/Respondent name/this person] to find new clients in [your/his/her/their] main business.

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

CLI_Q01 / EQ 20 - [Do/Does] [you/Respondent name/this person] currently have contracts with any of the following types of clients in [your/his/her/their] main business?

	Yes	No
Private businesses
Non-profit organizations or charities
Government agencies or departments
Private individuals

LMI_Q16 / EQ 21 – Thinking of [your/Respondent's name/this person's] largest contract, what is the total duration of that contract?

Is it:

1. Less than 3 months
2. From 3 months to less than 6 months
3. From 6 months to less than 12 months
4. 12 months or longer

LMI_Q17 / EQ 22 - During the last 12 months, did [you/Respondent name/this person] have any full days with no clients or work in [your/his/her/their] main business even though [you/he/she/they] wanted to work?

1. Yes
2. No

LMI_Q18 / EQ 23 - What would you say is [your/Respondent's name/this person's] main business over the next 12 months?

[Do/Does] [you/Respondent name/this person] plan to:

1. Expand and hire [more] employees
2. Expand without hiring [more] employees
3. Keep things about the same
4. Scale-down the business
5. Stop working or close the business

LMI_Q19 / EQ 24 - What is the main reason why [you/Respondent's name/this person] expect[s] to stop working or close [your/his/her/their] main business?

1. Low sales
2. Clients pay late or do not pay
3. Excess debt
4. Issues with suppliers
5. Lack of access to financing
6. Other business reasons
7. To accept a job with more income
8. To accept a job with more benefits
9. Attending school
10. Family responsibilities
11. Retirement
12. Health
13. Other personal reasons
14. Other

LFI_CHECK1 / EQ 25 - Last week, did [you/he/she/this person] work at a job or business?

1. Yes
2. No

LFI_CHECK2 / EQ 26 - Last week, did [you/he/she/this person] have a job or business from which [you/he/she/this person] [was/were] absent?

1. Yes
2. No

LFI_CHECK3 / EQ 27 - Did [you/he/she/this person] have more than one job or business last week?

1. Yes
2. No

LFI_CHECK4 / EQ 28 - Was this because [you/he/she/this person] changed employers?

1. Yes
2. No

LFI_CHECK5 / EQ 29 - [Has/Have] [you/Respondent's name/this person] ever worked at a job or business?

1. Yes
2. No

LFI_CHECK6 / EQ 30 - When did [you/Respondent's name/this person] last work?

Year:
Month:

LMI_Q20 / EQ 31 - [Excluding [your/his/her/their] main job or business, [has/have]/Have/Has] [you/Respondent's name/this person]] earned any money by freelancing, doing a paid gig, or completing a short-term job or task during the last 12 months?

1. Yes
2. No

LMI_Q21 / EQ 32 - [Was/Were] this freelancing, paid gig, or short-term task or job one of the jobs [you/Respondent name/this person] had last week, or something else entirely?

1. Yes, one of the jobs or businesses [you/Respondent name/this person] had last week
2. No, it was something else

EMP_Q02 / EQ 33 - [Was/Were] [you/Respondent name/this person] paid as an employee when [you/he/she/this person] freelanced, did a paid gig, or got paid to do a short-term task or job in the last 12 months?

1. Yes, only as an employee
2. Yes, both as an employee and as a self-employed worker
3. No, only as a self-employed worker

LMI_Q24 / EQ 34 - When was the last time [you/Respondent name/this person] freelanced, did a paid gig, or got paid to do a short-term task or job?

1. Last week or after
2. In the last 3 months, but before last week
3. In the last 3 to 6 months
4. In the last 6 to 12 months

SCC1_Q05 / EQ 35 - In the last 12 months, did [you/respondent name] receive support payments from a former spouse or partner?

1. Yes
2. No

SCC1_Q10 / EQ 36 - What is your best estimate of the amount of support payments [you/he/she/this person] received in the last 12 months?

SCC2_Q05 / EQ 37 - In the last 12 months, did [you/respondent name] make support payments to a former spouse or partner?

1. Yes
2. No

SCC2_Q10 / EQ 38 - What is your best estimate of the total amount [you/he/she/this person] paid in support payments in the last 12 months?

SCC3_Q05 / EQ 39 - In the last 12 months, did [you/respondent name] pay for child care, so that [you/he/she/they] could work at a paid job?

1. Yes
2. No

SCC3_Q10 / EQ 40 - What is your best estimate, of the total amount [you/he/she/this person] paid for child care in the last 12 months?

DSQ_Q01 / EQ 41 - [Do/Does] [you/respondent name] have any difficulty seeing?

Would you say:

1. No
2. Sometimes
3. Often
4. Always
5. Don't know

DSQ_Q02 / EQ 42 - [Do/Does] [you/he/she/this person] wear glasses or contact lenses to improve [your/his/her/their] vision?

Would you say:

1. Yes
2. No
3. Don't know

DSQ_Q03 / EQ 43 - [With [your/his/her/their] glasses or contact lenses, which/Which] of the following best describes [your/respondent's name] ability to see?

Would you say:

1. No difficulty seeing
2. Some difficulty seeing
3. A lot of difficulty seeing
4. [You/He/She/They] [are/is] legally blind
5. [You/He/She/They] [are/is] blind
6. Don't know

DSQ_Q04 / EQ 44 - How often does this [difficulty seeing/seeing condition] limit [your/his/her/their] daily activities?

Would you say:

1. Never
2. Rarely
3. Sometimes
4. Often
5. Always
6. Don't know

DSQ_Q05 / EQ 45 - [Do/Does] [you/respondent's name] have any difficulty hearing?

Would you say:

1. No
2. Sometimes
3. Often
4. Always
5. Don't know

DSQ_Q06 / EQ 46 - [Do/Does] [you/he/she/this person] use a hearing aid or cochlear implant?

Would you say:

1. Yes
2. No
3. Don't know

DSQ_Q07 / EQ 47 - [With [your/Respondent's name/this person's] hearing aid or cochlear implant which/Which] of the following best describes [your/respondent's name] ability to hear?

Would you say:

1. No difficulty hearing
2. Some difficulty hearing
3. A lot of difficulty hearing
4. [You/He/She/They] cannot hear at all
5. [You/He/She/They] [are/is] Deaf
6. Don't know

DSQ_Q08 / EQ 48 - How often does this [difficulty hearing/hearing condition] limit [your/his/her/their] daily activities?

Would you say:

1. Never
2. Rarely
3. Sometimes
4. Often
5. Always
6. Don't know

DSQ_Q09 / EQ 49 - [Do/Does] [you/respondent's name] have any difficulty walking, using stairs, using [your/his/her/their] hands or fingers or doing other physical activities?

Would you say:

1. No
2. Sometimes
3. Often
4. Always
5. Don't know

DSQ_Q10 / EQ 50 - How much difficulty [do/does] [you/he/she/this person] have walking on a flat surface for 15 minutes without resting?

Would you say:

1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. [You/He/She/They] cannot do at all
5. Don't know

DSQ_Q11 / EQ 51 - How much difficulty [do/does] [you/he/she/this person] have walking up or down a flight of stairs, about 12 steps without resting?

Would you say:

1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. [You/He/She/They] cannot do at all
5. Don't know

DSQ_Q12 / EQ 52 - How often [does this difficulty walking/does this difficulty using stairs/do these difficulties] limit [your/his/her/their] daily activities?

Would you say:

1. Never
2. Rarely
3. Sometimes
4. Often
5. Always
6. Don't know

DSQ_Q13 / EQ 53 - How much difficulty [do/does] [you/respondent's name] have bending down and picking up an object from the floor?

Would you say:

1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. [You/He/She/They] cannot do at all
5. Don't know

DSQ_Q14 / EQ 54 - How much difficulty [do/does] [you/he/she/this person] have reaching in any direction, for example, above [your/his/her/their] head?

Would you say:

1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. [You/He/She/They] cannot do at all
5. Don't know

DSQ_Q15 / EQ 55 - How often [does this difficulty bending down and picking up an object/does this difficulty reaching/do these difficulties] limit [your/his/her/their] daily activities?

Would you say:

1. Never
2. Rarely
3. Sometimes
4. Often
5. Always
6. Don't know

DSQ_Q16 / EQ 56 - How much difficulty [do/does] [you/respondent's name] have using [your/his/her/their] fingers to grasp small objects like a pencil or scissors?

Would you say:

1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. [You/He/She/They] cannot do at all
5. Don't know

DSQ_Q17 / EQ 57 - How often does this difficulty using [your/his/her/their] fingers limit [your/his/her/their] daily activities?

Would you say:

1. Never
2. Rarely
3. Sometimes
4. Often
5. Always
6. Don't know

DSQ_Q18 / EQ 58 - [Do/Does] [you/respondent's name] have pain that is always present?

Would you say:

1. Yes
2. No
3. Don't know

DSQ_Q19 / EQ 59 - [Do/Does] [you/he/she/this person] [also] have periods of pain that reoccur from time to time?

Would you say:

1. Yes
2. No
3. Don't know

DSQ_Q20 / EQ 60 - How often does this pain limit [your/his/her/their] daily activities?

Would you say:

1. Never
2. Rarely
3. Sometimes
4. Often
5. Always
6. Don't know

DSQ_Q21 / EQ 61 - When [you/respondent's name] [are/is] experiencing this pain, how much difficulty [do/does] [you/he/she/they] have with [your/his/her/their] daily activities?

Would you say:

1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. [You/He/She/They] cannot do at all
5. Don't know

DSQ_Q22 / EQ 62 - [Do/Does] [you/respondent's name] have any difficulty learning, remembering or concentrating?

Would you say:

1. Never
2. Rarely
3. Sometimes
4. Often
5. Always
6. Don't know

DSQ_Q23 / EQ 63 - Do you think [you/respondent's name] [have/has] a condition that makes it difficult in general for [you/him/her/them] to learn? This may include learning disabilities such as dyslexia, hyperactivity, attention problems, etc.

Would you say:

1. Yes
2. No
3. Don't know

DSQ_Q24 / EQ 64 - Has a teacher, doctor or other health care professional ever said that [you/respondent's name] had a learning disability?

Would you say:

1. Yes
2. No
3. Don't know

DSQ_Q25 / EQ 65 - How often are [your/his/her/their] daily activities limited by this condition?

Would you say:

1. Never
2. Rarely
3. Sometimes
4. Often
5. Always
6. Don't know

DSQ_Q26 / EQ 66 - How much difficulty [do/does] [you/respondent's name] have with [your/his/her/their] daily activities because of this condition?

Would you say:

1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. [You/He/She/They] cannot do most activities
5. Don't know

DSQ_Q27 / EQ 67 - Has a doctor, psychologist or other health care professional ever said that [you/respondent's name] had a developmental disability or disorder? This may include Down syndrome, autism, Asperger syndrome, mental impairment due to lack of oxygen at birth, etc.

Would you say:

1. Yes
2. No
3. Don't know

DSQ_Q28 / EQ 68 - How often are [your/respondent's name] daily activities limited by this condition?

Would you say:

1. Never
2. Rarely
3. Sometimes
4. Often
5. Always
6. Don't know

DSQ_Q29 / EQ 69 - How much difficulty [do/does] [you/respondent's name] have with [your/his/her/their] daily activities because of this condition?

Would you say:

1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. [You/He/She/They] cannot do most activities
5. Don't know

DSQ_Q30 / EQ 70 - [Do/Does] [you/he/she/this person] have any ongoing memory problems or periods of confusion?

Would you say:

1. Yes
2. No
3. Don't know

DSQ_Q31 / EQ 71 - How often are [your/his/her/their] daily activities limited by this problem?

Would you say:

1. Never
2. Rarely
3. Sometimes
4. Often
5. Always
6. Don't know

DSQ_Q32 / EQ 72 - How much difficulty [do/does] [you/respondent's name] have with [your/his/her/their] daily activities because of this problem?

Would you say:

1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. [You/He/She/They] cannot do most activities
5. Don't know

DSQ_Q33 / EQ 73 - [Do/Does] [you/respondent's name] have any emotional, psychological or mental health conditions?

Would you say:

1. No
2. Sometimes
3. Often
4. Always
5. Don't know

DSQ_Q34 / EQ 74 - How often are [your/his/her/their] daily activities limited by this condition?

Would you say:

1. Never
2. Rarely
3. Sometimes
4. Often
5. Always
6. Don't know

DSQ_Q35 / EQ 75 - When [you/respondent's name] [are/is] experiencing this condition, how much difficulty [do/does] [you/he/she/they] have with [your/his/her/their] daily activities?

Would you say:

1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. [You/He/She/They] cannot do most activities
5. Don't know

DSQ_Q36 / EQ 76 - [Do/Does] [you/respondent's name] have any other health problem or long-term condition that has lasted or is expected to last for six months or more?

Would you say:

1. Yes
2. No
3. Don't know

DSQ_Q37 / EQ 77 - How often does this health problem or long-term condition limit [your/his/her/their] daily activities?

Would you say:

1. Never
2. Rarely
3. Sometimes
4. Often
5. Always
6. Don't know

DSQ_Q38 / EQ 78 - [Do/Does] [you/respondent's name] have pain that is always present?

Would you say:

1. Yes
2. No
3. Don't know

DSQ_Q39 / EQ 79 - [Do/Does] [you/he/she/this person] [also] have periods of pain that reoccur from time to time?

Would you say:

1. Yes
2. No
3. Don't know

DSQ_Q40 / EQ 80 - How often does this pain limit [your/his/her/their] daily activities?

Would you say:

1. Never
2. Rarely
3. Sometimes
4. Often
5. Always
6. Don't know

DSQ_Q41 / EQ 81 - When [you/respondent's name] [are/is] experiencing this pain, how much difficulty [do/does] [you/he/she/they] have with [your/his/her/their] daily activities?

Would you say:

1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. [You/He/She/They] cannot do most activities
5. Don't know

UCN_Q005 / EQ 82 - During the past 12 months, was there ever a time when [you/respondent's name] felt that [you/he/she/they] needed health care, other than homecare services, but [you/he/she/they] did not receive it?

Would you say:

1. Yes
2. No

UCN_Q010 / EQ 83 - Thinking of the most recent time [you/respondent's name] felt this way, why didn't [you/he/she/they] get care?

Would you say:

1. Care not available in the area
2. Care not available at time required (e.g. doctor busy, away from office or no longer at that practice, inconvenient hours)
3. Do not have a regular health care provider
4. Waiting time too long
5. Appointment was cancelled
6. Felt would receive inadequate care
7. Cost
8. Decided not to seek care
9. Doctor didn't think it was necessary
10. Transportation issue
11. Other

UCN_Q015 / EQ 84 - Again, thinking of the most recent time, what was the type of care that was needed?

Would you say:

1. Treatment of a chronic physical health condition diagnosed by a health professional
2. Treatment of a chronic mental health condition diagnosed by a health professional
3. Treatment of an acute infectious disease (e.g. cold, flu and stomach flu)
4. Treatment of an acute physical condition (non-infectious)
5. Treatment of an acute mental health condition (e.g. acute stress reaction)
6. A regular check-up (including pre-natal care)
7. Care of an injury
8. Dental care
9. Medication / Prescription refill
10. Other

UCN_Q020 / EQ 85 - Did [you/he/she/this person] actively try to obtain the health care that was needed?

Would you say:

1. Yes
2. No

UCN_Q025 / EQ 86 - Where did [you/he/she/this person] try to get the service [you/he/she/they] [were/was] seeking?

Would you say:

1. A doctor's office
2. A hospital outpatient clinic
3. A community health centre
4. A walk-in clinic
5. An emergency department or emergency room
6. Other

Resources

• Vancouver-based Canfor Corporation announced the closure of its Plateau and Fort St. John operations in northern British Columbia. Canfor said the closures will impact approximately 500 employees and will remove 670 million board feet of annual production from the B.C. operations. Canfor also said that the wind down of operations is expected to be complete by the end of the year.
• In a separate statement, Canfor announced it will indefinitely curtail one shift at its Darlington facility in South Carolina, reduce operating hours at its Estill, South Carolina and Moultrie, Georgia locations, and implement curtailments across other southern U.S. operations. Canfor said these changes will reduce production by approximately 215 million board feet on an annualized basis.
• The Government of Canada announced it will challenge, under the Canada-United States-Mexico Agreement (CUSMA), the U.S. Department of Commerce's decision to increase softwood lumber duties.
• Vancouver-based First Majestic Silver Corp. and Gatos Silver, Inc. announced they had entered into a definitive merger agreement pursuant to which First Majestic will acquire all of the issued and outstanding common shares of Gatos for a total implied equity value of approximately USD $970 million. First Majestic said the transaction is expected to close in early 2025, subject to the satisfaction of customary closing conditions, including shareholder approval, clearance under Mexican anti-trust laws, and approval of the listing of the First Majestic common shares to be issued under the transaction on both the Toronto Stock Exchange and the New York Stock Exchange.
• Tumbler Ridge, British Columbia-based Conuma Resources announced that mining operations at its Quintette coal mine had resumed after 24 years of care and maintenance.
• The Government of Ontario announced that it and Wataynikaneyap (Watay) Power were advancing the second phase of the Watay Power Transmission Project. The Government said that approximately 1,800 kilometres of transmission line are being built by Watay Power Transmission Project through a government loan of up to $1.34 billion for the project's construction costs and that once built, the Watay transmission line will connect more than 18,000 people in 16 remote communities.

Manufacturing

• Vancouver-based Methanex Corporation announced it had entered into a definitive agreement to acquire Netherlands-based OCI Global's international methanol business, including OCI's interest in two methanol facilities in Texas and a currently idled methanol facility in the Netherlands, for USD $2.05 billion. Methanex said the transaction is expected to close in the first half of 2025, subject to Regulatory and shareholder approval and other closing conditions including TSX approval for the issuance of Methanex shares to OCI.

Other news

• The Bank of Canada reduced its target for the overnight rate by 25 basis points to 4.25%. The last change in the target for the overnight rate was a 25 basis points cut in July 2024. The Bank also said it is continuing its policy of balance sheet normalization.
• The Government of Canada announced a suite of reforms to mortgage rules, including increasing the $1 million price cap for insured mortgages to $1.5 million and expanding eligibility for 30 year mortgage amortizations to all first-time homebuyers and to all buyers of new builds. The Government said both are effective December 15, 2024.
• The Government of Canada announced additional measures to manage the volume of temporary resident arrivals, including:
  • Announcing a further reduction in the intake cap on international student study permits for 2025;
  • Updating the Post-Graduation Work Permit Program this fall;
  • Limiting work permit eligibility, later this year, to spouses of master's degree students to only those whose program is at least 16 months in duration; and
  • Limiting work permit eligibility later this year to spouses of foreign workers in management or professional occupations or in sectors with labour shortages.
• The Northwest Territories' minimum wage increased from $16.05 to $16.70 per hour on September 1st.
• Montreal-based BCE Inc. announced it had reached an agreement to sell its ownership stake in Maple Leaf Sports & Entertainment Ltd. (MLSE) to Rogers Communications Inc. of Toronto for $4.7 billion. BCE said the transaction is expected to close in mid-2025, subject to relevant sports league and other customary approvals.
• On September 30th, the Port of Montreal announced that a partial strike affecting the Viau and Maisonneuve terminals had begun at 7:00 a.m. and would continue until October 3rd, at 6:59 a.m.

United States and other international news

• On September 28th, United States President Joseph R. Biden, Jr. declared that major disasters exist in the States of Florida and North Carolina and ordered Federal aid to supplement State, tribal, and local recovery efforts in the areas affected by Hurricane Helene beginning on September 23rd and continuing.
• The U.S. Federal Open Market Committee (FOMC) lowered the target range for the federal funds rate by 50 basis points to 4.75% to 5.00%. The last change in the target range was a 25 basis points increase in July 2023. The Committee also said it will continue reducing its holdings of Treasury securities and agency debt and agency mortgage-backed securities.
• The European Central Bank (ECB) lowered the deposit facility by 25 basis points to 3.50%. The ECB also set the spread between the interest rate on the main refinancing operations and the deposit facility rate at 15 basis points and left the spread between the rate on the marginal lending facility and the rate on the main refinancing operations unchanged at 25 basis points. Accordingly, the interest rates on the main refinancing operations and the marginal lending facility were lowered to 3.65% and 3.90% respectively.
• The Bank of England's Monetary Policy Committee (MPC) voted to maintain the Bank Rate at 5.00%. The last change in the Bank Rate was a 25 basis points cut in August 2024.
• The Monetary Policy and Financial Stability Committee of Norway's Norges Bank left the policy rate unchanged at 4.5%. The last change in the policy rate was a 25 basis points increase in December 2023.
• The Bank of Japan announced it will encourage the uncollateralized overnight call rate to remain at around 0.25%.
• The Reserve Bank of Australia (RBA) left the cash rate target unchanged at 4.35%. The last change in the cash rate target was a 25 basis points increase in November 2023.
• The Executive Board of Sweden's Riksbank lowered the repo rate by 25 basis points to 3.25%. The last change in the repo rate was a 25 basis points reduction in August 2024.
• Funds managed by New York-based Blackstone Real Estate Partners, Blackstone Infrastructure Partners, Blackstone Tactical Opportunities, and Blackstone's private equity strategy for individual investors, along with the Canada Pension Plan Investment Board announced they had entered into a definitive agreement to acquire AirTrunk of Australia, a data center platform, from Macquarie Asset Management and the Public Sector Pension Investment Board, for an implied enterprise value of over AUD $24 billion. Blackstone said the transaction is subject to approval from the Australian Foreign Investment Review Board.
• OPEC announced that eight participating countries which had previously announced additional voluntary production cuts, including Saudi Arabia, Russia, Iraq, the United Arab Emirates, agreed to extend their additional voluntary production cuts of 2.2 million barrels per day for two months until the end of November 2024, after which these cuts will be gradually phased out on a monthly basis starting December 1, 2024.
• New York-based Verizon Communications Inc. and Frontier Communications Parent, Inc. of Texas announced they had entered into a definitive agreement for Verizon to acquire Frontier in an all-cash transaction valued at USD $20 billion. The companies said the transaction is expected to close in approximately 18 months, subject to approval by Frontier shareholders, receipt of certain regulatory approvals, and other customary closing conditions.
• Maryland-based Constellation Energy Corporation announced the signing of a 20-year power purchase agreement with Microsoft that will pave the way for the launch of the Crane Clean Energy Center (CCEC) and restart of Three Mile Island Unit 1 in Pennsylvania. Constellation said it expects the CCEC to be online in 2028.
• Sweden-based Northvolt AB, a battery developer and manufacturer, announced that measures related to its strategic review were expected to result in the redundancy of approximately 1,600 Northvolt employees in Sweden. Northvolt said this was a workforce reduction of approximately 20% at a global level and 25% in Sweden.

Financial market news

• West Texas Intermediate crude oil closed at USD $68.17 per barrel on September 30th, down from a closing value of USD $73.55 at the end of August. Western Canadian Select crude oil traded in the USD $51 to $60 per barrel range throughout September. The Canadian dollar closed at 74.08 cents U.S. on September 27th, down from 74.12 cents U.S. at the end of August. The S&P/TSX composite index closed at 24,000.37 on September 30th, up from 23,346.18 at the end of August.

Why are we conducting this survey?

One of the principal goals of the Government of Canada is to continually improve energy efficiency in Canada through practical and innovative programs and policies. Such improvements support a transition to a low carbon economy, reduce energy consumption and help lower greenhouse gas (GHG) emissions.

Natural Resources Canada, in partnership with Statistics Canada, is working to establish a better understanding of this sector in order to develop effective federal, provincial, territorial and municipal government programs and policies in support of energy efficiency and lower GHG emissions.

This survey will collect detailed information on the energy demand and consumption patterns of commercial and institutional buildings in Canada. Information will include the types and quantities of energy being used (such as electricity, natural gas, etc.), and building characteristics to better understand energy consumption. Information from this survey will be used by analysts, policy-makers, governments, utilities, industry associations, building managers, and business owners.

Reporting period

For the purposes of this survey, report information for the year of 2024.

What you will need to complete this questionnaire

For size of the building, you can refer to the Building Occupancy Permit, fire protection drawings or architectural drawings.

Reporting instructions

• Percentages should be rounded to whole numbers.
• When precise figures are not available, provide your best estimates.
• Enter “0” if there is no value to report.

Definitions

Commercial building:

A structure that is, partially or completely, used for commercial activities focusing on the exchange of goods or services for a profit.

e.g., stores, office buildings, restaurants, hotels, warehouses

Institutional building:

A structure that is, partially or completely, used for institutional activities focusing on not-for-profit services of public interest. 

e.g., schools, place of worship buildings, courthouses

Why have you been selected?

Statistics Canada uses a statistical method called sampling. It is an established way to determine characteristics of an entire population by surveying only part of the population. Buildings were selected as part of a random sample to represent other buildings of the same type (activity and geography). To ensure that the sample is an accurate reflection of the population as a whole, both nationally and regionally, it is important to have the participation of all those who have been selected through the sampling process.

Contact information

1. Verify or provide the contact information of the person who is filling out this questionnaire.

• Company or organization:
• First name:
• Last name:
• Title:
• Preferred language:
  • English
  • French
• Email address:
  Example: user@example.gov.ca
• Telephone number (including area code):
  Example: 123-123-1234
• Extension number (if applicable):
• Mailing address (number and street):
• City:
• Province, territory or state:
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  • British Columbia
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• Postal code or ZIP code:
  Example: A9A 9A9 or 12345-1234
• Country
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  • Other

Building list

Statistics Canada wants to confirm that the buildings below are in scope for the Survey of Commercial and Institutional Energy Use. At this time, all that is required is some basic information about each building; its address, floor area and activities. The last question will ask for the contact information of the correct person to answer more in-depth questions about each building such as energy consumption and usage, building modifications and building specific questions. Statistics Canada would appreciate if the contact information of someone that is most familiar with the details of the building could be provided.

2. For each building mentioned below, please verify and provide the requested information.

Press the Start button to answer the questions required for each building.

Press the Next button once you have finished answering for all buildings.

Building Name

Building Address

Building information

3. Would you be able to provide building information for Building Name Building Address?

The building information requested is the address, floor area and activity type (options will be provided).

• Yes
• No

Building information

4. Verify or provide the building information below and correct where needed.

Note: Building information modifications should only be done to correct an error.

• Building name:
• Building address (number and street):
• City:
• Province or territory:
  • Alberta
  • British Columbia
  • Manitoba
  • New Brunswick
  • Newfoundland and Labrador
  • Northwest Territories
  • Nova Scotia
  • Nunavut
  • Ontario
  • Prince Edward Island
  • Quebec
  • Saskatchewan
  • Yukon
• Postal code:
  Example: A9A 9A9

Building characteristics

5. On December 31, 2024, what will be the total floor area of this building?

For size of the building, you can refer to the Building Occupancy Permit, fire protection drawings or architectural drawings. The total floor area may be larger than the Gross Leasable Area (GLA).

Include floor area of all enclosed floors, mechanical rooms, common areas, basements and annexes.

Exclude floor area associated with any indoor parking, partially enclosed parking or portable structures.

When precise figures are not available, please provide your best estimate.

• Unit of measure:
  • Square feet
  • Square metres
    Total floor area of this building:
    OR
• Do not know

Building characteristics

6. Please indicate the percentage of the floor space of the building that will be used for commercial, institutional, agricultural, industrial, residential or vacant areas on December 31, 2024?

• Commercial
  Include office space, bank branch, hotel, motel, hostel, restaurant, bar, grocery store, pharmacy, cinema, ice rink, performing arts, etc.
• Institutional
  Include courthouse, police station, fire station, assisted daily care facility, preschool or daycare, primary or secondary school, trade school and vocational school.
  Exclude college, CEGEP, university and hospital.
• Post-secondary and hospital
  Include college, CEGEP, university and hospital.
  Exclude trade school, vocational school and veterinary hospital.
• Agricultural
• Industrial
• Residential
  Include occupied and vacant residential space.
• Vacant
  Include vacant commercial, institutional and organizational space.
• Unknown

Contact person

Note: A more detailed questionnaire may be sent early next year with questions about building characteristics, energy consumption and usage, building modifications and building type specific questions.

The designated contact person should be the person who is best suited to answer this questionnaire. This person would be someone who is knowledgeable about the energy consumption and usage of this building.

i.e., someone who has access to energy bills and knowledge about the structure and details of this building (e.g., property manager, building manager, facilities manager, building owner).

7. Is the current respondent the best person to answer questions about building characteristics, energy consumption and usage and building modifications about all units at Building Name Building Address?

• Yes
• No
  
  Provide the contact information for the designated contact person for the detailed questionnaire.
  • Company or Organization:
  • First name:
  • Last name:
  • Title:
  • Preferred language:
    • English
    • French
  • Email address:
    Example: user@example.gov.ca
  • Telephone number (including area code):
    Example: 123-123-1234
  • Extension number (if applicable):
  • Mailing address (number and street):
  • City:
  • Province, territory or state:
    • Alberta
    • British Columbia
    • Manitoba
    • New Brunswick
    • Newfoundland and Labrador
    • Northwest Territories
    • Nova Scotia
    • Nunavut
    • Ontario
    • Prince Edward Island
    • Quebec
    • Saskatchewan
    • Yukon
    • Alabama
    • Alaska
    • American Samoa
    • Arizona
    • Arkansas
    • California
    • Colorado
    • Connecticut
    • Delaware
    • District of Columbia
    • Federated States of Micronesia
    • Florida
    • Georgia
    • Guam
    • Hawaii
    • Idaho
    • Illinois
    • Indiana
    • Iowa
    • Kansas
    • Kentucky
    • Louisiana
    • Maine
    • Marshall Islands
    • Maryland
    • Massachusetts
    • Michigan
    • Minnesota
    • Mississippi
    • Missouri
    • Montana
    • Nebraska
    • Nevada
    • New Hampshire
    • New Jersey
    • New Mexico
    • New York
    • North Carolina
    • North Dakota
    • Northern Mariana Islands
    • Ohio
    • Oklahoma
    • Oregon
    • Palau
    • Pennsylvania
    • Puerto Rico
    • Rhode Island
    • South Carolina
    • South Dakota
    • Tennessee
    • Texas
    • U.S. Minor Outlying Islands
    • Utah
    • Vermont
    • Virgin Islands of the U.S.
    • Virginia
    • Washington
    • West Virginia
    • Wisconsin
    • Wyoming
  • Postal code or ZIP code:
    Example: A9A 9A9 or 12345-1234
  • Country:
    • Canada
    • United States
    • Other

  
  Would this designated contact person be able to answer the questionnaire for each of the buildings identified in this questionnaire?

  • Yes
  • No
• Do not know

Introduction

Coverage statement: Please report for the business unit(s) identified above. Include only the operation(s) located in Canada.

This information is collected under the authority of the Statistics Act, Revised Statutes of Canada, 1985, Chapter S-19.

Completion of this questionnaire is a legal requirement under this Act.

Survey purpose

The purpose of this survey is to obtain information on the supply of, and/or demand for, energy in Canada. This information serves as an important indicator of Canadian economic performance and is used by all levels of government in establishing informed policies in the energy area. The private sector also uses this information in the corporate decision-making process. Your information may also be used by Statistics Canada for other statistical and research purposes.

Confidentiality

Statistics Canada is prohibited by law from releasing any information it collects which could identify any person, business, or organization, unless consent has been given by the respondent or as permitted by the Statistics Act. Statistics Canada will use the information from this survey for statistical and research purposes.

This questionnaire should be completed and mailed to:

Statistics Canada, Operations and Integration Division,
JT2-B17, 150 Tunney's Pasture,
Ottawa, Ontario, K1A 0T6

or fax it to 1-800-755-5514.

Security of emails and faxes

Statistics Canada advises you that there could be a risk of disclosure during facsimile or e-mail. However, upon receipt, Statistics Canada will provide the guaranteed level of protection afforded to all information collected under the authority of the Statistics Act.

Data-sharing agreements

To reduce respondent burden, Statistics Canada has entered into data sharing agreements with provincial and territorial statistical agencies and other government organizations, which have agreed to keep the data confidential and use them only for statistical purposes.

Reporting instructions

Please refer to the reporting instruction and list of reporting companies before completing this report. NAICS, 32411, 32419

Please return the questionnaire within 20 days.

If you need help, call us at 1-888-881-3666 or write to us:

Statistics Canada, Operations and Integration Division,
150 Tunney's Pasture Driveway,
Ottawa, Ontario K1A 0T6

Visit our website at Statistics Canada

List of Reporting Companies

• 02 Federated Co-operatives Limited
• 03 Valero Energy Inc.
• 05 Husky Energy Inc
• 06 Imperial Oil Limited
• 07 Irving Oil Company, Limited
• 11 Shell Canada
• 13 Suncor Energy Inc
• 16 Tidewater Midstream Inc
• 19 Parkland Refining (B.C.) Ltd.
• 32 Gibson Energy Inc
• 54 Petro-canada Lubricants Inc. (Hollyfrontier Corporation)
• 55 North West Redwater Partnership (Sturgeon Refinery)

*Do not include sales to the companies listed above.

Aviation Gasoline

Aviation Gasoline
Table summary
This table contains no data. It is an example of an empty data table used by respondents to provide data to Statistics Canada.

Aviation Gasoline (Cubic metres)	NL	PE	NS	NB	QC	ON	MB	SK	AB	BC	YT	NT	NU
Cubic metres
1. Iron mines
2. Oil and gas extraction
3. Other mining
4. Food, beverage, tobacco manufacturing
5. Pulp and paper manufacturing
6. Iron and steel manufacturing
7. Aluminum and non-ferrous metal manufacturing
8. Cement manufacturing
9. Refined petroleum products manufacturing
10. Chemical manufacturing
11. All other manufacturing
12. Forestry, logging and support activities
13. Agriculture, fishing, hunting and trapping
14. Construction
15. Public administration
16. Electric power generation and distribution
17. Railways
18. Canadian airlines
19. Foreign airlines
20. Road transport and urban transit
21. Canadian marine
22. Foreign marine
23. Pipelines
24. Retail pump sales
25. Commercial and other institutional
26. Secondary distributors
27. Residential
Total manufacturing
Total net sales, all categories

Comments

Motor Gasoline

Motor Gasoline
Table summary
This table contains no data. It is an example of an empty data table used by respondents to provide data to Statistics Canada.

Motor Gasoline (Cubic metres)	NL	PE	NS	NB	QC	ON	MB	SK	AB	BC	YT	NT	NU
Cubic metres
1. Iron mines
2. Oil and gas extraction
3. Other mining
4. Food, beverage, tobacco manufacturing
5. Pulp and paper manufacturing
6. Iron and steel manufacturing
7. Aluminum and non-ferrous metal manufacturing
8. Cement manufacturing
9. Refined petroleum products manufacturing
10. Chemical manufacturing
11. All other manufacturing
12. Forestry, logging and support activities
13. Agriculture, fishing, hunting and trapping
14. Construction
15. Public administration
16. Electric power generation and distribution
17. Railways
18. Canadian airlines
19. Foreign airlines
20. Road transport and urban transit
21. Canadian marine
22. Foreign marine
23. Pipelines
24. Retail pump sales
25. Commercial and other institutional
26. Secondary distributors
27. Residential
Total manufacturing
Total net sales, all categories

Comments

Kerosene-type jet fuel

Kerosene-type jet fuel
Table summary
This table contains no data. It is an example of an empty data table used by respondents to provide data to Statistics Canada.

Kerosene-type jet fuel (Cubic metres)	NL	PE	NS	NB	QC	ON	MB	SK	AB	BC	YT	NT	NU
Cubic metres
1. Iron mines
2. Oil and gas extraction
3. Other mining
4. Food, beverage, tobacco manufacturing
5. Pulp and paper manufacturing
6. Iron and steel manufacturing
7. Aluminum and non-ferrous metal manufacturing
8. Cement manufacturing
9. Refined petroleum products manufacturing
10. Chemical manufacturing
11. All other manufacturing
12. Forestry, logging and support activities
13. Agriculture, fishing, hunting and trapping
14. Construction
15. Public administration
16. Electric power generation and distribution
17. Railways
18. Canadian airlines
19. Foreign airlines
20. Road transport and urban transit
21. Canadian marine
22. Foreign marine
23. Pipelines
24. Retail pump sales
25. Commercial and other institutional
26. Secondary distributors
27. Residential
Total Manufacturing
Total net sales, all categories

Comments

Propane

Propane
Table summary
This table contains no data. It is an example of an empty data table used by respondents to provide data to Statistics Canada.

Propane (Cubic metres)	NL	PE	NS	NB	QC	ON	MB	SK	AB	BC	YT	NT	NU
Cubic metres
1. Iron mines
2. Oil and gas extraction
3. Other mining
4. Food, beverage, tobacco manufacturing
5. Pulp and paper manufacturing
6. Iron and steel manufacturing
7. Aluminum and non-ferrous metal manufacturing
8. Cement manufacturing
9. Refined petroleum products manufacturing
10. Chemical manufacturing
11. All other manufacturing
12. Forestry, logging and support activities
13. Agriculture, fishing, hunting and trapping
14. Construction
15. Public administration
16. Electric power generation and distribution
17. Railways
18. Canadian airlines
19. Foreign airlines
20. Road transport and urban transit
21. Canadian marine
22. Foreign marine
23. Pipelines
24. Retail pump sales
25. Commercial and other institutional
26. Secondary distributors
27. Residential
Total manufacuring
Total net sales, all categories

Comments

Kerosene and stove oil

Kerosene and stove oil
Table summary
This table contains no data. It is an example of an empty data table used by respondents to provide data to Statistics Canada.

Kerosene and stove oil (Cubic metres)	NL	PE	NS	NB	QC	ON	MB	SK	AB	BC	YT	NT	NU
Cubic metres
1. Iron mines
2. Oil and gas extraction
3. Other mining
4. Manufacturing
5. Forestry, logging and support activities
6. Agriculture, fishing, hunting and trapping
7. Construction
8. Public administration
9. Electric power generation and distribution
10. Railways
11. Canadian airlines
12. Foreign airlines
13. Road transport and urban transit
14. Canadian marine
15. Foreign marine
16. Pipelines
17. Retail pump sales
18. Commercial and other institutional
19. Secondary distributors
20. Residential
Total net sales, all categories

Comments

Diesel fuel oil

Diesel fuel oil
Table summary
This table contains no data. It is an example of an empty data table used by respondents to provide data to Statistics Canada.

Diesel fuel oil (Cubic metres)	NL	PE	NS	NB	QC	ON	MB	SK	AB	BC	YT	NT	NU
Cubic metres
1. Iron mines
2. Oil and gas extraction
3. Other mining
4. Manufacturing
5. Forestry, logging and support activities
6. Agriculture, fishing, hunting and trapping
7. Construction
8. Public administration
9. Electric power generation and distribution
10. Railways
11. Canadian airlines
12. Foreign airlines
13. Road transport and urban transit
14. Canadian marine
15. Foreign marine
16. Pipelines
17. Retail pump sales
18. Commercial and other institutional
19. Secondary distributors
20. Residential
Total net sales, all categories

Comments

Light fuel oils

Light fuel oils
Table summary
This table contains no data. It is an example of an empty data table used by respondents to provide data to Statistics Canada.

Light fuel oils (Cubic metres)	NL	PE	NS	NB	QC	ON	MB	SK	AB	BC	YT	NT	NU
Cubic metres
1. Iron mines
2. Oil and gas extraction
3. Other mining
4. Manufacturing
5. Forestry, logging and support activities
6. Agriculture, fishing, hunting and trapping
7. Construction
8. Public administration
9. Electric power generation and distribution
10. Railways
11. Canadian airlines
12. Foreign airlines
13. Road transport and urban transit
14. Canadian marine
15. Foreign marine
16. Pipelines
17. Retail pump sales
18. Commercial and other institutional
19. Secondary distributors
20. Residential
Total net sales, all categories

Comments

Residual and heavy fuel oils

Residual and heavy fuel oils
Table summary
This table contains no data. It is an example of an empty data table used by respondents to provide data to Statistics Canada.

Residual and heavy fuel oils (Cubic metres)	NL	PE	NS	NB	QC	ON	MB	SK	AB	BC	YT	NT	NU
Cubic metres
1. Iron mines
2. Oil and gas extraction
3. Other mining
4. Manufacturing
5. Forestry, logging and support activities
6. Agriculture, fishing, hunting and trapping
7. Construction
8. Public administration
9. Electric power generation and distribution
10. Railways
11. Canadian airlines
12. Foreign airlines
13. Road transport and urban transit
14. Canadian marine
15. Foreign marine
16. Pipelines
17. Retail pump sales
18. Commercial and other institutional
19. Secondary distributors
20. Residential
Total net sales, all categories

Comments

Asphalt

Asphalt
Table summary
This table contains no data. It is an example of an empty data table used by respondents to provide data to Statistics Canada.

Asphalt (Cubic metres)	NL	PE	NS	NB	QC	ON	MB	SK	AB	BC	YT	NT	NU
Cubic metres
1. Construction
2. Manufacturing
3. Commercial and other institutional
4. Secondary distributors
Total net sales, all categories

Comments

Lubricants

Lubricants
Table summary
This table contains no data. It is an example of an empty data table used by respondents to provide data to Statistics Canada.

Lubricants (Cubic metres)	NL	PE	NS	NB	QC	ON	MB	SK	AB	BC	YT	NT	NU
Cubic metres
1. Iron mines
2. Oil and gas extraction
3. Other mining
4. Food, beverage, tobacco manufacturing
5. Pulp and paper manufacturing
6. Iron and steel manufacturing
7. Aluminum and non-ferrous metal manufacturing
8. Cement manufacturing
9. Refined petroleum products manufacturing
10. Chemical manufacturing
11. All other manufacturing
12. Forestry, logging and support activities
13. Agriculture, fishing, hunting and trapping
14. Construction
15. Public administration
16. Electric power generation and distribution
17. Railways
18. Canadian airlines
19. Foreign airlines
20. Road transport and urban transit
21. Canadian marine
22. Foreign marine
23. Pipelines
24. Retail pump sales
25. Commercial and other institutional
26. Secondary distributors
27. Residential
Total manufacturing
Total net sales, all categories

Comments

Total Summary

Summary of Net Sales, All Categories Totals
Table summary
This table contains no data. It is an example of an empty data table used by respondents to provide data to Statistics Canada.

	NL	PE	NS	NB	QC	ON	MB	SK	AB	BC	YT	NT	NU	Total Canada
Aviation gasoline
Motor Gasoline
Kerosene-type jet fuel
Propane
Kerosene and stove oil
Diesel fuel oil
Light fuel oils
Residual and heavy fuel oils
Asphalt
Lubricants

Screen questions

Introduction: The purpose of this study is to collect information to help understand the experiences and access to care of individuals with life-limiting illnesses and their unpaid caregivers.

Throughout the questionnaire we will be using the term "serious illness" and by that we are referring to life-limiting illnesses, diseases or conditions that cannot be cured and will ultimately shorten a person’s life.

If you are completing this questionnaire on behalf of someone with a serious illness, please answer the questions based on their experiences.

Do you or does someone you care about have a serious illness?

By “serious illness” we are referring to life-limiting illnesses, diseases or conditions that cannot be cured, get worse over time and will ultimately shorten a person’s life.

Include close family (e.g., children, partner, siblings, parents), friends or community members.

Select all that apply.

• Yes, I have a serious illness
• Yes, someone I care about has or had a serious illness
  OR
• No, neither I nor someone I care about has a serious illness

In the past 2 years, have you ever provided unpaid care or support for someone you care about who has a serious illness?

Unpaid care refers to any support or assistance you provide without receiving financial compensation. For example, helping with personal care, managing medications, providing emotional support, assisting with medical appointments or helping with household chores.

Include close family (e.g., children, partner, siblings, parents), friends or community members.

Select all that apply.

• Yes, I am currently providing unpaid care
• Yes, I have provided unpaid care in the last 2 years, but the person has since passed away
• Yes, I have provided unpaid care in the last 2 years, but I no longer do
  OR
• No, I have not provided unpaid care for anyone in the last 2 years

Age

What is your age?

• Age in years

Sex and gender

The following questions are about gender and sex at birth.

What is your gender?

[Gender refers to an individual’s personal and social identity as a man, a woman or a person who is not exclusively a man or a woman, for example, non-binary, agender, gender fluid, queer or Two-Spirit./Gender refers to an individual’s personal and social identity as a boy, a girl or a person who is not exclusively a boy or a girl, for example, non-binary, agender, gender fluid, queer or Two-Spirit./Gender refers to an individual’s personal and social identity as a man (or a boy), a woman (or a girl) or a person who is not exclusively a man (or a boy) or a woman (or a girl), for example, non-binary, agender, gender fluid, queer or Two-Spirit.]

Is it:

• [Man/Boy/Man (or boy)]
• [Woman/Girl/Woman (or girl)]
• Or please specify
  • Specify your gender

What was your sex at birth?

Sex at birth refers to the sex recorded on a person’s first birth certificate. It is typically observed based on a person’s reproductive system and other physical characteristics.

• Male
• Female

Please verify that all of the information is correct.

If all the information is correct, press the Next button.

To make changes, press the Previous button.

Your information

Gender: [Man/Boy/Man (or boy)/Woman/Girl/Woman (or girl)/Gender specified/Information not provided]

Sex at birth: [Male/Female/Information not provided]

Postal code

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

• Postal code
  Example: A9A 9A9

Dwelling type

What type of dwelling are you currently living in?

• Private home or apartment
• Retirement home or senior residence
  a retirement home is a privately paid residency for seniors who can direct their own care but may need a bit more support with their daily living activities.
• Long-term care facility or nursing home
  long-term care facilities or nursing homes provide living accommodation for people who require on-site delivery of 24 hour, 7 days a week supervised care.
• Unstable or temporary living situation
• Homeless
• Other
  • Please specify type of dwelling

Assessment

Next, a few questions to understand your care needs.

What serious illness are you living with that impacts you the most?

• Advanced cancer
• Chronic liver disease
• Chronic obstructive pulmonary disease (COPD) or other chronic lung condition
  e.g., cystic fibrosis, pulmonary hypertension, tuberculosis
• Dementia or Alzheimer's disease
• Heart disease or failure
• Human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS)
• Kidney failure
• Multiple organ failure
• Neurological disease
  e.g., amyotrophic lateral sclerosis (ALS), Lou Gehrig’s disease, multiple sclerosis, Parkinson’s disease, Huntington’s disease
• Stroke or cerebrovascular disease
• Weakened immune system or immunocompromised
• Other
  • Please specify the serious illness

Now some questions about primary healthcare. This is the type of healthcare usually delivered by family doctors or nurse practitioners who provide continuous care, are familiar with your medical history, and with whom you can book regular appointments. It is often the first point of entry to the Canadian health system.

Primary healthcare needs can include routine care such as check-ups and prescription refills as well as issues that need immediate care but are not emergencies, such as an infection, fever, headache, a sprained ankle, vomiting or an unexplained rash.

Patients sometimes have a care team which can include different healthcare professionals, as well as unpaid caregivers such as family, friends or community members.

Do you have a regular primary healthcare provider?

By this, we mean a health professional that you regularly consult with when you need care or advice for your health.

Select all that apply.

• Yes, a family doctor
• Yes, a nurse practitioner
• Yes, a palliative care specialist
• Yes, another specialist
• Yes, another health professional
  • Specify the other health professional
  OR
• No 

Is someone from your care team regularly completing a needs assessment for you?

A needs assessment is an evaluation of your health status, risks and needs.

A care team includes the care you receive from healthcare professionals, as well as the support you get from unpaid helpers like family or friends.

• Yes
• No
• Don’t know

Which of the following needs are being assessed by someone from your care team?

Select all that apply.

• Physical
• Psychological
• Social
  Include social support from family members or friends.
• Cultural
• Legal
• Spiritual
• End-of-life
• Loss or grief
• Other

Which conditions related to your serious illness limit your daily activities the most?

Select up to 3 answers.

• Physical limitations
  e.g., difficulty walking, using stairs, using your hands or fingers, problems with sight or hearing or doing other physical activities
• Severe pain
• Fatigue
• Trouble breathing
• Problems communicating
• Lack of appetite or nausea
• Cognitive limitations
  e.g., difficulty learning, remembering or concentrating
• Mental health conditions
  e.g., anxiety, depression, substance abuse
• Other
  • Please specify the condition
  OR
• None of the above

Planning

Now, a few questions to understand how your wishes, values and beliefs are reflected within the management of your illness and care planning. 

Have you engaged in conversations with someone from your care team about your wishes, values and beliefs regarding care for your serious illness?

For example, conversations may include discussions about where you would like to receive care, your treatment plan, pain management preferences, etc.

A care team may include healthcare professionals as well as unpaid helpers, like family or friends.

• Yes
• No

What topics did you discuss?

Select all that apply.

• Setting of care
  e.g., home, hospice, hospital, specialized care centre
• Treatment plan
  e.g., types of treatments, specific instructions for future care
• Life-sustaining treatment options
  e.g., resuscitation, ventilators, feeding tubes
• Pain management preferences
• Legal and financial matters
• Spiritual considerations
• Place of end-of-life care
  e.g., home, hospice, hospital
• Organ and tissue donation
• Funeral or memorial preferences
• Other
  • Please specify topics discussed

Have you chosen someone to be your substitute decision-maker?

A substitute decision-maker is the person who will make decisions about your care and treatments on your behalf only if you are incapable of doing so on your own. Depending on where you live in Canada, this person can also be called a medical proxy, health representative or agent or power of attorney for personal care.

• Yes
• No

How confident are you that your substitute decision-maker has the information they need to make decisions on your behalf?

• Very confident
• Somewhat confident
• Not very confident
• Not confident at all

Have you had discussions with your healthcare providers about your goals of care?

Goals of care are your overall priorities and health expectations for care based on your personal values, wishes, beliefs and perception of quality of life.

• Yes
• No

How helpful were these discussions in understanding the treatment and care options available to you?

• Very helpful
• Somewhat helpful
• Not very helpful
• Not at all helpful

Did you experience any of the following challenges expressing your wishes to your healthcare providers?

Select all that apply.

• Lack of knowledge about my condition
• Not enough time during appointments
• Language differences
• Cultural differences
• Fear of being judged or misunderstood
• Uncertainty about treatment options
• Lack of privacy during appointments
• Difficulty understanding medical terms
• Discomfort discussing certain topics
  e.g., end-of-life care, mental health
• Trust issues with healthcare team
• Inadequate support for decision-making
• Other
  • Please specify challenges
  OR
• No, I have not experienced challenges
  OR
• Not applicable

Overall, to what extent do you feel your healthcare providers respect your care goals and wishes?

• To a large extent
• To a moderate extent
• Not at all
• Not applicable

Care team

The following questions ask about aspects of both your health and social care.

This includes the care you receive from healthcare professionals, both public and private, as well as the support you get from unpaid helpers like family or friends.

Who would you say is providing support and care to you for your serious illness?

Select all that apply.

• Community volunteers
• Family doctor
• Family or friends
• Nurses or nurse practitioner
• Palliative care specialist
• Personal support workers
  e.g., home support worker or healthcare aide
• Psychologists            
• Social workers
• Specialists
• Spiritual advisors
• Other
  • Please specify the person who provides support and care
  OR
• I don’t have a care provider

Who is most responsible for managing and coordinating your care and treatment?

This includes monitoring your treatment and care plans and facilitating communication between the various teams providing treatment and care.

• Myself
• Community volunteers
• Family doctor
• Family or friends
• Nurses or nurse practitioner
• Palliative care specialist
• Personal support workers
• Psychologists
• Social workers
• Specialists
• Spiritual advisors
• Other
  • Please specify person most responsible
• No one

Please indicate your level of agreement with the following statements.

1. My care team works well together
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable
2. My care team helps improve my quality of life
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable
3. My care team addresses my concerns
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable
4. My healthcare providers collaborate well with me, my family and caregivers
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable

Management of pain and other symptoms

In this section we will ask about the pain and other symptom management that you receive related to your serious illness.

What symptoms are you experiencing that are the most concerning to you?

Select top three.

• Agitation
• Anxiety
• Changes in breathing patterns
• Constipation
• Dehydration
• Delirium
• Depression
• Diarrhea
• Dyspnea (shortness of breath)
• Fatigue
• Trouble sleeping
• Weakness
• Confusion
• Nausea
• Pain
• Poor appetite
• Vomiting
• Other
  • Please specify the most concerning symptoms

Overall, how satisfied are you with the support you are receiving to manage your pain and other symptoms?

• Very satisfied
• Somewhat satisfied
• Not very satisfied
• Not satisfied at all

Which challenges have you encountered accessing necessary treatments or medications for pain and symptom management?

Select all that apply.

• Cost and insurance issues
• Availability
  e.g., medications or treatments were not available or in stock
• Distance
  e.g., travelling distance to get to appointments or to access care services
• Wait times, referral issues and appointment availability
• My lack of knowledge
• Communication and language barrier
• Other
  • Please specify challenges
  OR
• I have not experienced any challenges in access

To what extent have these challenges affected your access and choices for care?

• Significantly affected
• Moderately affected
• Slightly affected
• Not at all affected

Comprehensive supportive care

In addition to addressing physical needs, it is important that those with a serious illness receive timely support for their mental, emotional, social, cultural and spiritual needs.

Please indicate your level of agreement with the following statements.

Note: Press the help button (?) for additional information.

1. I feel comfortable sharing my psychological needs with my healthcare team
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable
2. I often feel isolated from others
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable
3. I often experience emotional distress, anxiety or deep sadness
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable
4. My cultural background and beliefs are considered and respected in my care
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable
5. I have access to spiritual support that aligns with my beliefs
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable
6. I feel connected and supported by my community and social groups
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable
7. I receive adequate support in coping with the challenges of my illness
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable

Timely access

In this section, we will ask about how long it takes you to access the care you need.

Please indicate your level of agreement with the following statements.

1. In general, I have timely access to the care services that I need
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable
2. Care services are hard to access outside of regular hours (e.g., overnight, weekends or holidays)
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable
3. Overall, the wait times between when I need and receive care are reasonable
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable

Which services do you have difficulty accessing at the time you need it?

Select all that apply.

• Advance care planning
• Care coordination
• Grief support
• Medical equipment or supplies
• Mental health care
• Nutritional guidance
• Occupational therapy
• Pain and symptom management
• Personal care
  e.g., bathing, dressing, feeding
• Physiotherapy
• Referral to specialists
• Spiritual care
• Respite care for caregivers
• Other
  • Please specify services
  OR
• I do not have difficulty accessing these services

What factors impact your ability to access care promptly?

Select all that apply.

• Distance from care services
• Lack of transportation or challenges with transportation
• Availability of care providers or specialists
• Availability of services in my preferred care setting
• Lack of information about available care
• Financial constraints
  e.g., lack of insurance coverage
• Communication barriers
  e.g., language or cultural barriers
• Difficulty navigating the healthcare system
• Other
  • Please specify factors

Have there been situations where the lack of timely support for your serious illness led to complications?

• Yes
• No

Did these complications with your serious illness lead to going to the emergency room (ER)?

• Yes
• No

In the last 12 months, how many times have you visited the emergency room (ER)?

• Number of visits

Transitions in care setting

For the next set of questions we will ask about transitions in care. "Transitions in Care" refers to the process where an individual changes where they received care and who provides that care.

“Care Setting” refers to the location where the patient receives care. Examples of care settings include doctor’s office or clinic, home, hospital, hospice or long-term care facilities.

Have you experienced transitions in care settings?

• Yes
• No

What prompted these transitions?

Select all that apply.

• Change in care needs
• Cost issues
• Proximity to family or caregivers
• Access to specialized care
• Other
  • Please specify what prompted the transitions

Overall, how would you describe your experiences transitioning between care settings?

• Very easy
• Somewhat easy
• Somewhat difficult
• Very difficult

How well have your preferences for the setting of care been respected and accommodated?

• Completely respected
• Partially respected
• Not respected at all

In your experience with transitioning between care settings, what challenges have you faced?

Select all that apply.

• Coordination difficulties
  e.g., delayed transfers, missing medical records, disrupted care continuity
• Cost issues
• Emotional and support challenges
  e.g., stress, lack of support, difficulty adapting to new routines
• Information and communication barriers
  e.g., unclear information, missed services like counselling or medications
• Physical and accessibility issues
  e.g., transportation difficulties, inaccessible facilities, mobility challenges
• Other
  • Please specify challenges
  OR
• No challenges encountered

Services received at home

The following questions aim to understand your preferences and experiences in receiving care at home from professionals.

Home care services are professional support services that may assist with daily activities, medical care, mental health services, and more.

Overall, how satisfied are you with the care services you receive at home? 

• Very satisfied
• Somewhat satisfied
• Somewhat dissatisfied
• Very dissatisfied
• I do not receive any care services at home

Which of the following services received at home were you most satisfied with?

Select all that apply.

• Pain management
• Medical care and consultations
• Personal care or home support
  e.g., bathing, dressing, meal preparation, housekeeping
• Other healthcare services
  e.g., physiotherapy, occupational therapy, speech therapy, dietitian or nutritionist services
• Social work
• Medical equipment or supplies
  e.g., wheelchair, help using oxygen equipment
• Mental health services
• Spiritual counselling
• Respite services for caregiver
• Grief counselling
  OR
• Not satisfied with any services I receive

Which of the following services received at home were you least satisfied with?

Select all that apply.

• Pain management
• Medical care and consultations
• Personal care or home support
  e.g., bathing, dressing, meal preparation, housekeeping
• Other healthcare services
  e.g., physiotherapy, occupational therapy, speech therapy, dietitian or nutritionist services
• Social work
• Medical equipment or supplies
  e.g., wheelchair, homecare bed, oxygen equipment
• Mental health services
• Spiritual counselling
• Respite services for caregiver
• Grief counselling
  OR
• Satisfied with all services I receive

For which reasons were you dissatisfied with these services?

Select all that apply.

• Services needed not available in my area
• Poor quality
  e.g., concerns about provider competence, reliability of services
• Services did not address my needs
• I could not access enough services to meet my needs
• Long wait times to receive services
• Cost was too high
• There was a language barrier
• Other
  • Please specify reasons

Which of the following services were you unable to access at home?

Select all that apply.

• Pain management
• Medical care and consultations
• Personal care or home support
  e.g., bathing, dressing, meal preparation, housekeeping
• Other healthcare services
  e.g., physiotherapy, occupational therapy, speech therapy, dietitian or nutritionist services
• Social work
• Medical equipment or supplies
  e.g., wheelchair, help using oxygen equipment
• Mental health services
• Spiritual counselling
• Respite services for caregiver
• Grief counselling
  OR
• I was able to access all services at home
  OR
• I did not try to access these services at home

For what reasons have you been unable to access these services at home?

Select all that apply.

• Services needed not available in my area
• Cost was too high
• Lack of knowledge about available services or how to access them
• Healthcare provider did not recommend the service for me
• I am not eligible for funded home services
• Scheduling issues
• Spatial or access limitations of my home
• Cultural or language barriers
  e.g., services available do not accommodate my cultural or linguistic needs
• Transportation issues
• Quality concerns
• Privacy concerns
• Other
  • Please specify reasons
  OR
• I did not want to access services at my home
  OR
• I did not need these services at my home

Preferred setting of end-of-life care

“End-of-life care” refers to care provided during the final stages of a serious illness.

“Setting of Care” in this context refers to the preferred location for end-of-life care, chosen by the patient, their family and healthcare professionals. This choice, influenced by various circumstances, aims to respect the patient’s wishes while providing necessary care. Examples of possible settings include home, hospice, hospital or long-term care facilities.

Have you had discussions with your healthcare providers about your preferred setting for end-of-life care?

• Yes
• No

Where is your preferred setting for end-of-life care?

• Private home or apartment
• Hospice
  a special facility for people living with a serious illness who are nearing the end of life
• Hospital
• Seniors’ residence
• Long-term care facility
• Assisted living facility
• I don’t have one
• I don’t know
• Other
  • Please specify your preferred setting

What is most important to you when choosing your setting for end-of-life care?

Select top three.

• Severity of medical condition
• Pain and other symptom management
  e.g., whether symptoms are under control
• Availability of professional assistance
• Availability of informal assistance
  e.g., family, friends or community members
• Access to urgent care or specialists
• Finances
• Personal wishes
• Family considerations
• Social connections
• Spiritual or cultural considerations
• Other

Overall, how much does access to care impact your choice of settings for end of life?

• To a large degree
• To some degree
• To a small degree
• Not at all

Caregiver support

This section is designed to understand the support your primary caregiver provided to you and the support they received in caring for you during your serious illness. If you have had more than one caregiver, please focus your responses on your experience with your primary caregiver.

Do you have an unpaid caregiver?

A caregiver is someone who provides unpaid care and support to you in a nonprofessional capacity, such as a family member or a friend. Types of support may include personal care, help with household activities, transportation, etc.

• Yes
• No

What is your primary caregiver’s relationship to you?

They are:

• My spouse or common-law partner
• My partner
• My child
• My grandchild
• My parent
• My sibling
• My friend
• My neighbour or community member
• Other
  • Please specify their relationship to you

What is their age?

• Age in years

What is their gender?

[Gender refers to an individual’s personal and social identity as a man, a woman or a person who is not exclusively a man or a woman, for example, non-binary, agender, gender fluid, queer or Two-Spirit./Gender refers to an individual’s personal and social identity as a boy, a girl or a person who is not exclusively a boy or a girl, for example, non-binary, agender, gender fluid, queer or Two-Spirit./Gender refers to an individual’s personal and social identity as a man (or a boy), a woman (or a girl) or a person who is not exclusively a man (or a boy) or a woman (or a girl), for example, non-binary, agender, gender fluid, queer or Two-Spirit.]

Is it:

• [Man/Boy/Man (or boy)]
• [Woman/Girl/Woman (or girl)]
• Or please specify
  • Specify their gender

How long has your unpaid caregiver been supporting you?

• Less than 6 months
• 6 months to less than a year
• 1 to 2 years
• More than 2 years

Does your unpaid caregiver usually live with you?

• Yes
• No

What kinds of care does your unpaid caregiver provide for you?

Select all that apply.

• Personal care
  e.g., dressing, bathing, toileting
• Medical care
  e.g., help taking medicine, wound care
• Managing care
  e.g., making appointments, communicating with healthcare providers
• Help with household activities
  e.g., housework, home maintenance, outdoor work
• Transportation
  e.g., to appointments, for errands
• Meal preparation, help with eating or having food delivered
• Banking, paying bills or preparing taxes
• Psychological, spiritual and emotional support
  e.g., social visits, outings
• Financial support to help pay for services
• Other
  • Please specify the kind of care they provide

Sources of information

The following questions aim to understand where you find information about your serious illness, resources and support.

Have any of your healthcare providers provided you with helpful sources of information (e.g., brochures, websites, support groups) for your serious illness and your care options?

• Yes
• No

Do you feel you have had sufficient opportunities to discuss and ask questions about your illness and care with your healthcare providers?

• Yes
• No

Have your caregivers and family members been provided with necessary information about your serious illness and care options?

• Yes
• No
• I don’t know

Besides healthcare providers, where else did you seek information for the care and support you needed for your serious illness?

Select all that apply.

• Local, provincial or national organizations
• International organizations or resources
• Internet search
  e.g., Google
• Health-specific websites or online forums
• Social media, blogs or vlogs
• Family, friends or community members
• Traditional media
  e.g., books, magazines, TV, radio
• Educational institutions
• Spiritual groups
• Other
  • Please specify sources of information
  OR
• I did not seek additional information

Cultural considerations

The following questions aim to understand your unique experiences, preferences and challenges in respect to your culture or spirituality while receiving care for your serious illness.

Overall, how comfortable are you discussing your cultural needs with your care providers?

• Very comfortable
• Somewhat comfortable
• Not comfortable
• Not comfortable at all
• Not applicable

Overall, how would you describe the care providers' sensitivity to your cultural needs?

Cultural sensitivity is awareness and respect for another’s cultural beliefs, values and practices.

• Very culturally sensitive
• Somewhat culturally sensitive
• Not very culturally sensitive
• Not culturally sensitive at all
• Not applicable

What types of cultural or spiritual misunderstandings or barriers have you encountered?

Select all that apply.

• Difficulties related to language or communication
• Differences in care approach due to cultural expectations or beliefs
• Dietary or food-related
• Misinterpretation of cultural or spiritual rituals or practices
• Lack of accommodation or privacy to carry out cultural practices
• Inappropriate remarks or behaviour
• Other
  • Please specify types of misunderstandings or barriers
  OR
• I have not encountered any types of cultural or spiritual misunderstandings

Palliative care

Palliative care is a relatively new field of medicine that takes a holistic approach to caring for those living with a serious illness.

It encompasses much of the care already asked about in this questionnaire, from pain and symptom management to emotional and spiritual needs and aims to consider the individual needs of each person living with a serious illness and their families and loved ones.

It can begin as soon as an illness is diagnosed, and it can be provided at the same time as someone is receiving treatments aimed at curing their illness.

Next are a few questions regarding palliative care.

Which of the following professionals have spoken with you about palliative care?

Note: Press the help button (?) for additional information.

Select all that apply.

• Family doctor or nurse practitioner
• Palliative care specialist
• Other medical specialist
• Social worker
• Psychologist
• Patient advocate
• Other
  • Please specify the professional
  OR
• No one has spoken to me about palliative care

Considering the definition provided, to what degree would you say you have received a palliative approach to your care?

A palliative approach is a specialized form of medical care for people with serious illnesses. It focuses on providing relief from symptoms and concerns, with the goal of improving quality of life for both the person with a serious illness and their family and caregivers. It is a holistic approach that addresses physical, emotional, social and spiritual needs and can be provided alongside treatment for the serious illness.

• To a large degree
• To some degree
• To a small degree
• Not at all

Please indicate your level of agreement with the following statements.

1. I began receiving palliative care early in the progression of my disease
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
2. The people I am close to have received support to help them cope with my illness
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
3. My care is coordinated across medical, social and psychological needs
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
4. The care I received for my serious illness has improved my mental health
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
5. I am supported by a team who are focused on my well-being
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree

Palliative care aims to improve the quality of life for those living with a serious illness, their unpaid caregivers and family members by providing holistic care focused on individual needs and wishes.

Quality of life encompasses many aspects of life that contribute to well-being, including physical and mental health, personal beliefs, social relationships and other factors such as where we live.

With this in mind, please answer the following question:

To what extent has the care you have received for your serious illness affected your overall quality of life?

• Improved significantly
• Improved somewhat
• No change
• Declined somewhat
• Declined significantly

Main activity

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

If the main activity was “sickness” or “short-term illness”, indicate the usual main activity.

Was it:

• Working at a paid job or business
• Vacation from paid work
• Looking for paid work
• Going to school, including vacation from school
• Caring for children
• Household work
• Retired
• Maternity, paternity or parental leave
• Long term illness
• Volunteering
• Care-giving other than for children
• Other

Education

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

• Less than high school diploma or its equivalent
• High school diploma or a high school equivalency certificate
• Trades certificate or diploma
• College, CEGEP or other non-university certificate or diploma (other than trades certificates or diplomas)
• University certificate or diploma below the bachelor’s level
• Bachelor’s degree
  e.g., B.A., B.A. (Hons), B.Sc., B.Ed., LL.B.
• University certificate, diploma or degree above the bachelor’s level

Sexual orientation

This question collects information on sexual orientation to inform health programs that promote equitable access and treatment for individuals living with a serious illness in Canada.

What is your sexual orientation?

Sexual orientation refers to how a person describes their sexuality.

• Heterosexual (i.e., straight)
• Lesbian or gay
• Bisexual or pansexual
• Or please specify
  • Specify your sexual orientation:

Martial status

What is your marital status?

Is it:

• Married
  For Quebec residents only, select the "Married" category if your marital status is "civil union".
• Living common law
  Two people who live together as a couple but who are not legally married to each other.
• Never married (Not living common law)
• Separated (Not living common law)
• Divorced (Not living common law)
• Widowed (Not living common law)

Indigenous identity

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

First Nations (North American Indian) includes Status and Non-Status Indians.

If "Yes", select the responses that best describes this person now.

• No, not First Nations, Métis or Inuk (Inuit)
  OR
• Yes, First Nations (North American Indian)
• Yes, Métis
• Yes, Inuk (Inuit)

Sociodemographic characteristics

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.

Select all that apply.

Are you:

• White
• South Asian
  e.g., East Indian, Pakistani, Sri Lankan
• Chinese
• Black
• Filipino
• Arab
• Latin American
• Southeast Asian
  e.g., Vietnamese, Cambodian, Laotian, Thai
• West Asian
  e.g., Iranian, Afghan
• Korean
• Japanese
• Other
  • Specify other group

Place of birth, immigration and citizenship

Where were you born?

• Born in Canada
• Born outside Canada

Are you a Canadian citizen?

• Yes, a Canadian citizen by birth
• Yes, a Canadian citizen by naturalization (Canadian citizen by naturalization refers to an immigrant who was granted citizenship of Canada under the Citizenship Act.)
• No, not a Canadian citizen

Are you a landed immigrant or permanent resident?

A landed immigrant or permanent resident is a person who has been granted the right to live in Canada permanently by immigration authorities.

• No
• Yes

In what year did you first become a landed immigrant or a permanent resident?

If exact year is not known, enter best estimate.

• Year of immigration

Language

Can you speak English or French well enough to conduct a conversation?

• English only
• French only
• Both English and French
• Neither English nor French

Total income

Now a question about total household income.

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, 2023?

Income can come from various sources such as from work, investments, pensions, or government. Examples include Employment Insurance, social assistance, child benefits and other income such as child support, spousal support (alimony) and rental income.

Capital gains should not be included in the household income.

• Rounded to the nearest CAN$

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, 2023?

• Less than $20,000
• $20,000 to less than $40,000
• $40,000 to less than $60,000
• $60,000 to less than $80,000
• $80,000 to less than $100,000
• $100,000 to less than $150,000
• $150,000 and over

Open-ended question

Do you have any further concerns about your care regarding your serious illness now or in the future, that have not been covered by this questionnaire? If yes, please let us know what they are below.

• Enter your comments

Caregiver age

What is your age?

• Age in years

Caregiver sex and gender

The following questions are about gender and sex at birth.

What is your gender?

[Gender refers to an individual’s personal and social identity as a man, a woman or a person who is not exclusively a man or a woman, for example, non-binary, agender, gender fluid, queer or Two-Spirit./Gender refers to an individual’s personal and social identity as a boy, a girl or a person who is not exclusively a boy or a girl, for example, non-binary, agender, gender fluid, queer or Two-Spirit./Gender refers to an individual’s personal and social identity as a man (or a boy), a woman (or a girl) or a person who is not exclusively a man (or a boy) or a woman (or a girl), for example, non-binary, agender, gender fluid, queer or Two-Spirit.]

Is it:

• [Man/Boy/Man (or boy)]
• [Woman/Girl/Woman (or girl)]
• Or please specify
  • Specify your gender

What was your sex at birth?

Sex at birth refers to the sex recorded on a person’s first birth certificate. It is typically observed based on a person’s reproductive system and other physical characteristics.

• Male
• Female

Please verify that all of the information is correct.

If all the information is correct, press the Next button.

To make changes, press the Previous button.

Your information

Gender: [Man/Boy/Man (or boy)/Woman/Girl/Woman (or girl)/Gender specified/Information not provided]

Sex at birth: [Male/Female/Information not provided]

Information of the person living with a serious illness

We will now ask you some questions regarding the person you are currently providing unpaid care for, or the last person for whom you have provided unpaid care in relation to a serious illness. If you are currently providing unpaid care for more than one person, please consider the person you usually provide the most hours of unpaid care for.

To facilitate the flow of the questionnaire, questions regarding the person being cared for will be asked using the past tense. 

In order to personalize the survey, could you please provide the first name of the person you cared for?

Note: If you prefer not to provide the person's real first name, you can use a pseudonym or a number, as the first name is only used as a reference for the questions that follow.

• First name

What was your relationship with [Patient Name]?

I was:

• Their spouse or common-law partner
• Their partner
• Their child
• Their grandchild
• Their parent
• Their sibling
• Their friend
• Their neighbour or community member
• Other
  • Please specify your relationship with [Patient Name]

Age of the person living with a serious illness

What was [Patient Name]'s age?

• Age in years

Gender of the person living with a serious illness

What was [Patient Name]'s gender?

[Gender refers to an individual’s personal and social identity as a man, a woman or a person who is not exclusively a man or a woman, for example, non-binary, agender, gender fluid, queer or Two-Spirit./Gender refers to an individual’s personal and social identity as a boy, a girl or a person who is not exclusively a boy or a girl, for example, non-binary, agender, gender fluid, queer or Two-Spirit./Gender refers to an individual’s personal and social identity as a man (or a boy), a woman (or a girl) or a person who is not exclusively a man (or a boy) or a woman (or a girl), for example, non-binary, agender, gender fluid, queer or Two-Spirit.]

Was it:

• [Man/Boy/Man (or boy)]
• [Woman/Girl/Woman (or girl)]
• Or please specify
  • Specify [Patient Name]'s gender

What was [Patient Name]'s sex at birth?

Sex at birth refers to the sex recorded on a person’s first birth certificate. It is typically observed based on a person’s reproductive system and other physical characteristics.

• Male
• Female

Please verify that all of the information is correct.

If all the information is correct, press the Next button.

To make changes, press the Previous button.

[Patient Name]'s information

Gender: [Man/Boy/Man (or boy)/Woman/Girl/Woman (or girl)/Gender specified/Information not provided]

Sex at birth: [Male/Female/Information not provided]

Postal code of the person living with a serious illness

To determine which geographic region [Patient Name] lived in, provide their postal code.

• Postal code
  Example: A9A 9A9

Dwelling type

What type of dwelling was [Patient Name] living in?

• Private home or apartment
• Retirement home or senior residence
  a retirement home is a privately paid residency for seniors who can direct their own care but may need a bit more support with their daily living activities
• Long-term care facility or nursing home
  long-term care facilities or nursing homes provide living accommodation for people who require on-site delivery of 24 hour, 7 days a week supervised care
• Unstable or temporary living situation
• Homeless
• Other
  • Please specify type of dwelling

Assessment

Next, a few questions to understand the care needs of [Patient Name].

What serious illness was [Patient Name] living with that impacted them the most?

• Advanced cancer
• Chronic liver disease
• Chronic obstructive pulmonary disease (COPD) or other chronic lung condition
  e.g., cystic fibrosis, pulmonary hypertension, tuberculosis
• Dementia or Alzheimer’s disease
• Heart disease or failure
• Human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS)
• Kidney failure
• Multiple organ failure
• Neurological disease
  e.g., amyotrophic lateral sclerosis (ALS), Lou Gehrig’s disease, multiple sclerosis, Parkinson’s disease, Huntington’s disease
• Stroke or cerebrovascular disease
• Weakened immune system or immunocompromised
• Other
  • Please specify the serious illness

Now some questions about primary healthcare. This is the type of healthcare usually delivered by family doctors or nurse practitioners who provide continuous care, are familiar with your medical history, and with whom you can book regular appointments. It is often the first point of entry to the Canadian health system.

Primary healthcare needs can include routine care such as check-ups and prescription refills as well as issues that need immediate care but are not emergencies, such as an infection, fever, headache, a sprained ankle, vomiting or an unexplained rash.

Patients sometimes have a care team which can include different healthcare professionals, as well as unpaid caregivers such as family, friends or community members.

Did [Patient Name] have a regular primary healthcare provider?

By this, we mean a health professional they regularly consulted with when they needed care or advice for their health.

Select all that apply.

• Yes, a family doctor
• Yes, a nurse practitioner
• Yes, a palliative care specialist
• Yes, another specialist
• Yes, another health professional
  • Specify the other health professional
  OR
• No

Was someone from [Patient Name]'s care team regularly completing a needs assessment for them?

A needs assessment is an evaluation of your health status, risks and needs.

A care team includes the care you receive from healthcare professionals, as well as the support you get from unpaid helpers like family or friends.

• Yes
• No
• Don’t know

Which of the following needs were being assessed by someone from [Patient Name]s care team?

Select all that apply.

• Physical
• Psychological
• Social
  Include social support from family members or friends.
• Cultural
• Legal
• Spiritual
• End-of-life
• Loss or grief
• Other

Which conditions related to [Patient Name]'s serious illness limited their daily activities the most?

Select up to 3 answers.

• Physical limitations
  e.g., difficulty walking, using stairs, using their hands or fingers, problems with sight or hearing or doing other physical activities
• Severe pain
• Fatigue
• Trouble breathing
• Problems communicating
• Lack of appetite or nausea
• Cognitive limitations
  e.g., difficulty learning, remembering or concentrating
• Mental health conditions
  e.g., anxiety, depression, substance abuse
• Other
  • Please specify the condition
  OR
• None of the above

Planning

Now, a few questions to understand how [Patient Name]'s wishes, values and beliefs were reflected within the management of their illness and care planning. 

Did [Patient Name] engage in conversations with someone from their care team about their wishes, values and beliefs regarding care for their serious illness?

For example, conversations may have included discussions about where they liked to receive care, their treatment plan, pain management preferences, etc.

A care team may include healthcare professionals as well as unpaid helpers, like family or friends.

• Yes
• No
• Don’t know

What topics were discussed?

Select all that apply.

• Setting of care
  e.g., home, hospice, hospital, specialized care centre
• Treatment plan
  e.g., types of treatments, specific instructions for future care
• Life-sustaining treatment options
  e.g., resuscitation, ventilators, feeding tubes
• Pain management preferences
• Legal and financial matters
• Spiritual considerations
• Place of end-of-life care
  e.g., home, hospice, hospital
• Organ and tissue donation
• Funeral or memorial preferences
• Other
  • Please specify topics discussed

Did [Patient Name] select a substitute decision-maker?

A substitute decision-maker is the person who makes decisions about care and treatments on behalf of a person who is seriously ill, only if they are incapable of doing so on their own. Depending on where you live in Canada, this person can also be called a medical proxy, health representative or agent or power of attorney for personal care.

• Yes, I was the substitute decision-maker
• Yes, myself and someone else were the substitute decision-makers
• Yes, they had a different substitute decision-maker
• No
• I don’t know

How confident are you that you had the information you needed to make decisions on [Patient Name]'s behalf?

• Very confident
• Somewhat confident
• Not very confident
• Not confident at all

Did [Patient Name] have discussions with their healthcare providers about their goals of care?

Goals of care are your patients' priorities and health expectations for care based on their personal values, wishes, beliefs and perception of quality of life.

• Yes
• No

How helpful were these discussions in understanding the treatment and care options available to [Patient Name]?

• Very helpful
• Somewhat helpful
• Not very helpful
• Not at all helpful

Did [Patient Name] experience any challenges expressing their wishes to their healthcare providers?

Select all that apply.

• Their lack of knowledge about their condition
• Not enough time during appointments
• Language differences
• Cultural differences
• Fear of being judged or misunderstood
• Uncertainty about treatment options
• Lack of privacy during appointments
• Difficulty understanding medical terms
• Discomfort discussing certain topics
  e.g., end-of-life care, mental health
• Trust issues with healthcare team
• Inadequate support for decision-making
• Other
  • Please specify challenges
  OR
• No, they did not experience challenges
  OR
• Not applicable

Overall, did you feel [Patient Name]'s healthcare providers respected their care goals and wishes?

• Yes, to a large extent
• Yes, to a moderate extent
• No, not at all
• Not applicable

Care team

The following questions ask about aspects of both [Patient Name]'s health and social care.

This includes the care you receive from healthcare professionals, both public and private, as well as the support you get from unpaid helpers like family or friends.

Besides you, who would you say provided support and care to [Patient Name] for their serious illness?

Select all that apply.

• Community volunteers
• Family doctor
• Family or friends
• Nurses or nurse practitioner
• Palliative care specialist
• Personal support workers
  e.g., home support worker or healthcare aide
• Psychologists
• Social workers
• Specialists
• Spiritual advisors
• Other
  • Please specify the person who provided support and care
  OR
• Only myself

Who was most responsible for managing and coordinating [Patient Name]'s care and treatment?

This includes monitoring their treatment and care plans and facilitating communication between the various teams providing treatment and care.

• [Patient Name]
• Myself
• Community volunteers
• Family doctor
• Family or friends
• Nurses or nurse practitioner
• Palliative care specialist
• Personal support workers
• Psychologists
• Social workers
• Specialists
• Spiritual advisors
• Other
  • Please specify person most responsible
• No one

Please indicate your level of agreement with the following statements.

1. [Patient Name]'s care team worked well together
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable
2. [Patient Name]'s care team helped improve their quality of life
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable
3. [Patient Name]'s care team addressed their concerns
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable
4. Healthcare providers collaborated well with [Patient Name], their family and their caregivers
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable

Management of pain and other symptoms

In this section we will ask about the pain and other symptom management that [Patient Name] has received related to their serious illness.

What were the most concerning symptoms for [Patient Name]?

Select top three.

• Agitation
• Anxiety
• Changes in breathing patterns
• Constipation
• Dehydration
• Delirium
• Depression
• Diarrhea
• Dyspnea (shortness of breath)
• Fatigue
• Trouble sleeping
• Weakness
• Confusion
• Nausea
• Pain
• Poor appetite
• Vomiting
• Other
  • Please specify the most concerning symptoms

Overall, how satisfied was [Patient Name] with the support they received to manage their pain and other symptoms?

• Very satisfied
• Somewhat satisfied
• Not very satisfied
• Not satisfied at all
• Not applicable

From your experience, did [Patient Name] face any challenges in accessing necessary treatments or medications for pain and symptom management?

Select all that apply.

• Cost and insurance issues
• Availability
  e.g., medications or treatments were not available or in stock
• Distance
  e.g., travelling distance to get to appointments or to access care services
• Wait times, referral issues, and appointment availability
• Lack of knowledge
• Communication and language barrier
• Other
  • Please specify challenges
  OR
• [Patient Name] did not experience any challenges in access

To what extent have these challenges affected [Patient Name]’s access and choices for care?

• Significantly affected
• Moderately affected
• Slightly affected
• Not at all affected

Comprehensive supportive care

In addition to addressing physical needs, it is important that those with a serious illness receive timely support for their mental, emotional, social, cultural and spiritual needs.

Please indicate your level of agreement with the following statements.

Note: Press the help button (?) for additional information.

1. [Patient Name] felt comfortable sharing their psychological needs with their healthcare team
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable
2. [Patient Name] often felt isolated from others
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable
3. [Patient Name] often experienced emotional distress, anxiety, or deep sadness
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable
4. [Patient Name]’s cultural background and beliefs were considered and respected in their care
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable
5. [Patient Name] had access to spiritual support that aligned with their beliefs
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable
6. [Patient Name] felt connected and supported by their community and social groups
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable
7. [Patient Name] received adequate support in coping with the challenges of their illness
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable

Timely access

In this section, we will ask about how long it took [Patient Name] to access the care they needed.

Please indicate your level of agreement with the following statements.

1. In general, [Patient Name] had timely access to the care services they needed
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable
2. Care services were hard to access outside of regular hours (e.g., overnight, weekends or holidays)
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable
3. Overall, the wait times between when [Patient Name] needed and received care were reasonable
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Not applicable

Which services has [Patient Name] had difficulty accessing at the time they needed it?

Select all that apply.

• Advance care planning
• Care coordination
• Grief support
• Medical equipment or supplies
• Mental health care
• Nutritional guidance
• Occupational therapy
• Pain and symptom management
• Personal care
  e.g., bathing, dressing, feeding
• Physiotherapy
• Referral to specialists
• Spiritual care
• Respite care for caregivers
• Other
  • Please specify services
  OR
• [Patient Name] did not have difficulty accessing these services

What factors impacted [Patient Name]’s ability to access care promptly?

Select all that apply.

• Distance from care services
• Lack of transportation or challenges with transportation
• Availability of care providers or specialists
• Availability of services in [Patient Name]’s preferred care setting
• Lack of information about available care
• Financial constraints
  e.g., lack of insurance coverage
• Communication barriers
  e.g., language or cultural barriers
• Difficulty navigating the healthcare system
• Other
  • Please specify factors

Were there situations where the lack of timely support in [Patient Name]’s serious illness led to complications?

• Yes
• No

Did these complications with [Patient Name]’s serious illness lead to going to the emergency room (ER)?

• Yes
• No

In the last 12 months, how many times did [Patient Name] visit the emergency room (ER)?

[Please report for the last 12 months before they passed away.]

• Number of visits

Transitions in care settings

For the next questions we will ask question about transitions in care. "Transitions in Care" refers to the process where an individual changes where they received care and who provides that care.

“Care Setting” refers to the location where the patient receives care. Examples of care settings include doctor’s office or clinic, home, hospital, hospice or long-term care facilities.

Did [Patient Name] experience transitions in care settings?

• Yes
• No

What prompted these transitions?

Select all that apply.

• Change in care needs
• Cost issues
• Proximity to family or caregivers
• Access to specialized care
• Other
  • Please specify what prompted these transitions

From your perspective, how would you describe [Patient Name]'s overall experiences transitioning between care settings?

• Very easy
• Somewhat easy
• Somewhat difficult
• Very difficult

How well were [Patient Name]’s preferences for the setting of care respected and accommodated?

• Completely respected
• Partially respected
• Not respected at all
• I don't know

In your experience with [Patient Name]’s transitioning between care settings, what challenges did they face?

Select all that apply.

• Coordination difficulties
  e.g., delayed transfers, missing medical records, disrupted care continuity
• Cost issues
• Emotional and support challenges
  e.g., stress, lack of support, difficulty adapting to new routines
• Information and communication barriers
  e.g., unclear information, missed services like counselling or medications
• Physical and accessibility issues
  e.g., transportation difficulties, inaccessible facilities, mobility challenges
• Other
  • Please specify challenges
  OR
• No challenges encountered

Services received at home

The following questions aim to understand [Patient Name]’s preferences and experiences in receiving care at home.

Home care services are professional support services that may assist with daily activities, medical care, mental health services, and more.

Overall, how satisfied was [Patient Name] with the care services they received at home?

• Very satisfied
• Somewhat satisfied
• Somewhat dissatisfied
• Very dissatisfied
• [Patient Name] did not receive any care services at home

Which of the following services received at home was [Patient Name] most satisfied with?

Select all that apply.

• Pain management
• Medical care and consultations
• Personal care or home support
  e.g., bathing, dressing, meal preparation, housekeeping
• Other healthcare services
  e.g., Physiotherapy, Occupational therapy, Speech therapy, Dietitian or nutritionist services
• Social work
• Medical equipment or supplies
  e.g., wheelchair, help using oxygen equipment
• Mental health services
• Spiritual counselling
• Respite services for caregiver
• Grief counselling
  OR
• [Patient Name] was not satisfied with any services they received

Which of the following services received at home was [Patient Name] least satisfied with?

Select all that apply.

• Pain management
• Medical care and consultations
• Personal care or home support
• e.g., bathing, dressing, meal preparation, housekeeping
• Other healthcare services
  e.g., physiotherapy, occupational therapy, speech therapy, dietitian, or nutritionist services
• Social work
• Access to medical equipment or supplies
  e.g., wheelchair, homecare bed, oxygen equipment
• Mental health services
• Spiritual counselling
• Respite services for caregiver
• Grief counselling
  OR
• [Patient Name] was satisfied with all services they received

For which reasons was [Patient Name] dissatisfied with these services?

Select all that apply.

• Services needed were not available in [Patient Name]’s area
• Poor quality
  e.g., concerns about provider competence, reliability of services
• Services did not address [Patient Name]’s needs
• I could not access enough services to meet [Patient Name]’s needs
• Long wait times to receive services
• Cost was too high
• There was a language barrier
• Other
  • Please specify reasons                      

Which of the following services was [Patient Name] unable to access at home?

Select all that apply.

• Pain management
• Medical care and consultations
• Personal care or home support
  e.g., bathing, dressing, meal preparation, housekeeping
• Other healthcare services
  e.g., physiotherapy, occupational therapy, speech therapy, dietitian or nutritionist services
• Social work
• Medical equipment or supplies
  e.g., wheelchair, help using oxygen equipment
• Mental health services
• Spiritual counselling
• Respite services for caregiver
• Grief counselling
  OR
• [Patient Name] was able to access all services at home
  OR
• [Patient Name] did not try to access these services at home

For what reasons was [Patient Name] unable to access these services at home?

Select all that apply.

• Services needed not available in their area
• Cost was too high
• Lack of knowledge about available services or how to access them
• Healthcare provider did not recommend the service for them
• They were not eligible for funded home services
• Scheduling issues
• Spatial or access limitations of their home
• Cultural or language barriers
  e.g., services available did not accommodate their cultural or linguistic needs
• Transportation issues
• Quality concerns
• Privacy concerns
• Other
  • Please specify reasons
  OR
• [Patient Name] did not want to access services at their home
  OR
• [Patient Name] did not need these services at home

Preferred setting of end-of-life care

“End-of-life care” refers to care provided during the final stages of a serious illness.

“Setting of Care” in this context refers to the preferred location for end-of-life care, chosen by the patient, their family and healthcare professionals. This choice, influenced by various circumstances, aims to respect the patient’s wishes while providing necessary care. Examples of possible settings include home, hospice, hospital or long-term care facilities.

Did [Patient Name] have discussions with their healthcare providers about their preferred setting for end-of-life care?

• Yes
• No
• Don’t know

Where was [Patient Name]’s preferred setting for end-of-life care?

• Private home or apartment
• Hospice
  a special facility for people living with a serious illness who are nearing the end of life
• Hospital
• Seniors’ residence
• Long-term care facility
• Assisted living facility
• [Patient Name] didn’t have one
• I don’t know
• Other
  • Please specify preferred setting

What was most important to [Patient Name] when choosing their setting for end-of-life care?

Select top three.

• Severity of medical condition
• Pain and other symptom management
  e.g., whether symptoms are under control
• Availability of professional assistance
• Availability of informal assistance
  e.g., family, friends, or community members
• Access to urgent care or specialists
• Finances
• Personal wishes
• Family considerations
• Social connections
• Spiritual or cultural considerations
• Other
  OR
• Don’t know

Overall, how much did access to care impact [Patient Name]’s choice of settings for their end of life?

• To a large degree
• To some degree
• To a small degree
• Not at all
• Don’t know

Did [Patient Name] die in their preferred setting for end-of-life care?

• Yes
• No
• Don’t know

Caregiver support

This section is designed to understand your experience as a caregiver, focusing on the support you received and your overall experience.

How long were you a caregiver for [Patient Name]?

• Less than 6 months
• 6 months to less than a year
• 1 to 2 years
• More than 2 years

How many hours per week did you usually dedicate to providing care for [Patient Name]?

Types of care and support may include providing personal care, help with household activities, transportation, meal preparation, etc.

• Less than one hour per week
• 1 to less than 5 hours per week
• 5 to less than 15 hours per week
• 15 to less than 35 hours per week
• 35 hours or more per week

Did you live with [Patient Name] while providing care for them?

• Yes
• No

What kinds of care did you provide for [Patient Name]?

Select all that apply.

• Personal care
  e.g., dressing, bathing, toileting
• Medical care
  e.g., help taking medicine, wound care
• Managing care
  e.g., making appointments, communicating with healthcare providers
• Help with household activities
  e.g., housework, home maintenance, outdoor work
• Transportation
  e.g., to appointments, for errands
• Meal preparation, help with eating or having food delivered
• Banking, paying bills or preparing taxes
• Psychological, spiritual and emotional support
  e.g., social visits, outings
• Financial support to help pay for services
• Other
  • Please specify the kind of care you provided

Did you have an assessment to determine your own needs for support as a caregiver for [Patient Name]?

Support for caregivers might include training, support groups, home care and temporary respite care for the person you take care of.

• Yes
• No
• I don’t know

Overall, did you receive the help and support you needed to care for [Patient Name]?

• Yes, totally
• Yes, partially
• No

In your role as a caregiver, where do you feel more support would have been the most beneficial?

Select the top three.

• Enhanced communication with healthcare providers
  e.g., better clarity and more information
• Professional homecare services
• Caregiver training
  e.g., training on organizing care, giving medications, changing dressings
• Respite care
  e.g., to enable a break from caregiving duties
• Financial support
  e.g., assistance with expenses
• Work flexibility
• Emotional and psychological counselling
• Relief from other responsibilities
  e.g., childcare, meal preparation, and housework for your own household
• Dedicated personal time
• Peer support
  e.g., connecting with other caregivers for shared experiences and advice
• Other
  • Please specify the area needing more support
  OR
• I had all the support I needed

Please indicate your level of agreement with the following statements.

1. [Patient Name]’s healthcare providers were always willing to answer my questions
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
2. When I felt I needed help with caregiving responsibilities I knew where to get support
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
3. I knew where to go when I needed information regarding my caregiving responsibilities
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
4. Overall, I had a positive experience being a caregiver for [Patient Name]
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree

Sources of information

The following questions aim to understand where the person with a serious illness found information about their serious illness, resources and support.

Did any of [Patient Name]’s healthcare providers provide them with helpful sources of information (e.g., as brochures, websites, support groups) for their serious illness and care options?

• Yes
• No
• I don't know

From your perspective, did [Patient Name] have sufficient opportunities to discuss and ask questions about their illness and care with their healthcare providers?

• Yes
• No
• Not applicable

Have you and [Patient Name]’s family members also been provided with necessary information about [Patient Name]’s serious illness and care options?

• Yes
• No

Besides healthcare providers, where else did [Patient Name] seek information for the care and support they needed for their serious illness?

Select all that apply.

• Local, provincial, or national organizations
• International organizations or resources
• Internet search
  e.g., Google
• Health-specific websites or online forums
• Social media, blogs or vlogs
• Family, friends or community members
• Traditional media
  e.g., books, magazines, TV, radio
• Educational institutions
• Spiritual groups
• Other
  • Please specify the source of information
  OR
• [Patient Name] did not seek additional information
  OR
• Don't know

Cultural considerations

The following questions aim to understand [Patient Name]’s unique experiences, preferences, and challenges in respect to their culture or spirituality while receiving care for their serious illness.

Overall, how comfortable was [Patient Name] discussing their cultural needs with their care providers?

• Very comfortable
• Somewhat comfortable
• Not comfortable
• Not comfortable at all
• Not applicable

Overall, how would you describe the care providers' sensitivity to [Patient Name]’s cultural needs?

Cultural sensitivity is awareness and respect for another’s cultural beliefs, values and practices.

• Very culturally sensitive
• Somewhat culturally sensitive
• Not culturally sensitive
• Not culturally sensitive at all
• Not applicable

What types of cultural or spiritual misunderstandings or barriers did [Patient Name] encounter?

Select all that apply.

• Difficulties related to language or communication
• Differences in care approach due to cultural expectations or beliefs
• Dietary or food-related
• Misinterpretation of cultural or spiritual rituals or practices
• Lack of accommodation or privacy to carry out cultural practices
• Inappropriate remarks or behaviour
• Other
  • Please specify type of misunderstanding or barrier
  OR
• [Patient Name] did not encounter any types of cultural or spiritual misunderstandings

Palliative care

Palliative care is a relatively new field of medicine that takes a holistic approach to caring for those living with a serious illness.

It encompasses much of the care already asked about in this questionnaire, from pain and symptom management to emotional and spiritual needs and aims to consider the individual needs of each person living with a serious illness and their families and loved ones.

It can begin as soon as an illness is diagnosed, and it can be provided at the same time as someone is receiving treatments aimed at curing their illness.

Next are a few questions regarding palliative care.

Which of the following professionals spoke with [Patient Name] about palliative care?

Note: Press the help button (?) for additional information.

Select all that apply.

• Family doctor or nurse practitioner
• Palliative care specialist
• Other medical specialist
• Social worker
• Psychologist
• Patient advocate
• Other
  • Please specify the professional
  OR
• No one has spoken to [Patient Name] about palliative care

Considering the definition provided, to what degree would you say [Patient Name] has received a palliative approach to their care?

A palliative approach is a specialized form of medical care for people with serious illnesses. It focuses on providing relief from symptoms and concerns, with the goal of improving quality of life for both the person with a serious illness and their family and caregivers. It is a holistic approach that addresses physical, emotional, social and spiritual needs and can be provided alongside treatment for the serious illness.

• To a large degree
• To some degree
• To a small degree
• Not at all

Please indicate your level of agreement with the following statements.

1. [Patient Name] received palliative care early in the progression of their disease
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Don't know
2. The people [Patient Name] was close to received support to help them cope with [Patient Name]’s illness
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Don't know
3. [Patient Name]’s care was coordinated across medical, social and psychological needs
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Don't know
4. The care [Patient Name] received for their serious illness has improved their mental health
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Don't know
5. [Patient Name] was supported by a team who were focused on their well-being
   • Strongly agree
   • Agree
   • Disagree
   • Strongly disagree
   • Don't know

Palliative care aims to improve the quality of life for those living with a serious illness, their unpaid caregivers and family members by providing holistic care focused on individual needs and wishes.

Quality of life encompasses many aspects of life that contribute to well-being, including physical and mental health, personal beliefs, social relationships and other factors such as where we live.

With this in mind, please answer the following question:

To what extent did the care received by [Patient Name] for their serious illness affect their overall quality of life?

• Improved significantly
• Improved somewhat
• No change
• Declined somewhat
• Declined significantly

Education of person living with a serious illness

What was the highest certificate, diploma or degree that [Patient Name] completed?

• Less than high school diploma or its equivalent
• High school diploma or a high school equivalency certificate
• Trades certificate or diploma
• College, CEGEP or other non-university certificate or diploma (other than trades certificates or diplomas)
• University certificate or diploma below the bachelor’s level
• Bachelor’s degree
  e.g., B.A., B.A. (Hons), B.Sc., B.Ed., LL.B.
• University certificate, diploma or degree above the bachelor’s level

Sexual orientation of the person living with a serious illness

This question collects information on sexual orientation to inform health programs that promote equitable access and treatment for individuals living with a serious illness in Canada.

Please answer to the best of your knowledge.

What was [Patient Name]’s sexual orientation?

Sexual orientation refers to how a person describes their sexuality.

• Heterosexual (i.e., straight)
• Lesbian or gay
• Bisexual or pansexual
• Or please specify
  • Specify this person's sexual orientation:

Marital status of the person living with a serious illness

What was [Patient Name]’s marital status?

Was it:

• Married
  For Quebec residents only, select the "Married" category if your marital status is "civil union".
• Living common law
  Two people who live together as a couple but who are not legally married to each other.
• Never married (Not living common law)
• Separated (Not living common law)
• Divorced (Not living common law)
• Widowed (Not living common law)

Indigenous identity of the person living with a serious illness

Was [Patient Name] First Nations, Métis or Inuk (Inuit)?

First Nations (North American Indian) includes Status and Non-Status Indians.

If "Yes", select the responses that best describes this person.

• No, not First Nations, Métis or Inuk (Inuit)
  OR
• Yes, First Nations (North American Indian)
• Yes, Métis
• Yes, Inuk (Inuit)

Sociodemographic characteristics of the person living with a serious illness

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.

Select all that apply.

Was [Patient Name]:

• White
• South Asian
  e.g., East Indian, Pakistani, Sri Lankan
• Chinese
• Black
• Filipino
• Arab
• Latin American
• Southeast Asian
  e.g., Vietnamese, Cambodian, Laotian, Thai
• West Asian
  e.g., Iranian, Afghan
• Korean
• Japanese
• Other
  • Specify other group

Place of birth, immigration and citizenship of person living with serious illness

Where was [Patient Name] born?

• Born in Canada
• Born outside Canada

Was [Patient Name] a Canadian citizen?

• Yes, a Canadian citizen by birth
• Yes, a Canadian citizen by naturalization (Canadian citizen by naturalization refers to an immigrant who was granted citizenship of Canada under the Citizenship Act.)
• No, not a Canadian citizen

Was [Patient Name] a landed immigrant or permanent resident?

A landed immigrant or permanent resident is a person who has been granted the right to live in Canada permanently by immigration authorities.

• No
• Yes

In what year did [Patient Name] first become a landed immigrant or a permanent resident?

If exact year is not known, enter best estimate.

• Year of immigration

Language of the person living with a serious illness

Could [Patient Name] speak English or French well enough to conduct a conversation?

• English only
• French only
• Both English and French
• Neither English nor French

Total income of the person living with a serious illness

Now a question about total household income.

What is your best estimate of [Patient Name]’s total household income received by all household members, from all sources, before taxes and deductions, during the year ending December 31, 2023?

Income can come from various sources such as from work, investments, pensions, or government. Examples include Employment Insurance, social assistance, child benefits and other income such as child support, spousal support (alimony) and rental income.

Capital gains should not be included in the household income.

• Rounded to the nearest CAN$

What is your best estimate of [Patient Name]’s total household income received by all household members, from all sources, before taxes and deductions, during the year ending December 31, 2023?

• Less than $20,000
• $20,000 to less than $40,000
• $40,000 to less than $60,000
• $60,000 to less than $80,000
• $80,000 to less than $100,000
• $100,000 to less than $150,000
• $150,000 and over

Open-ended question

Do you have any further concerns about the care [Patient Name] received for their serious illness, that have not been covered by this questionnaire? If yes, please let us know what they are below.

• Enter your comments

Proxy question

Did someone help you complete this questionnaire?

• Yes, someone helped me complete the questionnaire
• No, I completed the questionnaire myself

Province

In which province or territory [do/did] [you/[Patient Name]] live?

• Province or territory
  • Alberta
  • British Columbia
  • Manitoba
  • New Brunswick
  • Newfoundland and Labrador
  • Northwest Territories
  • Nova Scotia
  • Nunavut
  • Ontario
  • Prince Edward Island
  • Quebec
  • Saskatchewan
  • Yukon
  OR
• Outside of Canada

Administrative information

To avoid duplication of surveys, Statistics Canada may enter into agreements to share the data from this survey with provincial and territorial ministries of health. The ministries of health may make the data available to local health authorities.

Provincial and territorial ministries of health and local health authorities would receive the survey responses and the postal code.

To avoid duplication of surveys, Statistics Canada may enter into agreements to share the data from this survey with provincial and territorial ministries of health and the Institut de la statistique du Québec. The Institut de la statistique du Québec and the ministries of health may make this data available to local health authorities.

Provincial and territorial ministries of health, the Institut de la statistique du Québec and local health authorities would receive the survey responses and the postal code.

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

Do you agree to share the data you provided?

[If you are answering on behalf of someone else, please consult that person./If you are able to, please consult [Patient Name] before providing a response.]

• Yes
• No

Business or organization information

1. Which of the following categories best describes this business or organization?

• Government agency
• Private sector business
• Non-profit organization
  • Who does this organization primarily serve?
    • Households or individuals
      e.g., child and youth services, community food services, food bank, women's shelter, community housing services, emergency relief services, religious organization, grant and giving services, social advocacy group, arts and recreation group
    • Businesses
      e.g., business association, chamber of commerce, condominium association, environmental support or protection services, group benefit carriers (pensions, health, medical)
• Don't know

2. In what year was this business or organization first established?

Please provide the year this business or organization first began operations.

Year business or organization was first established:
OR
Don't know

• Approximately how long ago was this business or organization first established?
  • 2 years ago or less
    Established in 2024, 2023, or 2022.
  • 3 to 10 years ago
    Established in 2014 to 2021.
  • 11 to 20 years ago
    Established in 2004 to 2013.
  • More than 20 years ago
    Established in 2003 or earlier.
  • Don't know

3. Over the last 12 months, which of the following international activities did this business or organization conduct?

Select all that apply.

• Export or sell goods outside of Canada
  Include both intermediate and final goods.
• Export or sell services outside of Canada
  Include services delivered virtually and in person.
  e.g., software, cloud services, legal services, environmental services, architectural services, digital advertising
• Make investments outside of Canada
• Sell goods to businesses or organizations in Canada who then resold them outside of Canada
• Import or buy goods from outside of Canada
  Include both intermediate and final goods.
• Import or buy services from outside of Canada
  Include services received virtually and in person.
  e.g., software, cloud services, legal services, environmental services, architectural services, digital advertising
• Relocate any business or organizational activities or employees from another country into Canada
  Exclude temporary foreign workers.
• Relocate any business or organizational activities or employees from Canada to another country
• Engage in other international business or organizational activities
• OR
• None of the above

4. Over the next three months, how are each of the following expected to change for this business or organization?

Exclude seasonal factors or conditions.

• Number of employees
  • Increase
  • Stay about the same
  • Decrease
  • Not applicable
  • Don't know
• Vacant positions
  • Increase
  • Stay about the same
  • Decrease
  • Not applicable
  • Don't know
• Sales of goods or services offered by this business or organization
  • Increase
  • Stay about the same
  • Decrease
  • Not applicable
  • Don't know
• Selling price of goods or services offered by this business or organization
  • Increase
  • Stay about the same
  • Decrease
  • Not applicable
  • Don't know
• Demand for goods or services offered by this business or organization
  • Increase
  • Stay about the same
  • Decrease
  • Not applicable
  • Don't know
• Imports of goods or services
  • Increase
  • Stay about the same
  • Decrease
  • Not applicable
  • Don't know
• Exports of goods or services
  • Increase
  • Stay about the same
  • Decrease
  • Not applicable
  • Don't know
• Operating income
  • Increase
  • Stay about the same
  • Decrease
  • Not applicable
  • Don't know
• Operating expenses
  • Increase
  • Stay about the same
  • Decrease
  • Not applicable
  • Don't know
• Profitability
  • Increase
  • Stay about the same
  • Decrease
  • Not applicable
  • Don't know
• Cash reserves
  • Increase
  • Stay about the same
  • Decrease
  • Not applicable
  • Don't know
• Capital expenditures
  e.g., machinery, equipment
  • Increase
  • Stay about the same
  • Decrease
  • Not applicable
  • Don't know
• Training expenditures
  • Increase
  • Stay about the same
  • Decrease
  • Not applicable
  • Don't know
• Marketing and advertising budget
  • Increase
  • Stay about the same
  • Decrease
  • Not applicable
  • Don't know
• Expenditures in research and development
  • Increase
  • Stay about the same
  • Decrease
  • Not applicable
  • Don't know

Business or organization obstacles

5. Over the next three months, which of the following are expected to be obstacles for this business or organization?

Select all that apply.

• Shortage of labour force
• Recruiting skilled employees
• Retaining skilled employees
• Shortage of space or equipment
• Rising cost of inputs
  An input is an economic resource used in a firm's production process.
  e.g., labour, capital, energy and raw materials
• Rising costs in real estate, leasing or property taxes
• Rising inflation
• Rising interest rates and debt costs
  e.g., borrowing fees, interest payments
• Difficulty acquiring inputs, products or supplies from within Canada
• Difficulty acquiring inputs, products or supplies from abroad
• Maintaining inventory levels
• Insufficient demand for goods or services offered
• Fluctuations in consumer demand
• Attracting new or returning customers
• Lack of financial resources
• Technological limitations
• Regulatory constraints
• Cost of insurance
• Transportation costs
• Obtaining financing
• Increasing competition
• Challenges related to exporting or selling goods and services to customers in other provinces or territories
• Challenges related to exporting or selling goods and services outside of Canada
• Maintaining sufficient cash flow or managing debt
• Other obstacle
  • Specify other obstacle:
• OR
• None of the above

Flow condition: If at least two obstacles are selected in Q5, go to Q6. Otherwise, go to Q7.

Display condition: Display in Q6 the obstacles selected in Q5.

6. Of the obstacles selected in the previous question, which obstacle is expected to be the most challenging over the next three months?

• Shortage of labour force
• Recruiting skilled employees
• Retaining skilled employees
• Shortage of space or equipment
• Rising cost of inputs
  An input is an economic resource used in a firm's production process.
  e.g., labour, capital, energy and raw materials
• Rising costs in real estate, leasing or property taxes
• Rising inflation
• Rising interest rates and debt costs
  e.g., borrowing fees, interest payments
• Difficulty acquiring inputs, products or supplies from within Canada
• Difficulty acquiring inputs, products or supplies from abroad
• Maintaining inventory levels
• Insufficient demand for goods or services offered
• Fluctuations in consumer demand
• Attracting new or returning customers
• Lack of financial resources
• Technological limitations
• Regulatory constraints
• Cost of insurance
• Transportation costs
• Obtaining financing
• Increasing competition
• Challenges related to exporting or selling goods and services to customers in other provinces or territories
• Challenges related to exporting or selling goods and services outside of Canada
• Maintaining sufficient cash flow or managing debt
• Other obstacle

Flow condition: If “Rising cost of inputs” is selected in Q5, go to Q7. Otherwise, go to Q8.

7. Over the next three months, rising costs of which of the following inputs are expected to be obstacles for this business or organization?

Select all that apply.

• Rising cost of labour
• Rising cost of capital
• Rising cost of energy
• Rising cost of raw materials
• OR
• Don't know

Flow condition: If "Difficulty acquiring inputs, products or supplies from within Canada", "Difficulty acquiring inputs, products or supplies from abroad", or "Maintaining inventory levels" is selected in Q5, go to Q8. Otherwise, go to Q11.

Display condition: If "Difficulty acquiring inputs, products or supplies from within Canada", "Difficulty acquiring inputs, products or supplies from abroad", or "Maintaining inventory levels" is selected in Q5, display in Q8.

Supply chain challenges

8. How long does this business or organization expect the following to continue to be an obstacle?

• Difficulty acquiring inputs, products or supplies from within Canada
  • Less than 3 months
  • 3 months to less than 6 months
  • 6 months to less than 12 months
  • 12 months or more
  • Don't know
• Difficulty acquiring inputs, products or supplies from abroad
  • Less than 3 months
  • 3 months to less than 6 months
  • 6 months to less than 12 months
  • 12 months or more
  • Don't know
• Maintaining inventory levels
  • Less than 3 months
  • 3 months to less than 6 months
  • 6 months to less than 12 months
  • 12 months or more
  • Don't know

9. Over the last three months, how have supply chain challenges experienced by this business or organization changed?

Supply chain challenges include difficulty acquiring inputs, products or supplies from within Canada or abroad and difficulty maintaining inventory levels.

Exclude seasonal factors or conditions.

• Supply chain challenges have worsened
  • Which of the following factors have contributed to these challenges?
    Select all that apply.
    • Increased prices of inputs, products or supplies
    • Increased delays in deliveries of inputs, products or supplies
    • Supply shortages resulted in fewer inputs, products or supplies being available
    • Supply shortages resulted in no inputs, products or supplies available
    • Other factor
      • Specify other factor:
    • OR
    • Don't know
• Supply chain challenges have remained about the same
• Supply chain challenges have improved

10. Over the next three months, how does this business or organization expect supply chain challenges to change?

Supply chain challenges include difficulty acquiring inputs, products or supplies from within Canada or abroad and difficulty maintaining inventory levels.

Exclude seasonal factors or conditions.

• Supply chain challenges are expected to worsen
• Supply chain challenges are expected to remain about the same
• Supply chain challenges are expected to improve

Flow condition: If “Government agency” was selected in Q1, go to Q12. Otherwise, go to Q11.

Display condition: If “Non-profit organization” is selected in Q1, do not display “Transfer the business” or “Sell the business” in Q11.

Expectations for the next year

11. Over the next 12 months, does this business or organization plan to do any of the following?

Select all that apply.

• Expand current location of this business or organization
• Expand operations of this business or organization internationally
• Expand operations of this business or organization into a new province or territory within Canada
• Move operations of this business or organization to another location within the province or territory
• Move operations of this business or organization to another province or territory within Canada entirely
• Expand this business or organization to other locations within the same province or territory
• Expand this business or organization without increasing physical space
  i.e., hiring more staff who will work remotely, or expanding online sales capacity
• Restructure this business or organization
  Restructuring involves changing the financial, operational, legal or other structures of the business or organization to make it more efficient or more profitable.
• Acquire other businesses, organizations or franchises
• Invest in other businesses or organizations
• Merge with other businesses or organizations
• Reduce the physical space of this business or organization
• Scale down operations of this business or organization to within a single province or territory within Canada
• Transfer the business
• Sell the business
• OR
• Close the business or organization
• OR
• Don't know
• OR
• None of the above

Languages of services

12. Over the last 12 months, in which languages did this business or organization provide the following services or perform the following activities?

Website

Select all that apply.

• English
• French
• Other language
• OR
• Not applicable
• OR
• Don't know

Marketing and advertising

Select all that apply.

• English
• French
• Other language
• OR
• Not applicable
• OR
• Don't know

Outdoor signage

Select all that apply.

• English
• French
• Other language
• OR
• Not applicable
• OR
• Don't know

Indoor signage

Select all that apply.

• English
• French
• Other language
• OR
• Not applicable
• OR
• Don't know

Customer service

Select all that apply.

• English
• French
• Other language
• OR
• Not applicable
• OR
• Don't know

Sales

Select all that apply.

• English
• French
• Other language
• OR
• Not applicable
• OR
• Don't know

External communications

Include media releases.

Select all that apply.

• English
• French
• Other language
• OR
• Not applicable
• OR
• Don't know

Internal communications

Select all that apply.

• English
• French
• Other language
• OR
• Not applicable
• OR
• Don't know

Languages of work

13. What percentage of employees in this business or organization is required to be bilingual in English and French?

If the business or organization does not require bilingual employees, please enter '0'.

Provide your best estimate rounded to the nearest percentage.

Percentage of employees required to be bilingual in English and French:

Labour disruptions

14. Are any of the employees of this business or organization unionized?

• Yes
  • What percentage of the employees of this business or organization are unionized?
    • Percentage of employees that are unionized:
    • OR
    • Don't know
• No
• Don't know

Flow condition: If "Yes" is selected in Q14, go to Q15. Otherwise, go to Q16.

15. Over the last 12 months, has this business' or organization's operations been affected by an internal labour disruption?

e.g., strike, lockout, work-to-rule

• Yes
  • Over the last 12 months, which of the following labour disruptions affected this business' or organization's operations?
      Select all that apply.
    • Strike
    • Lockout
    • Work-to-rule
    • Other type of labour disruption
      • Specify other type of labour disruption:
    • OR
    • Don't know
• No
• Don't know

Flow condition: If "Yes" is selected in Q15, go to Q16. Otherwise, go to Q17.

16. To what extent did the labour disruptions in the last 12 months impact this business' or organization's operations?

• Not at all
• To a minor extent
• To a moderate extent
• To a large extent
• Don't know

Flow condition: If any of "Export or sell goods outside of Canada", "Export or sell services outside of Canada", "Import and buy goods from outside of Canada" or "Import or buy services from outside of Canada" is selected in Q3, go to Q17. Otherwise, go to Q18.

Global events and impact on trade

17. Does this business or organization expect its trade with other countries to be impacted positively or negatively due to events in other parts of the world over the next 12 months?

Consider positive or negative impacts due to conflicts, tariffs, environmental regulations, changes in government, famines, etc.

Exclude natural environmental issues or natural disasters, such as storms, earthquakes, or wildfires.

• Yes
• No
• Don't know

Flow condition: If "Yes" is selected in Q17, go to Q18. Otherwise, go to Q19.

18. For events affecting each of the following parts of the world, what is the anticipated impact on trade conducted by this business or organization?

• United States
  • Positive impact
  • No impact
  • Negative impact
  • No trade conducted with this region
  • Don't know
• Mexico
  • Positive impact
  • No impact
  • Negative impact
  • No trade conducted with this region
  • Don't know
• Central and South America
  • Positive impact
  • No impact
  • Negative impact
  • No trade conducted with this region
  • Don't know
• United Kingdom
  • Positive impact
  • No impact
  • Negative impact
  • No trade conducted with this region
  • Don't know
• Europe
  Exclude the United Kingdom
  • Positive impact
  • No impact
  • Negative impact
  • No trade conducted with this region
  • Don't know
• China
  • Positive impact
  • No impact
  • Negative impact
  • No trade conducted with this region
  • Don't know
• Asia and Middle East
  Exclude China
  • Positive impact
  • No impact
  • Negative impact
  • No trade conducted with this region
  • Don't know
• Africa
  • Positive impact
  • No impact
  • Negative impact
  • No trade conducted with this region
  • Don't know
• Oceania
  e.g., Australia and New Zealand
  • Positive impact
  • No impact
  • Negative impact
  • No trade conducted with this region
  • Don't know
• Other region
  • Positive impact
  • No impact
  • Negative impact
  • No trade conducted with this region
  • Don't know

Labour and wages

19. Over the next 12 months, how does this business or organization expect its average wages to change?

• Increase
  • Over the next 12 months, at what rate does this business or organization expect to increase its average wages?
    • At a slower rate than last year
    • At a similar rate as last year
    • At a faster rate than last year
    • Don't know
• Stay the same
• Decrease
• Don't know

Flow condition: If "Increase" is selected in Q19, go to Q20. Otherwise, go to Q21.

20. Over the next 12 months, what are the factors expected to influence decisions about average wage increases for this business or organization?

Select all that apply.

• Current rate of inflation
• Expected rate of inflation
• Labour market tightness
• Labour productivity
• Minimum wage legislation
• Capacity to attract labour
• Retaining talent
• Other factor
  • Specify other factor:
• OR
• Don't know

Interest rates

21. Over the last 12 months, what is the level of impact interest rates have had on this business or organization?

• No impact
• Low impact
• Medium impact
• High impact
• Don't know

Flow condition: If "Low impact", "Medium impact", or "High impact" is selected in Q21, go to Q22. Otherwise, go to Q23.

22. Which of the following has been most impacted by interest rates for this business or organization?

• New borrowing costs
• Cost of existing debt
• Capital expenditures
• Sales of products and services offered by this business or organization
• Financing for customers
• Exchange rates
• Investments made by this business or organization
• Don't know

Liquidity

23. Does this business or organization have the cash or liquid assets required to operate for the next three months?

• Yes
• No
  • Will this business or organization be able to acquire the cash or liquid assets required?
    • Yes
    • No
    • Don't know
• Don't know

Debt

24. Over the next three months, does this business or organization plan to apply to a financial institution for a new line of credit, a new term loan, a new non-residential mortgage, or refinancing of an existing non-residential mortgage?

Include commercial mortgages.
Exclude residential mortgages.

• Yes
• No
  • Does this business or organization have the ability to take on more debt?
    Answer based on this business' or organization's ability, even if there are no plans to take on more debt.
    • Yes
    • No
      • For which of the following reasons is this business or organization unable to take on more debt?
        Select all that apply.
        • Cash flow
        • Lack of confidence or uncertainty in future sales
        • Request would be turned down
        • Too difficult or time consuming to apply
        • Interest rates are unfavourable
        • Payment terms are unfavourable
        • Credit rating
        • Other reason
          • Specify other reason:
        • OR
        • Not applicable
        • OR
        • Don't know
    • Don't know
• Don't know

Working arrangements

25. Over the next three months, what percentage of the employees of this business or organization is anticipated to work on-site or work remotely?

Exclude employees that are primarily engaged in providing driving or delivery services or employees that primarily work at client premises, and contractors.

Working on-site refers to working from an office or job site, while working remotely refers to an employee working from home or another location of the employee's choosing, other than their regular on-site location.

Provide your best estimate rounded to the nearest percentage.

If the percentages are unknown, leave the question blank.

1. Work on-site exclusively
   Percentage of employees:
2. Work on-site most hours
   Percentage of employees:
3. Work approximately the same number of hours on-site and remotely
   i.e., 2-3 days per week on site
   Percentage of employees:
4. Work remotely most hours
   Percentage of employees:
5. Work remotely exclusively
   Percentage of employees:

Future outlook

26. Over the next 12 months, what is the future outlook for this business or organization?

• Very optimistic
• Somewhat optimistic
• Somewhat pessimistic
• Very pessimistic
• Don't know

Flow condition: If "Private sector business" is selected in Q1, go to Q27. Otherwise, go to "Contact person".

Ownership

(i) The groups identified within the following questions are included in order to gain a better understanding of businesses owned by members of various communities across Canada.

27. What percentage of this business or organization is owned by each of the following groups?

Provide your best estimate rounded to the nearest percentage.
If the business or organization is not owned by anyone that falls under that group, please enter "0".

What percentage of this business or organization is owned by women?
Percentage of business or organization owned by women:
OR
Prefer not to say
OR
Don't know

What percentage of this business or organization is owned by First Nations, Métis or Inuit peoples?
Percentage of business or organization owned by First Nations, Métis or Inuit peoples:
OR
Prefer not to say
OR
Don't know

What percentage of this business or organization is owned by immigrants to Canada?
Percentage of business or organization owned by immigrants to Canada:
OR
Prefer not to say
OR
Don't know

What percentage of this business or organization is owned by persons with a disability?
Percentage of business or organization owned by persons with a disability:
OR
Prefer not to say
OR
Don't know

What percentage of this business or organization is owned by lesbian, gay, bisexual, transgender, queer, or two-spirited (LGBTQ2) people?
Percentage of business or organization owned by LGBTQ2 people:
OR
Prefer not to say
OR
Don't know

What percentage of this business or organization is owned by members of visible minorities?
A member of a visible minority in Canada may be defined as someone (other than an Indigenous person) who is non-white in colour or race, regardless of place of birth.
Percentage of business or organization owned by visible minorities:
OR
Prefer not to say
OR
Don't know

Flow condition: If more than 50% of this business or organization is owned by members of visible minorities, go to Q28. Otherwise, go to "Contact person".

28. It was indicated that at least 51% of this business or organization is owned by members of visible minorities. Please select the categories that describe the owner or owners.

Select all that apply.

• South Asian
  e.g., East Indian, Pakistani, Sri Lankan
• Chinese
• Black
• Filipino
• Latin American
• Arab
• Southeast Asian
  e.g., Vietnamese, Cambodian, Laotian, Thai
• West Asian
• e.g., Afghan, Iranian
• Korean
• Japanese
• Other group
  • Specify other group:
• OR
• Prefer not to say