Audit of Asset Protection and Life Cycle Management

Final audit report
Audit of Asset Protection and Life Cycle Management

Internal Audit Services
Statistics Canada
September 30, 2009

Executive summary
- Audit opinion
- Key audit findings
Introduction
Audit observations, recommendations and management responses
Appendix A–Criteria and related controls

Executive summary

This audit was a risk-based management request. Its Terms of Reference were approved at the Internal Audit Committee on October 7, 2007. The audit represents part of an overall plan toaddress tracking practices and security of capital assets at Statistics Canada.

As of March 31, 2007, computer hardware and vehicles at Statistics Canada contained nearly 22,000 items in its inventory and had an estimated book value of over $22 million. Capital assets such as computer hardware are critical to operations at Statistics Canada, enabling the Agency to properly carry out its daily activities.

The objective of this audit was to assess the effectiveness of controls for monitoring and recording tangible assets. The audit focused on two tangible asset groups, computer hardware and vehicles, within the National Capital Headquarters. The audit testing covered acquisition of assets for the period of April 1, 2001 to March 31, 2007.

Statistics Canada’s Internal Audit Services engaged Audit Services Canada to conduct the audit of asset protection and life cycle management.

Audit Opinion

The audit found that Statistics Canada’s internal control system supporting the management of capital assets contained some weaknesses. Improvements are required in the areas of authorizing, purchasing, tracking and reconciling capital assets within the Corporate Support ServicesDivision (CSSD) and Financial Management Operations and Systems Division (FMOSD).

Key Audit Findings

The accounting reports at Statistics Canada confirmed that assets were acquired, amortized and disposed of in accordance to the guidance outlined in Treasury Board Accounting Standard 3.1 - Capital Assets with some exceptions in the areas of financial signing authority delegation, acquisition, tracking and overall reconciliation of assets. The audit confirmed that the documentation of inventory of capital assets was accurately presented and that securityprocedures are in place to monitor assets.

At the time of the audit, auditors noted that policies and procedures were being developed to ensure compliance with the Treasury Board Accounting Standard 3.1 - Capital Assets.

Management agrees with the recommendations, its response indicates its commitment to take action. In fact, management has already started to implement all of the proposed corrective actions that will address the findings; currently, many of the planned deliverables have become business practices, while the remaining management actions are scheduled to be implemented byMarch 2010 at the latest.

Introduction

1. Background

The purpose of the audit of asset protection and life cycle management is to provide management with an assessment of the effectiveness of controls for acquiring, recording, monitoring and reporting of tangible assets ¹. It is expected that proper controls are in place to safeguard and manage these assets. The audit will examine the processes related to capital assets to determine the extent to which the controls in place are meeting the requirements set forth by TreasuryBoard Secretariat (TBS) accounting standards.

The number of computer hardware had significantly increased in the past decade. It was considered that an audit was important to ensure that proper controls were in place to protect assets considered valuable. Additionally, vehicles were added to the scope of the audit due to recent acquisition which represented significant value to Statistics Canada.

The Office of the Comptroller General (OCG) had identified assets in their horizontal audit plan. The risk assessment for the government was identified as “high”. It was considered that an audit would bring value to the organization by bringing an assurance that procedures, guidelines andpolicies were properly implemented in the organization.

On April 1, 2001, the government introduced changes to its accounting systems by implementing the Financial Information Strategy which includes the adoption of accrual accounting. In order to implement this change, TBS has issued accounting standards for capital assets that are based on the Public Sector Accounting Board recommendations. The Treasury Board Accounting Standard (TBAS) 3.1 - Capital Assets, the standard relevant to this audit, defines capital assets as: tangible assets that are purchased, constructed, developed with the intention of being used on a continuous basis and are not intended for sale in the ordinary course of business. Under TBAS 3.1 - Capital Assets, capital asset values and amortizations are reported in the Government’s financial statements, as well as any gains or losses recognized when the organization disposes ofthese capital assets.

As of March 31, 2007, computer hardware and vehicles at Statistics Canada contained nearly 22,000 items in its inventory and had an estimated book value of over $22 million. Capital assets such as computer hardware represent a critical part of the operations of Statistics Canada enabling them to properly carry out their daily activities.

The Financial Management Operations and Systems Division (FMOSD) is responsible for assisting Statistics Canada in meeting government and central agency objectives through the conceptualization, design, implementation and development of the Agency’s financial management framework and infrastructure pertaining to policy development, expenditure andrevenue accounting, financial statements and reporting, and the delivery of programs and services. It is also responsible for providing functional leadership, guidance and direction on allfinancial reporting systems and processes.

Recently, FMOSD has developed a framework (informatics hardware) to oversee compliance with TBAS 3.1 - Capital Assets. This includes guidelines ² that outline criteria for tracking different asset classes and disposing of them at the end of their useful life. The guidelines also contain procedures that account for the treatment of pooled assets.

The Corporate Support Services Division (CSSD) is responsible for facilities management and materiel and contract services. CSSD uses the Automated Material Management Information System (AMMIS) for tracking the acquisition, location, operation and disposal of capital assets. Each asset is entered into this database and assigned an item number.

In consultation with CSSD, FMOSD performs a monthly reconciliation of AMMIS to the Common Department Financial System (CDFS) to ensure that inventory is in agreement with financial recordkeeping at Statistics Canada.

Transactions are authorized via the delegation of authorities at each phase of the lifecycle of the assets, according to sections 32, 33 and 34 of the Federal Administration Act (FAA). To exercise FAA delegated authority, the incumbent must hold a position with this authority, based on theDelegation of Financial Signing Authorities matrix, and have a valid specimen card.

2. Audit Objectives

The objective of this audit was to assess the effectiveness of controls for monitoring andrecording tangible assets.

The detailed sub-objectives of the audit were the following:

Ensure that the inventory of capital assets on hand is complete.
Ensure that controls are in place to safeguard assets from theft or unauthorized access.
Ensure that effective procedures are in place to determine the assets' value, including improvements, amortization and the estimated useful life of capital assets.
Ensure that the procedures in place within Statistics Canada for capital assets are in accordance with TBAS 3.1 - Capital Assets. Assets need to follow a life cycle. Asset reporting must follow an amortization schedule leading up to disposal of these assets.

3. Audit Scope

The audit focussed on inventory valuation and recording of tangible assets, (computer hardware and vehicles) in Statistics Canada within the National Capital Headquarters. The audit universe included pooled and individual capital assets that had a useful life greater than one year and a cost greater than or equal to $10,000. The audit reviewed compliance with applicable StatisticsCanada policies and procedures as well as TBAS 3.1 - Capital Assets standard.

The high level processes in terms of identified or perceived risks to the organization and the presence of a well defined control framework were reviewed during the scope phase for this audit.

The audit testing covered assets acquired from April 1, 2001 to March 31, 2007. The audit was conducted within CSSD and FMOSD divisions at Statistics Canada. On March 31, 2007 computer hardware had an estimated book value of over $21 million, and vehicles were valued at $1 million. The ten vehicles were comprised of eight cars and two highly specialized trailers used for the Canadian Health Measures Survey.

4. Criteria and Related Controls

The criteria used to assess the effectiveness of controls for monitoring and recording of tangibleassets included the following:

proper reporting of inventory;
correct coding and mathematical accuracy of reports;
security in place to protect assets;
proper authorization in place;
documentation of a lifecycle;
proper handling of transactions from an accounting point of view; and
compliance with TBAS 3.1 - Capital Assets and with Statistics Canada’s framework (informatics hardware) developed by FMOSD (to oversee compliance with TBAS 3.1 - Capital Assets).

5. Audit Approach and Methodology

The following methodologies were used to conduct this audit:

interviewed key individuals and examined pertinent documentation including departmental policies and procedures related to the two asset groups (computer hardware and vehicles);
documented the control framework;
reviewed a sample of the items in the two asset groups (computer hardware and vehicles) to establish whether controls are adequate;
verified selected assets for proper recording; and,
verified the physical existence of selected assets.

An original random sample of 149 records was selected for computer hardware (individual and pooled assets) in AMMIS from a population of 21,944 records with an estimated book value of over $21 million for computer hardware. Vehicles were assessed on the whole population as there were only ten vehicles which were valued at $1 million. For computer hardware, the audit program specified that each sampled item was to be traced to shipping documents, invoices, purchase orders, accounting reports and physical location to ensure adequacy and effectiveness of controls at all stages of the processes. 58 percent of the sample was allocated to individual computer hardware and 42 percent was allocated to pooled assets (a larger weight was given toindividual computer hardware because it had a higher overall value).

Upon initiating the examination phase, the sample was adjusted due to the fact that the supporting documentation had been lost as a result of a flood that occurred in January 2007 at Statistics Canada. This event resulted in a sample reduction from 149 to 100 records. The same allocation of 58 percent and 42 percent was maintained for computer hardware and pooled assets. The reduced sample did not affect the quality of the audit.

6. Acknowledgement

Internal Audit Services would like to thank the staff and management of Statistics Canada for their dedicated work and cooperation in the conduct and reporting phases of this auditengagement.

7. Statement of Assurance

Audit Services Canada provided Internal Audit Services with the following statement:

Audit Services Canada (ASC) has conducted this audit in accordance with the internal audit standards for the Government of Canada, as articulated in the Treasury Board Policy on Internal Audit. In compliance with this policy, and based on our professional judgment, ASC has examined sufficient, relevant evidence and obtained adequate information and explanation to support the accuracy of the conclusions contained in this report. The conclusions were based on acomparison of the situations as they existed at the time of the audit and the audit criteria.

Audit Observations, Recommendations and Management Responses

The audit found that Statistics Canada’s internal control system supporting the management of capital assets contained some weaknesses. The accounting reports at Statistics Canada confirmed that assets were acquired, amortized and disposed of in accordance to the guidance outlined in Treasury Board Accounting Standard 3.1 - Capital Assets with some exceptions in the areas offinancial signing authority delegation, acquisition, tracking and overall reconciliation of assets.

The audit confirmed that the documentation of inventory of capital assets was accurately presented and that security procedures are in place to monitor assets. Further, auditors noted that policies and procedures were being developed to ensure compliance with the Treasury Board Accounting Standard 3.1 - Capital Assets.

1. Completeness of Inventory

Departments must ensure that capital assets inventory is complete and properly reported. It alsorequires that reports are mathematically accurate and coded properly.

Based on a review of reports provided by FMOSD, the audit found that documentation was accurately presented. Accounting reports were also reviewed to verify for evidence of supervisory review and reconciliations to other reports. The auditors verified the existence of correcting journals entries which was evidenced by journal vouchers prepared by FMOSD.

The auditors found that the computer hardware inventory was missing some item numbers. The numerical sequence of the inventory was verified in the AMMIS database. It was determined that the system does not allow for automatic updates; for examples changes can be due to coding errors and archiving of disposed assets. These coding changes were found to create a resulting gap in the sequence of the inventory.

Gaps in sequence could be an indication that records are not properly kept and that records do not represent the actual physical inventory on hand.

Recommendation #1

Corporate Support Services Division should ensure that a process to review and authorize all changes made in coding is in place. The division should also ensure that an automated or written record is kept whenever a change in coding is made in the Automated Materiel Management Information System.

Management Response and Action Plan

Management accepted the recommendation

In order to ensure that proper sequence in identifying the records have no gaps, CSSD will:

review current coding guidelines
develop Standard Operating Procedures dealing with coding and coding changes.
procedures will be developed in conjunction with FMOSD
inform all Asset Management staff dealing with coding of the changes in the procedures
monitor the application of the new procedures for a period of 6 months to ensure that all staff is applying the new procedures correctly

Note: Changes to coding is conducted by Asset Management personnel only (clients no longerhave access to this function).

changes are made only as the result of a Heat Case Trouble Ticket (SRM), which allows clients to submit, track and manage changes to assets
changes are initiated and actioned only when received from an authorized FRC.
a cross reference to the SRM is noted in AMMIS to provide the appropriate audit trail.
a cross reference to the author of the changes is noted in the Heat Case and AMMIS to allow for easier follow-up
procedures will be posted to the CSSD website to provide guidance to clients
a communiqué will be released advising clients that the website has been updated
Standard Operating Procedures for AMMIS will be reviewed and updated as necessary

Asset Management conducts monthly reviews to ensure coding is active and sends reports to applicable clients for coding updates/changes. The authority for coding changes is theresponsibility of the FRC not CSSD.

Accountability and timeline

CSSD/Unit Head Asset Management: Directives July 2009

CSSD/Asset Management Supervisor/AMMIS HelpDesk - Monitoring report – February 2010:

only proper changes made
audit trails available
documentation
posted procedures reviewed and updated
Monthly reviews
Communiqué

2. Security in Place to Protect Assets

Departments must ensure that capital assets are secured and protected from theft or unauthorizedaccess.

The audit found that security procedures are in place to monitor assets. The audit confirmed that Quality Control/Asset Management affixes a tag number to the asset to identify it. The assetinformation and location are subsequently recorded in AMMIS.

Transfer of ownership was found to be well documented between Quality Control/Asset Management, Shipping/Receiving and the final client. Shipping/Receiving transfers ownershipof assets to Quality Control/Asset Management to ensure that the asset is tagged.

The audit also noted that Quality Control/Asset Management performs an annual inventory of capital assets. If a discrepancy is found, an attempt is made to resolve it. If the asset is not found, an update is made to accurately reflect the true inventory status in AMMIS. It was also noted thatmerchandise is properly locked up in cages prior to its delivering to client divisions.

In a test to establish physical existence of the sampled asset, the audit revealed that there were assets that could not be traced to their actual location. In 10 instances, the AMMIS location was incorrect, but through a more in depth search, the audit team was able to locate the assets. However, audit testing for physical evidence identified 15 assets out of 93 assets (16%) thatcould not be located according to AMMIS information. The reasons provided are that:

asset had been disposed of;
asset was out of scope, due to location outside of the National Capital Headquarters region or purchase date prior to April 1, 2001; and
asset was currently in use and not on-site (one vehicle and two trailers).

The audit revealed that there were problems in reconciling these 15 identified assets to their original invoices. Without the ability to reconcile the physical existence of assets to the inventory management system, asset completeness and security cannot be assured. It is the client’s responsibility to notify the Quality Control/Asset Management Section if the location of an item requires updating in AMMIS.

Some employees at Statistics Canada order/purchase items for various employees/divisions. Although it is not currently a requirement, some of these employees keep detailed lists documenting the location where the ordered assets have been disbursed to, while other purchasers do not keep such records.

Divisions in charge of purchasing assets and disbursing them to multiple users may want to consider maintaining a tracking database to reconcile against AMMIS on a periodic basis.

Recommendation #2

The Quality Control/Asset Management Section should perform an annual inventory count to reconcile assets with the Automated Materiel Management Information System information. The location of the asset should be updated in the Automated Materiel Management InformationSystem accordingly.

Management Response and Action Plan

Management accepted the recommendation.

In the absence of formal procedures for Asset Management to perform an inventory count to reconcile assets with the AMMIS information, Asset Management, in conjunction with the client, perform inventory counts to reconcile all assets with the AMMIS information IAW TreasuryBoard Material Management Policy Art 9.1

In order to ensure that reconciliations are conducted, CSSD will further define the following:

review TB and FAA policies for conducting stocktaking /reconciliation of inventory held
types of checks to be conducted
the Accountability for stocktaking
the stocktaking/reconciliation processes
define offsetting and write-offs
Stocktaking and account verification documentation
Stocktaking/reconciliation frequency and procedures.
Stocktaking/reconciliation schedules for specialized commodities, i.e. capital assets
Reports available from AMMIS

Accountability and timeline

CSSD: Reconciliation Completed 2008

CSSD/Unit Head Asset Management: Procedures for stock taking, offsetting and write off December 2009

Recommendation #3

Corporate Support Services Division should develop operating practices to ensure that divisions/clients notify Quality Control/Asset Management of all transactions requiring an update in the Automated Materiel Management Information System. This would include the movement of an asset to a different location.

Management Response and Action Plan

Management accepted the recommendation.

FMOSD’s response to recommendation #5 also addresses the invoice reconciliation issue.

Although clients have had the capability to update AMMIS locations or submit SRMs to Asset Management to effect the change, procedures have been developed requesting that the client advise Asset Management via SRM of changes to asset information, i.e. Locations, contactperson, description, etc.

A communiqué will be released advising clients that the website has been updated

Accountability and timeline

CSSD: Directive and Communiqué - July 2009

3. Proper Authorization in Place

Capital assets must be authorized, acquired and paid using an effective delegation of authorities.

Overall, sections 32, 33 and 34 of the FAA were properly segregated for all transactions reviewed. The testing of approvals for sections 32, 33 and 34 of the Delegation of Financial Signing Authorities (DFSA) found several instances where the specimen signature cards were not always valid. In a sample of 84 records, there were:

thirty-one cases where the section 32 signor did not have a valid specimen card for either the date of the purchase or the Financial Responsibility Centre (FRC) of the purchase;
four cases where the section 34 signor did not have a valid specimen card for either the date of purchase or the FRC of the purchase; and,
two cases where the section 33 signor did not have a valid specimen card for either the date of purchase or the FRC of the purchase;

During the audit, it was observed that the specimen signature card did not correspond to the actual authority of the employee and with the information in the DFSA system. Without evidence of appropriate delegation of authority, there is a risk that funds could be spent inappropriately.

Statistics Canada does not currently have an Office Supplies Acquisition Procedure to define appropriate purchases for a signatory holding this authority.

Archived original invoices and supporting documentation were very difficult to locate. Initially, about 45% of the original invoices were not found. A more in-depth review of the archived invoices helped the auditors to locate some misplaced invoices. At the end of this exercise there were still 20 out of 55 (36%) invoices that were not found. Since the original invoices are kept with the originators throughout the department, FMOSD relies on the goodwill of these individuals to send them the originals after the fiscal year end. This system is not working well and should be modified. It would also be recommended for FMOSD to have the original receiptsin hand when authorizing section 33.

Recommendation # 4

Financial Management Operations and Systems Division should ensure that employees understand and apply the procedures for signature verification for sections 32, 33 and 34 properly;

Financial Management Operations and Systems Division should review the signature cards periodically to ensure they reflect the authority permitted under the Delegation of Financial Signing Authorities matrix for each position in Statistics Canada; and ensure that procedures are in place for signature verification for sections 32, 33, 34 are properly applied.

Management Response and Action Plan

Management accepted the recommendation.

FMOSD has provided recent training to all delegated employees to ensure a common understanding and application of the procedures for sections 32, 34 and 33 from October 2008 to March 2009. This training is available to all employees at any time.

FMOSD reviewed all signature cards. FMOSD will confirm signature cards on a yearly basis to ensure accuracy.

Accountability and timeline

FMOSD: Training – Completed April 2009

D. Bain: Review signature cards - Completed April 2009

Recommendation # 5

Financial Management Operations and Systems Division should establish a revised procedure to ensure that original invoices are on hand before authorizing section 33. The new procedure should also be monitored to ensure that it is properly applied.

Management Response and Action Plan

Management accepted the recommendation.

FMOSD implemented a new document management process in January of 2009. All documents (except regional travel), for headquarters and regional offices, will be held in a central location. FMOSD will ensure that the documentation is accurately stored for future consultation.

Accountability and timeline

FMOSD: Document management process - Completed January 2009

4. Proper Handling of Transactions from an Accounting Perspective

Departments must ensure accounting transactions are handled properly; this includes determiningasset value, cost of improvements, amortization and estimated useful life of capital assets.

In an effort to document the useful life of an asset, the audit tested TBAS 3.1 - Capital Assets for compliance. One of the guidelines in this standard specifies the estimated length of time (or useful life) by asset types. Testing identified that the application of estimated useful life provisions, as outlined in TBAS 3.1 - Capital Assets, is generally found (Also, see Section 2.5 of the report).

During the preliminary assessment of the FMOSD operations the auditors reviewed reports and confirmed that FMOSD has a documented system for tracking value, amortization, improvements, impairments and the estimated useful life of assets. The audit also confirmed that individual assets were properly amortized, in most cases, and that assets were properly disposed of.

Additionally, the TBAS 3.1 - Capital Assets policy includes a guideline which specifies the estimated length of time (or useful life) required for certain asset categories.

TBAS 3.1 - Capital Assets states that it is optional to pool assets for capitalization and amortization; however, Statistics Canada has decided to pool specific purchases less than $10,000, if the total asset pool is greater than $1 Million. The categories of assets that are capitalized to the pool are monitors, desktops, laptops, communication switches, external laser jet printers and external hard drives. If a purchase is less than $10,000 and not within one of the categories that are to be pooled, the purchase is expensed. The audit found that all assets were properly categorized as either pooled or individual assets.

Acquisitions and disposals are extracted from AMMIS monthly by FMOSD and adjustments are made to the pool. Pool amortization is calculated manually by FMOSD since AMMIS does not have this functionality. This calculation is reviewed by the Chief of Financial Statements (FMOSD) and subsequently the journal voucher is approved by the Chief of Accounting Operations (FMOSD) according to section 33 FAA.

The audit sample revealed that 22 out of 38 (57.8%) assets were expensed when they were eligible for capitalized pooling.

By only extracting acquisitions and disposals on a monthly basis, opportunities can be missed for capitalizing these assets in the pool because AMMIS data entry is backdated.

The reconciliation of pooled assets with AMMIS and CDFS could identify assets which should be capitalized rather than expensed.

Recommendations for sections 2.4 and 2.5 have been grouped together (See recommendationsbelow).

5. Compliance with Treasury Board Accounting Standard (TBAS)

TBAS 3.1 - Capital Assets requires that the estimated useful life of a capital asset is reviewed on a regular basis and revised when the appropriateness of a change can be clearly demonstrated. Measures such as life cycle management help to ensure that the procedures in place withinStatistics Canada for reporting of capital assets are in accordance with the TBS policy.

During the period under review, FMOSD did not conduct a review of the estimated useful life nor does it have any criteria for the disposal of capital assets. However, the auditors found evidence that FMOSD is in the process of developing procedures to review the estimated useful life of assets.

The Chief, Infrastructure/LAN Support indicated that it is the responsibility of the division to track assets, determine when these are ready for disposal and notify the LAN Administrator. Currently, there are no set criteria for asset disposal. Divisions may dispose of an item if it is broken and it is not repairable or if the age of the asset warrants replacement, which varies based on location and function.

Recommendation #6

Financial Management Operations and Systems Division should perform a periodic reconciliation of assets eligible for pooled capitalizing in the Automated Material Management Information System, with those capitalized in the pool and amortized in CDFS.

Financial Management Operations and Systems Division should perform a regular review of the estimated useful life for eligible assets.

Management Response and Action Plan

Management accepted the recommendation.

FMOSD will perform a validation of all assets to be included in the pool at the end of the fiscal year to ensure that all back-dated assets are accounted for properly. If necessary, a final adjustment will be accounted for in the pooled assets account. FMOSD will compare a report generated from AMMIS and the manual report to be provided from CSSD

FMOSD will verify at the end of the fiscal year if the ‘useful life’ is accurate.

Accountability and timeline

FMOSD: Back-dated assets are accounted for 'useful life' verified - Completed April 2009

Recommendation #7

Corporate Support Services Division should provide clear guidance to staff entering back-dated assets and provide the Financial Management Operations and Systems Division with a list ofthese assets on a monthly basis.

Corporate Support Services Division should provide clear guidance to staff regarding disposalof assets (including criteria which define the reason for disposal)

Management Response and Action Plan

Management accepted the recommendation.

In order to ensure that proper sequence in identifying the records has no gap, CSSD will:
review current back-dated assets practices
develop Standard Operating Procedures dealing with back-dated assets and procedures to follow when dealing with back-dated assets
liaise with AMMIS HelpDesk WRT reports
develop instructions in conjunction with FMOSD
inform all Asset Management staff dealing with coding of the changes in the guidelines
monitor the application of the new guidelines for a period of 6 months to ensure that all staff is applying the new guidelines correctly
A communiqué will be released advising clients that the website has been updated

CSSD has provided interim procedures to provide clear guidance to staff entering data andensure that back-dated assets are accounted for properly.

CSSD is currently reviewing internal procedures and will establish clear guidance for thedisposal of assets including the criteria which defines the reason for disposal.

In order to ensure the proper procedures for disposal of assets has no gap, CSSD will:

review current disposal of assets practices
liaise with AMMIS HelpDesk to ensure common use of disposal codes
instructions will be developed in conjunction with stakeholders
communicate in writing to all Asset Management staff dealing with disposal of assets

Specifically CSSD will:

develop Standard Operating Procedures dealing with disposal of assets to include:
definition of Surplus/excess materiel
Disposition of surplus materiel – Crown Assets Distribution Group (CSDG) and Computers for Schools (CFS)
Prepare Reports of surplus
Disposal approving authorities
Scrap material
Custody of materiel reported as surplus
Disposition of excess materiel as it relates to CTAT regulations
Special disposal instructions
monitor the application of the new guidelines for a period of 6 months to ensure that all staff is applying the new guidelines correctly
A communiqué will be released advising clients that the website has been updated

Accountability and timeline

CSSD/Asset Management: Procedures for back-dated assets, Monitoring report and Communiqué - March 2010

CSSD: Interim procedures for back-dated assets – Completed May 2009

CSSD: Procedures - Completed July 2009

CSSD/Asset Management: Revised practices - December 2009

CSSD/Asset Management: Procedures for disposal of assets - March 2010

Appendix A: Criteria and Related Controls

Note

Also called hard assets.
At the time of the audit the framework was still in draft form. It has since been approved on March 2, 2009.

Introduction

The following conventions are used in this document:

Question text in bold font is read to the respondent. Text in normal font is not read to the respondent. Instructions to the person asking the questions or taking the measures are prefaced by the word “Instruction”, and are not read aloud.
Question text in bold font enclosed by brackets () is read to the respondent at the discretion of the person asking the questions.
In this text, the use of the masculine is generic and applies to both men and women. Please note that during the actual interview, the questions were personalized to be appropriate to the gender of the respondent.
Text enclosed by square brackets [] is dynamic and may or may not appear on the computer screen based on the age, sex or other characteristics of the respondent.
The options “Don’t Know” (DK) and “Refusal” (RF) are allowed on every question/measure unless otherwise stated. However, these response categories are shown in this document only when the flow from these responses is not to the next question/measure.

Respondent verification component

Upon arrival at the mobile clinic, the respondent is logged into the clinic by the clinic coordinator, which involves the following steps.

RVB_N11
Instruction: Press <1> to print the Respondent Verification Sheet.
1 Print the form
Note: For a sample respondent verification sheet, see Appendix I.

RVB_R11
Here is the first of several forms we will be asking you to complete. Please read it carefully and provide the information requested.
Instruction: Provide the respondent with the Respondent Verification Sheet.
When the respondent returns the form, check to ensure that all requested information has been filled in and is legible.
Note: Don’t Know and Refused are not allowed.

RVB_N12
Instruction: Press <1> to print the labels with the respondent’s CLINICID as a bar code identifier.
Attach the first label to a bracelet, and place the bracelet around the wrist of the respondent.
Attach the second label to the Physical Activity Readiness Questionnaire (PAR-Q) form.
1 Print the labels
Note: Don’t Know and Refused are not allowed.

NSC_N16
Instruction: Press <1> to print the labels with the respondent’s short name.
Attach the first label to the respondent's file folder.
Attach the second label to a urine sample container, and give the container to the respondent.
1 Print the label
Note: Don’t Know and Refused are not allowed.

Note: The respondent’s full name, gender, date of birth and their preferred official language are confirmed or updated using information from the Respondent Verification Form (appendix I).

RVC_END

Consent component

To be completed by all respondents.

Consent (CON)

CON_N01
Instruction: Press <1> to print the Consent form(s).
1 Print the form(s)
Note: For respondents aged 6-14 print the assent and consent forms (see Appendix II).
Note: For respondents aged 14-19 print the consent (no DNA) form (see Appendix II).
Note: For respondents aged 20-79 print the consent form (see Appendix II).

CON_Q11
Before we start the clinic tests, we need to review the consent booklet that was given to you during the interview at your home. Did you have a chance to read that booklet?
Instruction: Show the respondent the consent package.

Yes
No (Go to CON_R13)
Note: Don’t Know and Refused are not allowed.
All respondents

CON_R12
Do you have any questions about any of the information in the consent booklet or about the clinic portion of the survey?
Instruction: Answer any questions as thoroughly as possible
Note: Don’t Know and Refused are not allowed.
Go to CON_R14

CON_R13
Here is a copy of the booklet. Please take a few minutes to read through it. If you have any questions about the information in the booklet or the clinic tests, I can answer them for you.
Instruction: Hand the consent package to the respondent and give them time to read through it (approximately 5 minutes).
Note: Don’t Know and Refused are not allowed.

CON_R14
Here is the Consent form for participation in the clinic portion of the survey. Please read the form carefully and mark either the “Yes” or “No” box for each item.
Instruction: Provide [the parent or guardian/the respondent] with the Consent form.
When [the parent or guardian/the respondent] returns the form, check to ensure that it has been completed correctly.
Sign and date the form as the witness.
Note: Don’t Know and Refused are not allowed.
If respondent is 14 or older, go to CON_N16.

CON_N15
Instruction: Record whether a parent or guardian has consented to the respondent participating in the physical measure tests.

Yes
No (Go to CON_END)
Note: Don’t Know and Refused are not allowed.
Respondents aged 13 and under

CON_R16
Your parent or guardian has said you can take part in the tests today. If you would like to participate we need you to write or print your name on this form.
Instruction: Provide the child with the Assent form.
When the child returns the form, check to ensure that it has been completed correctly.
Sign and date the form as the witness.
Note: Don’t Know and Refused are not allowed.

CON_N16
Instruction: Record whether the respondent has consented to participating in the physical measure tests.

Yes
No (Go to CON_END)
Note: Don’t Know and Refused are not allowed.
All respondents

CON_N21
Instruction: Record whether a Report of Laboratory Tests has been requested.

Yes
No
Note: Don’t Know and Refused are not allowed.
If respondent’s age is 6 to 13, go to CON_N24.

CON_N23
Instruction: Record whether Statistics Canada has been authorised to provide information regarding Hepatitis B and C to the appropriate provincial authority.

Yes
No
Note: Don’t Know and Refused are not allowed.
Respondents aged 14 and over
If respondent has requested a Report of Laboratory Tests or if the respondent has declined to share Hepatitis B and C results with the appropriate provincial authority or if CON_AGE > 13, go to CON_N25.

CON_R23
You have indicated on your consent form that you do not want to receive a copy of your laboratory test results. However, you have agreed that Statistics Canada can test your blood for Hepatitis B and C. I just want you to be aware that, by agreeing to have the Hepatitis B and C tests done, you will receive the results if you test positive.
Instruction: Answer any questions as thoroughly as possible.
Note: Don’t Know and Refused are not allowed.
If respondent is 14 or older, go to CON_N25.

CON_N24
Instruction: Record whether a parent or guardian has consented to storage of the respondent’s blood and urine.

Yes
No (Go to CON_END)
Note: Don’t Know and Refused are not allowed.
Respondents aged 13 and under

CON_N25
Instruction: Record whether the respondent has agreed to storage of blood and urine.

Yes
No
Note: Don’t Know and Refused are not allowed.
All respondents excluding those who did not consent to storage of blood and urine [not CON_Q24 = 2] If respondent is 19 or younger, go to CON_END.

CON_N26
Instruction: Record whether the respondent has agreed to storage of DNA.

Yes
No
Note: Don’t Know and Refused are not allowed.
Respondents aged 20 and over

CON_END

Report (REP)

If the parent or guardian has not consented to the respondent participating in the physical measures tests or if the respondent has not consented to the physical measures tests, go to REP_END. If the respondent has declined a Report of Laboratory Tests, or if no mailing address exists (i.e., the street and city fields in the mailing address are empty), go to REP_B22.

REP_R11
You will receive a copy of [your/[name of respondent]’s] physical measurement test results at the end of the clinic visit today but we will not have the results of the blood and urine tests for about 8-12 weeks.
Note: Don’t Know and Refused are not allowed.

REP_Q12
What delivery method would you prefer?
Instruction: Read categories to respondent.

Regular mail
Courier
Note: Don’t Know and Refused are not allowed.
Respondents who want to receive a copy of their laboratory test results
If respondent is 14 or older or if no mailing address exists (i.e., the street and city fields in the mailing address are empty), go to REP_B22.

REP_N13
Instruction: Record the name of the person who signed the Consent form.
Enter the person’s first and last name.
Note: Don’t Know, Refused and Empty are not allowed.
If no mailing address exists (i.e., the street and city fields in the mailing address are empty), go to REP_B22.

REP_Q21
I would like to confirm your mailing address. Is it:
[Address]

Yes (Go to REP_END)
No
Note: Don’t Know and Refused are not allowed.
Respondents who have the street and city fields listed in the mailing address

REP_B22
What is your mailing address?
INSTRUCTION: Record the mailing address: civic number, street name, apartment number (if necessary), city, postal code and province.
Respondents who have the street and city fields in the mailing address blank

REP_END

Urgent condition (URG)

If no telephone number exists, go to URG_B12.

URG_Q11
I would like to confirm your telephone number. Is it:
[Telephone Number]

Yes (Go to URG_END)
No
Note: Don’t Know and Refused are not allowed. Respondents who have a telephone number on file

URG_B12
What is your telephone number?
Instruction: Enter the area code and telephone number. Enter “000” if no telephone. Respondents who do not have a telephone number on file

URG_END

Screening component

To be completed by all respondents.

Screening component introduction (SCI)

SCI_R1
The following questions are asked to ensure that you are given all the tests for which you are eligible. Some questions may have been asked during the home interview, but we need to ensure that our information is up-to-date. We also need to know if any changes have occurred since the home interview. It is important to note that some medications and physical conditions may exclude you from certain tests.

Please answer to the best of your knowledge, as accurate information about you is important.

Note: If the respondent is younger than 14 then the following sentence is added:

Your parent or guardian may need to help you answer some of these questions .

Note: Don’t Know and Refused are not allowed.

SCI_END

Adherence to guidelines (ATG)

ATG_R11
At the time of the home interview you were given a set of pre-testing guidelines. We will now review those guidelines.
Note: Don’t Know and Refused are not allowed.

ATG_Q11
When did you last eat or drink anything other than water?
Instruction: Enter the time followed by “AM” or “PM”. (insert respondent answer between 01:00 and 12:59)
Note: Don’t Know and Refused are not allowed.
All respondents
If difference between Appointment Time and ATG_Q11 is 10 hours or more or If CON_AGE > 69, go to ATG_Q21.

ATG_N12
Instruction: Probe to determine what and how much the respondent ate or drank. Record whether the respondent met the fasting requirements.

Yes
No
Note: Don’t Know and Refused are not allowed.
Respondents who ate or drank something other than water less than 10 hours before their appointment time [ATG_Q11 -appointment time < 10 hours]
If respondent is older than 69, go to ATG_Q21.

ATG_N13
Instruction: Record whether the respondent should be screened out of the mCAFT.

Yes
No
Note: Don’t Know and Refused are not allowed.
Respondents aged 69 and under

ATG_Q21
Have you smoked cigarettes or used other tobacco or nicotine products during the past 2 hours?

Yes
No
All respondents

ATG_Q31
Have you consumed any alcohol since midnight?

Yes
No (Go to ATG_Q41)
Note: Don’t Know and Refused are not allowed.
All respondents

ATG_N32
Instruction: Probe to determine when and how much the respondent drank.
Record whether the respondent should be excluded from one or more tests.

Yes
No (Go to ATG_Q41)
Note: Don’t Know and Refused are not allowed.
Respondents who had consumed alcohol on the day of their appointment [ATG_Q31 = 1]

ATG_N33
From which tests should the respondent be excluded?
Instruction: Mark all that apply.

Grip strength
mCAFT
Sit and reach
Partial curl-ups
Note: Don’t Know and Refused are not allowed.
Respondent who had consumed alcohol on the day of their appointment and should be excluded from one or more tests [ATG_N32 = 1]

ATG_Q41
Have you exercised today? (e.g., running, swimming, weight training, etc.)

Yes
No (Go to ATG_END)
Note: Don’t Know and Refused are not allowed.
All respondents

ATG_Q42
For how long did you exercise?

1 to 15 minutes
16 to 30 minutes
31 to 60 minutes
More than one hour
Respondents who had exercised on the day of their appointment [ATG_Q41 = 1]

ATG_END

Physical and health conditions (PHC)

PHC_R11
I am now going to ask you about your current health and physical condition.
Note: Don’t Know and Refused are not allowed.
If the respondent is male, or if the respondent is a female younger than 14 or older than 55, go to PHC_Q31.

PHC_Q11
Are you currently pregnant?

Yes
No
Note: Refused is not allowed.
Female respondents aged 14 to 55
If respondent is pregnant, go to PHC_Q12. Otherwise, go to PHC_Q31.

PHC_Q12
In what week are you?
(insert respondent answer between 1 and 45)
Female respondents aged 14 to 55 who are pregnant [PHC_Q11 = 1]

PHC_Q31
Have you been diagnosed with exercise induced asthma or a breathing condition that worsens with exercise? (For example: chronic bronchitis, emphysema, COPD.)

Yes (Go to PHC_Q36)
No
Note: Don’t Know and Refused are not allowed.
All respondents
If according to the household interview the respondent has been diagnosed with asthma, go to PHC_Q32. If CCC_Q41 = 1 (respondent has been diagnosed with chronic bronchitis), go to PHC_Q33. If CCC_Q43 = 1 (respondent has been diagnosed with emphysema), go to PHC_Q34. If CCC_Q45 = 1 (respondent has been diagnosed with chronic obstructive pulmonary disease), go to PHC_Q35. If PHC_Q31 = 1, go to PHC_Q36. Otherwise go to PHC_Q41.

PHC_Q32
During the interview in your home, it was reported that you had asthma. Is this correct?

Yes (Go to PHC_Q36)
No
Respondents who had previously reported being diagnosed with asthma [PHC_Q31 = 2 and CCC_Q11 = 1]
If according to the household interview the respondent has been diagnosed with chronic bronchitis, go to PHC_Q33. If CCC_Q43 = 1 (respondent has been diagnosed with emphysema), go to PHC_Q34. If CCC_Q45 = 1 (respondent has been diagnosed with chronic obstructive pulmonary disease), go to PHC_Q35. If PHC_Q31 = 1, go to PHC_Q36. Otherwise go to PHC_Q41.

PHC_Q33
During the interview in your home, it was reported that you had chronic bronchitis. Is this correct?

Yes
No
Respondents who had previously reported being diagnosed with bronchitis [PHC_Q31 = 2 and CCC_Q41 = 1]
If according to the household interview the respondent has been diagnosed with emphysema, go to PHC_Q34. If CCC_Q45 = 1 (respondent has been diagnosed with chronic obstructive pulmonary disease), go to PHC_Q35. If PHC_Q31 = 1, go to PHC_Q36. Otherwise go to PHC_Q41.

PHC_Q34
During the interview in your home, it was reported that you had emphysema. Is this correct?

Yes
No
Respondents who had previously reported being diagnosed with emphysema [PHC_Q31 = 2 and CCC_Q43 = 1]
If according to the household interview the respondent has been diagnosed with chronic obstructive pulmonary disease, go to PHC_Q35. If PHC_Q31 = 1, go to PHC_Q36. Otherwise go to PHC_Q41.

PHC_Q35
During the interview in your home, it was reported that you had chronic obstructive pulmonary disease (COPD). Is this correct?

Yes
No
Respondents who had previously reported being diagnosed with chronic obstructive pulmonary disease [PHC_Q31 = 2 and CCC_Q45 = 1]
If respondent has been diagnosed with exercise induced asthma or a breathing condition that worsens with exercise, go to PHC_Q36. Otherwise go to PHC_Q41.

PHC_Q36
Are you currently taking any medication for your breathing condition(s)?

Yes
No (Go to PHC_Q41)
Note: Don’t Know and Refused are not allowed.
Respondents who had previously reported being diagnosed with any type of breathing condition [PHC_Q31 = 1 or PHC_Q32 = 1 or PHC_Q33 = 1 or PHC_Q34 = 1 or PHC_Q35 = 1]
If respondent is older than 69, go to PHC_Q41.

PHC_Q37
Do you have your medication with you?

Yes
No
Note: Don’t Know and Refused are not allowed.
Respondents aged 69 and under who had previously reported being diagnosed with any type of breathing condition [age < 70 and PHC_Q36 = 1]

PHC_Q41
Do you have an acute condition (e.g., sprained ankle, cold, flu, other infection) or chronic condition that may prevent you from participating in any of the tests today?

Yes - Specify (insert respondent answer to a maximum of 80 characters)
No (Go to PHC_Q51)

Note: Don’t Know and Refused are not allowed.

All respondents

PHC_N42
From which tests should the respondent be excluded because of this condition?
Instruction: Probe to determine the seriousness of the condition.
Mark all that apply.

Phlebotomy
Urine
Height and Weight
Skinfolds
Activity monitor
Spirometry
mCAFT
Grip strength
Sit and reach
Partial curl-ups
Oral health
None
Note: Don’t Know and Refused are not allowed.
Respondents with an acute or chronic condition that would prevent participation in clinic tests [PHC_41 = 1]

PHC_Q51
Do you have hemophilia?

Yes
No
Note: Don’t Know and Refused are not allowed.
All respondents

PHC_Q52
Have you received chemotherapy in the past four weeks?

Yes
No
Note: Don’t Know and Refused are not allowed.
All respondents

PHC_END

Spirometry questions (SPQ)

If respondent is older than 12, go to SPQ_R21.

SPQ_R11
The next set of questions is related to the health of [respondent’s first name]’s lungs.
Instruction: Ask the questions of the parent or guardian of the respondent.
Note: Don’t Know and Refused are not allowed.

SPQ_Q11
Has your child ever had wheezing or whistling in the chest at any time in the past?

Yes
No (Go to SPQ_Q16)
Note: Don’t Know and Refused are not allowed.
Parent or guardian of respondents aged 12 and under

SPQ_Q12
Has your child had wheezing or whistling in the chest in the last 12 months?

Yes
No (Go to SPQ_Q16)
Note: Don’t Know and Refused are not allowed.
Parent or guardian of respondent aged 12 and under who has ever had wheezing or whistling in the chest at any time in the past[SPQ_Q11 = 1]

SPQ_Q13
How many attacks of wheezing has your child had in the last 12 months?
Instruction: Read categories to respondent.

1 to 3 attacks
4 to 12 attacks
More than 12 attacks
Note: Don’t Know and Refused are not allowed.
Parent or guardian of respondents aged 12 and under who has had wheezing or whistling in the chest in the last 12 months [SPQ_Q12 = 1]

SPQ_Q14
In the last 12 months, how often, on average, has your child’s sleep been disturbed due to wheezing?
Instruction: Read categories to respondent.

Never woken with wheezing
Less than one night per week
One or more nights per week
Note: Don’t Know and Refused are not allowed.
Parent or guardian of respondents aged 12 and under who has had wheezing or whistling in the chest in the last 12 months [SPQ_Q12 = 1]

SPQ_Q15
In the last 12 months, has wheezing ever been severe enough to limit your child’s speech to only one or two words at a time between breaths?

Yes
No
Note: Don’t Know and Refused are not allowed.
Parent or guardian of respondents aged 12 and under who has had wheezing or whistling in the chest in the last 12 months [SPQ_Q12 = 1]

SPQ_Q16
In the last 12 months, has your child’s chest sounded wheezy during or after exercise?

Yes
No
Note: Don’t Know and Refused are not allowed.
Parent or guardian of respondents aged 12 and under

SPQ_Q17
In the last 12 months, has your child had a dry cough at night, apart from a cough associated with a cold or a chest infection?

Yes
No
Note: Don’t Know and Refused are not allowed.
Parent or guardian of respondents aged 12 and under
Go to SPQ_END.

SPQ_R21
The next set of questions is related to the health of your lungs.
Note: Don’t Know and Refused are not allowed.

SPQ_Q21
Do you cough regularly?

Yes
No
Note: Don’t Know and Refused are not allowed.
Respondents aged 13 and over

SPQ_Q22
Do you cough up phlegm regularly?

Yes
No
Note: Don’t Know and Refused are not allowed.
Respondents aged 13 and over

SPQ_Q23
Do even simple chores make you short of breath?

Yes
No
Note: Don’t Know and Refused are not allowed.
Respondents aged 13 and over

SPQ_Q24
Do you wheeze when you exert yourself, or at night?

Yes
No
Note: Don’t Know and Refused are not allowed.
Respondents aged 13 and over

SPQ_Q25
Do you get frequent colds that persist longer than those of other people you know?

Yes
No
Note: Don’t Know and Refused are not allowed.
Respondents aged 13 and over

SPQ_END

Medications and health remedies (MHR)

Prescription medications

If no prescription medications were reported in the household interview, go to MHR_Q121.

MHR_R100
Now I’d like to confirm your use of prescription medications.
Instruction: For each medication listed from the home interview, ask the following two questions.
Note: Don’t Know and Refused are not allowed.

CDP_Q1
During the interview in your home, it was reported that you were taking [name of prescription medication]. Are you still taking that medication?

Yes
No (Go to next medication or MHR_Q121)
Never took the medication (Go to next medication or MHR_Q121)
Note: Don’t Know and Refused are not allowed.
Respondents who had previously reported that they were taking prescription medication

CDP_Q2
When was the last time that you took that medication?
Instruction: Read categories to respondent.

Today
Yesterday
Within the last week
Within the last month
More than one month ago
Respondents who had previously reported that they were taking prescription medication

MHR_Q121
Are you taking any other prescription medications? (Remember to include prescribed medications such as insulin, nicotine patches and birth control (pills, patches or injections).)

Yes
No (Go to MHR_R200)

Note: Don’t Know and Refused are not allowed.

Respondents who had previously reported that they were taking prescription medication

MHR_Q122
How many?
(insert respondent answer between 1 and 95)
Instruction: For each other prescription medication, to a maximum of five, ask the following five questions.
Note: Don’t Know and Refused are not allowed.
Respondents who had previously reported that they were taking prescription medication [MHR_Q121 = 1]

NDP_Q1
Is a Drug Identification Number (DIN) available for the medication?
Instruction: If necessary, help the respondent to find the DIN on the bottle, tube or box.

Yes
No (Go to NDP_Q4)
Note: Don’t Know and Refused are not allowed.
Respondents who had previously reported that they were taking prescription medication

NDP_Q2
What is the DIN of the medication?
Instruction: Record DIN from the bottle, tube or box. Be sure to use eight digits; use leading zeros to fill the field if necessary (e.g., 00012345).
(insert Drug Identification Number between 00000001 and 99999995)
Note: Don’t Know and Refused and Empty are not allowed.
Respondents who had previously reported that they were taking prescription medication

NDP_N3
Instruction: The name associated with DIN [number] is [medication name]. Please confirm.

Yes (Go to NDP_Q5)
No
Note: Don’t Know and Refused are not allowed.

NDP_Q4
What is the exact name and dosage of the medication?
Instruction: Record the exact name and dosage of the medication from the bottle, tube or box.
Note: Empty is not allowed.
Respondents who had previously reported that they were taking prescription medication

NDP_Q5
When was the last time that you took that medication?
Instruction: Read categories to respondent.

Today
Yesterday
Within the last week
Within the last month
More than one month ago
Respondents who had previously reported that they were taking prescription medication

Over-the-Counter medications

If no over-the-counter medications were reported in the household interview, go to MHR_Q221.

MHR_R200
Now I’d like to confirm your use of over-the-counter medications.
Instruction: For each medication listed from the home interview, ask the following two questions.
Note: Don’t Know and Refused are not allowed.

CDP_Q1
During the interview in your home, it was reported that you were taking [name of over-the-counter medication]. Are you still taking that medication?

Yes
No (Go to next medication or MHR_Q221)
Never took the medication (Go to next medication or MHR_Q221)
Note: Don’t Know and Refused are not allowed.
Respondents who had previously reported that they were taking over-the-counter medication

CDP_Q2
When was the last time that you took that medication?
Instruction: Read categories to respondent.

Today
Yesterday
Within the last week
Within the last month
More than one month ago
Respondents who had previously reported that they were taking over-the-counter medication

MHR_Q221
Are you taking any other over-the-counter medications? (Pain killers, antacids, allergy pills and hydrocortisone creams are all examples of over-the-counter medications.)

Yes
No (Go to MHR_R300)
Note: Don’t Know and Refused are not allowed.
Respondents who had previously reported that they were taking over-the-counter medication

MHR_Q222
How many?
(insert respondent answer between 1 and 95)
Instruction: For each other over-the-counter medication, to a maximum of five, ask the following five questions.
Note: Don’t Know and Refused are not allowed.
Respondents who had previously reported that they were taking over-the-counter medication [MHR_Q221 = 1]

NDP_Q1
Is a Drug Identification Number (DIN) available for the medication?
Instruction: If necessary, help the respondent to find the DIN on the bottle, tube or box.

Yes
No (Go to NDP_Q4)
Note: Don’t Know and Refused are not allowed.
Respondents who had previously reported that they were taking over-the-counter medication

NDP_Q2
What is the DIN of the medication?
Instruction: Record DIN from the bottle, tube or box. Be sure to use eight digits; use leading zeros to fill the field if necessary (e.g., 00012345).
(insert Drug Identification Number between 00000001 and 99999995)
Note: Don’t Know, Refused and Empty are not allowed.
Respondents who had previously reported that they were taking over-the-counter medication

NDP_N3
Instruction: The name associated with DIN [number] is [medication name]. Please confirm.

Yes (Go to NDP_Q5)
No
Note: Don’t Know and Refused are not allowed.

NDP_Q4
What is the exact name and dosage of the medication?
Instruction: Record the exact name and dosage of the medication from the bottle, tube or box.
Note: Empty is not allowed.
Respondents who had previously reported that they were taking over-the-counter medication

NDP_Q5
When was the last time that you took that medication?
Instruction: Read categories to respondent.

Today
Yesterday
Within the last week
Within the last month
More than one month ago
Respondents who had previously reported that they were taking over-the-counter medication

Health product and herbal remedies

If no health product or herbal remedies were reported in household interview, go to MHR_Q321.

MHR_R300
Now I’d like to confirm your use of health products and herbal remedies.
Instruction: For each product or remedy listed from the home interview, ask the following two questions.
Note: Don’t Know and Refused are not allowed.

CDP_Q1
During the interview in your home, it was reported that you were taking [name of product or remedy]. Are you still taking that product?

Yes
No (Go to next product or MHR_Q321)
Never took the product (Go to next product or MHR_Q321)
Note: Don’t Know and Refused are not allowed.
Respondents who had previously reported that they were taking a health product or herbal remedy

CDP_Q2
When was the last time that you took that product?
Instruction: Read categories to respondent.

Today
Yesterday
Within the last week
Within the last month
More than one month ago
Respondents currently taking a health product or herbal remedy

MHR_Q321
Are you taking any other health products or herbal remedies such as vitamins, minerals, fish oils and other oils, and botanical or homeopathic preparations?

Yes
No (If CON_AGE < 14, go to MHR_N611. Otherwise go to MHR_R411)
Note: Don’t Know and Refused are not allowed.
Respondents who had previously reported that they were taking a health product or herbal remedy

MHR_Q322
How many?
(insert respondent answer between 1 and 95)
Instruction: For each other product or remedy, to a maximum of five, ask the following five questions.
Note: Don’t Know and Refused are not allowed.
Respondents currently taking a health product or herbal remedy [MHR_Q321 = 1]

NDP_Q1
Is a Drug Identification Number (DIN) available for the product?
Instruction: If necessary, help the respondent to find the DIN on the bottle, tube or box.

Yes
No (Go to NDP_Q4)
Note: Don’t Know and Refused are not allowed.
Respondents currently taking a health product or herbal remedy

NDP_Q2
What is the DIN of the product?
Instruction: Record DIN from the bottle, tube or box. Be sure to use eight digits; use leading zeros to fill the field if necessary (e.g., 00012345).
(insert Drug Identification Number between 00000001 and 99999995)
Note: Don’t Know, Refused and Empty are not allowed.
Respondents currently taking a health product or herbal remedy

NDP_N3
Instruction: The name associated with DIN [number] is [product name]. Please confirm.

Yes (Go to NDP_Q5)
No
Note: Don’t Know and Refused are not allowed.

NDP_Q4
What is the exact name and dosage of the product?
Instruction: Record the exact name and dosage of the product from the bottle, tube or box.
Note: Empty is not allowed.
Respondents currently taking a health product or herbal remedy

NDP_Q5
When was the last time that you took that product?
Instruction: Read categories to respondent.

Today
Yesterday
Within the last week
Within the last month
More than one month ago
Respondents currently taking a health product or herbal remedy
If respondent is younger than 14, go to MHR_N611.

MHR_R411
Now I am going to ask you some questions about your use of other substances such as performance enhancing or recreational drugs. We ask these questions because these drugs can affect the results of the physical and biological measures that we will be taking today. You can be assured that anything you say will remain confidential.
Note: Don’t Know and Refused are not allowed.

MHR_Q411
In the past week have you used any performance enhancing or recreational drugs such as steroids, marijuana or cocaine?

Yes
No
Respondents aged 14 and over

MHR_N611
From which tests should the respondent be excluded because of medication use?
Instruction: Mark all that apply.

Spirometry
mCAFT
Grip strength
Sit and reach
Partial curl-ups
None
Note: Don’t Know and Refused are not allowed.

MHR_END

Physical activity readiness (PAR)

PAR_R01
For respondents 14 or older:
Next you need to complete a questionnaire called the Physical Activity Readiness Questionnaire. These questions are used to identify people for whom certain tests might be inappropriate. Please read the questionnaire and answer each question thinking about the tests that you will be doing today. If you have any questions please ask me. When you have completed the questionnaire, sign and date the bottom of the form.

Instruction: Provide the respondent with a blank PAR-Q (shown in Appendix III).
Show the laminated card with pictures of each testing component to the respondent.
Ensure that all PAR-Q questions have been answered.
Ensure that the respondent has signed and dated the form.
Sign and date the form as the witness.

For respondents younger than 14:
Next you need to complete a questionnaire called the Physical Activity Readiness Questionnaire. These questions are used to identify people for whom certain tests might be inappropriate. Your parent or guardian may need to help you read and answer some of these questions. If you have any questions please ask me. When you're done, please write or print your name at the bottom of this form.

Instruction: Provide the respondent with a blank PAR-Q (shown in Appendix III).
Show the laminated card with pictures of each testing component to the respondent.
Ensure that all PAR-Q questions have been answered.
Ask the parent or guardian to sign and date the form.
Sign and date the form as the witness.
Note: Don’t Know and Refused are not allowed.

PAR_R02
I am now going to enter that information into our computer system. I may have some additional questions about your responses.
Note: Don’t Know and Refused are not allowed.

PAR_N11
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Instruction: Enter the response from the PAR-Q completed by the respondent.

Yes
No
Note: Don’t Know and Refused are not allowed.
All respondents

PAR_N21
Do you feel pain in your chest when you do physical activity?
Instruction: Enter the response from the PAR-Q completed by the respondent.

Yes
No
Note: Don’t Know and Refused are not allowed.
All respondents

PAR_N31
In the past month, have you had chest pain when you were not doing physical activity?
Instruction: Enter the response from the PAR-Q completed by the respondent.

Yes
No
Note: Don’t Know and Refused are not allowed.
All respondents

PAR_N41
Do you lose your balance because of dizziness or do you ever lose consciousness?
Instruction: Enter the response from the PAR-Q completed by the respondent.

Yes
No (Go to PAR_N51)
Note: Don’t Know and Refused are not allowed.
All respondents

PAR_Q42
In completing the questionnaire you reported that you lost your balance because of dizziness or have lost consciousness. Which condition was the reason for that response?

Lost balance
Lost consciousness
Both
Respondents who previously reported losing their balance because of dizziness or losing consciousness [PAR_N41 = 1]

PAR_Q43
Was the last time that you [lost your balance/lost consciousness] within the last year?

Yes
No
Note: Don’t Know and Refused are not allowed.
Respondents who previously reported losing their balance because of dizziness or losing consciousness [PAR_N41 = 1]

PAR_Q44
Under which condition(s) does this happen?
Instruction: Mark all that apply.

Standing up quickly
Getting up from lying down
After an injury/accident (e.g., concussion, head injury)
During an illness (e.g., inner ear infection)
During or after exercise
After fasting for a long period of time
On hot days
At random
Other – Specify (insert respondent answer to a maximum of 80 characters)
Respondents who previously reported losing their balance because of dizziness or losing consciousness [PAR_N41 = 1]
If respondent has not lost balance or lost consciousness in the last year, go to PAR_N51.
If respondent has lost balance or lost consciousness in the last year and PAR_Q44 < 9, go to PAR_N51.

PAR_N45
Should the respondent be excluded from the mCAFT because of this condition?

Yes
No
Note: Don’t Know and Refused are not allowed.
[PAR_Q43 = 1 and PAR_Q44 = 9]

PAR_N51
Do you have a bone or joint problem (for example back, knee or hip) that could be made worse by a change in your physical activity?
Instruction: Enter the response from the PAR-Q completed by the respondent.

Yes
No (Go to PAR_N61)
Note: Don’t Know and Refused are not allowed.
All respondents

PAR_Q52
In completing the questionnaire you reported that you have a bone or joint problem. The problem is with which bone or joint?
Instruction: Mark all that apply.

Head / Jaw
Neck
Back / Spine (excluding neck)
Shoulder
Arm / Elbow
Wrist
Hand / Finger
Hip
Leg / Knee
Ankle
Foot / Toe
Respondents who previously reported having a bone or joint problem [PAR_N51 = 1]

PAR_B53A
For each bone or joint identified in question PAR_Q52, ask the following three questions:

BJP_Q1
What is the condition that affects your [bone or joint]

Arthritis (osteoarthritis or rheumatoid arthritis)
Vertebral disorder (e.g., chronic back or neck pain)
Osteoporosis
Chronic soft tissue condition (e.g., tendonitis)
Chronic joint condition (e.g., bursitis, carpal tunnel syndrome)
Acute soft tissue condition (e.g., pulled muscle, sprain, strain)
Acute bone condition (e.g., broken bone)
Neuromuscular disorder (e.g., multiple sclerosis, cerebral palsy, spinal cord dysfunction, muscular dystrophy, brain injury)
Amputation
Other – Specify (insert respondent answer to a maximum of 80 characters)
Respondents who previously reported having a bone or joint problem

For each bone or joint identified in question PAR_Q52, ask the following three questions:

BJP_Q2
What types of activities aggravate your [identified problem]?
Instruction: Probe as necessary to determine whether the respondent should be excluded from any physical tests.
Mark all that apply.

Bending
Lifting
Climbing stairs
Walking or running
Squeezing
Twisting
Stretching or reaching
Other – Specify (insert respondent answer to a maximum of 80 characters)
Respondents who previously reported having a bone or joint problem

BJP_N3
From which tests should the respondent be excluded because of this condition?
Instruction: Mark all that apply.

mCAFT
Grip strength
Sit and reach
Partial curl-ups
None
Note: Don’t Know and Refused are not allowed
Respondents who previously reported having a bone or joint problem

PAR_N61
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or a heart condition?
Instruction: Enter the response from the PAR-Q completed by the respondent.

Yes
No (Go to PAR_N71)
Note: A list of confirmed and new prescription drugs is displayed under a heading, “Medications Currently Being Taken.”
Note: Don’t Know and Refused are not allowed.
All respondents

PAR_Q62
For which condition(s) are you taking the drugs?
Instruction: Mark all that apply.

High blood pressure
Low blood pressure
Angina
Previous heart attack
Aneurysm
Arrhythmia
Other heart condition – Specify (insert respondent answer to a maximum of 80 characters)
Other medical condition – Specify (insert respondent answer to a maximum of 80 characters)
Note: Don’t Know, Refused and Empty are not allowed.
Respondents currently taking prescription drugs [PAR_Q61 = 1]

PAR_N71
Do you know of any other reason why you should not do physical activity?
Instruction: Enter the response from the PAR-Q completed by the respondent.

Yes – Specify (insert respondent answer to a maximum of 80 characters)
No (Go to PAR_END)
Note: Don’t Know and Refused are not allowed.
All respondents

PAR_N72
From which tests should the respondent be excluded because of this condition?
Instruction: Probe to determine the seriousness of the condition.
Mark all that apply.

mCAFT
Grip strength
Sit and reach
Partial curl-ups
None
Note: Don’t Know and Refused are not allowed.
[PAR_Q71 = 1]

PAR_END

Other reason for screening out (ORS)

ORS_Q1
Are there any other reasons why you should not participate in one or more of the physical tests?

Yes
No
All respondents

ORS_N1
Instruction: Is there any other reason why the respondent should not perform the Grip Strength test?

Yes – Specify (insert respondent answer to a maximum of 80 characters)
No
Note: Don’t Know and Refused are not allowed.
All respondents

ORS_N2
Instruction: Is there any other reason why the respondent should not perform the Spirometry test?

Yes – Specify (insert respondent answer to a maximum of 80 characters)
No
Note: Don’t Know and Refused are not allowed.
All respondents
If respondent is older than 69, go to ORS_END.

ORS_N3
Instruction: Is there any other reason why the respondent should not perform the modified Canadian Aerobic Fitness Test (mCAFT)?

Yes – Specify (insert respondent answer to a maximum of 80 characters)
No
Note: Don’t Know and Refused are not allowed.
Respondents aged 69 and under

ORS_N4
Instruction: Is there any other reason why the respondent should not perform the Sit and Reach test?

Yes – Specify (insert respondent answer to a maximum of 80 characters)
No
Note: Don’t Know and Refused are not allowed.
Respondents aged 69 and under

ORS_N5
Instruction: Is there any other reason why the respondent should not perform the Partial Curl-up test?

Yes – Specify (insert respondent answer to a maximum of 80 characters)
No
Note: Don’t Know and Refused are not allowed.
Respondents aged 69 and under

ORS_END

Urine collection component

Introduction (UCI)

UCI_R01
Now we would like you to provide a urine sample. Please fill the cup up to the line and put the lid back on tightly. Once you are finished, place the filled cup in the brown paper bag and bring it back to this room. If you are unable to provide a sample at this time then we will try again later during the clinic visit.
Note: Don’t Know and Refused are not allowed.

UCI_END

Urine collection (URC)

URC_N01
Instruction: Record whether the respondent provided a urine sample.

Yes (Go to URC_END)
No
Note: Don’t Know and Refused are not allowed.
Note: Save the current time (for use in the Lab Component).

URC_N02
Instruction: Record the reason why the respondent did not provide a urine sample.

Refusal
Unable to provide
Other – Specify (insert respondent answer to a maximum of 80 characters)
Note: Don’t Know and Refused are not allowed.

URC_END

Anthropometric component

Anthropometric component introduction (ACI)

ACI_R01
Next will be a series of body measurements.
Note: See Canadian Health Measures Survey Protocols for further details on measurement protocols and procedures.
Note: Don’t Know and Refused are not allowed.
All respondents

ACI_END

Height and weight measurement (HWM)

To be completed by all respondents except those meeting the exclusion criteria:

The respondent has an acute condition that prevents him/her from completing the measure.
Respondents who are unable to stand or sit unassisted.

HWM_Q11
I’m going to start by measuring how tall you are. Please remove your shoes and stand with your feet together and your heels, buttocks, back, and head in contact with the measuring device. Look straight ahead and stand as tall as possible. Now, take a deep breath in and hold it.

Instruction: Ensure the respondent’s head is in the Frankfort plane. Take the measurement while the breath is being held.
Note: Don’t Know and Refused are not allowed.

HWM_N11
Instruction: Record how the data will be captured.

Electronically
Manually (Go to HWM_N11B)
Self-report (Go to HWM_N11B)
Note: Self-report data should only be recorded under specific circumstance (e.g. wheelchair bound, bun or hair piece that the respondent is unwilling to remove, etc.)
Note: Don’t Know and Refused are not allowed.
[PHC_Q42C = 2]

If captured Electronically:

HWM_N11A
Instruction: Ensure that the stadiometer is set to centimetres (cm). Press the “Send” button on the left side of the digital display box or the “Data” button on the SPC (send to PC) device. (insert stadiometer information between 700.00 and 2130.00 in millimetres)
Note: Don’t Know and Refused are not allowed.

If captured Manually or self-reported:

HWM_N11B
Instruction: Record the standing height in centimetres. (insert standing height between 70.00 and 213.00 in centimetres)
Don’t Know, Refused (Go to HWM_S11)

HWM_N11C
Instruction: Re-enter the standing height in centimetres. (insert standing height between 70.00 and 213.00 in centimetres)

HWM_S11
Instruction: If the measurement could not be taken, specify the reason.
(insert respondent answer to a maximum of 80 characters)
Note: Don’t Know, Refused and Empty are not allowed.
Self-reported: Go to HWM_R13

HWM_R12
Next I’d like you to sit on this box so that I can measure how tall you are when you are sitting. Sit with your back and head against the measuring device. Put your hands on your lap and keep your legs still. Look straight ahead and sit up as straight as possible. Now, take a deep breath in and hold it.

Instruction: Ensure the respondent’s head is in the Frankfort plane.
Ensure the respondent does not contract the gluteal muscles nor push with the legs.
Take the measurement while the breath is being held.
Note: Don’t Know and Refused are not allowed.

If captured Electronically:

HWM_N12A
Instruction: Ensure that the stadiometer is set to centimetres (cm).
Press the “Send” button on the left side of the digital display box or the “Data” button on the SPC (send to PC) device. (insert stadiometer information between 700.00 and 2130.00 in millimetres)
Note: Don’t Know and Refused are not allowed.

If captured Manually

HWM_N12B
Instruction: Record the sitting height in centimetres. (insert stadiometer information between 70.00 and 213.00 in centimetres)
Don’t Know, Refused (Go to HWM_S12)

HWM_N12C
Instruction: Re-enter the sitting height in centimetres. (insert stadiometer information between 70.00 and 213.00 in centimetres)

HWM_S12
Instruction: If the measurement could not be taken, specify the reason.
(insert respondent answer to a maximum of 80 characters)
Note: Don’t Know, Refused and Empty are not allowed.

HWM_R13
Next I’m going to measure how much you weigh. Please step onto the centre of the scale and face me. Keep your hands at your sides and look straight ahead.

Instruction: Ensure the respondent has on only minimal clothing (no shoes) and has nothing in his/her pockets.
Record in F4 – Remarks any exceptions to a normal weight measurement such as amputations, pregnancy, wheelchair, castings etc.
Note: Don’t Know and Refused are not allowed.

HWM_N13
Instruction: Record how the data will be captured.

Electronically
Manually (Go to HWM_N13B)
Note: Don’t Know and Refused are not allowed.

If captured Electronically:

HWM_N13A
Instruction: Ensure the scale is set to kilograms (kg). When the measurement is stable, press <Print> on the scale.
Press <1> to save the measurement in Blaise.

1 Save the measurement

If respondent is more than 12 weeks pregnant, to to SFM_END

If captured Manually:

HWM_N13B
Instruction: When the measurement is stable, record the weight. (insert measurement between 0.00 and 300.00 kilograms)
Don’t Know, Refused (Go to HWM_S13)

HWM_N13C
Instruction: Re-enter the weight in kilograms.
(insert measurement between 0.00 and 300.00)
If respondent is more than 12 weeks pregnant, to to SFM_END

HWM_S13
Instruction: If the measurement could not be taken, specify the reason.
(insert respondent answer to a maximum of 80 characters)
Note: Don’t Know, Refused and Empty are not allowed.
If respondent is more than 12 weeks pregnant, go to SFM_END.

HWM_R14
Now I’m going to measure your waist circumference. First I need to feel for your hip bones and for the bottom of your ribs. I will take the measurement between these two points. Please stand up straight with your arms hanging loosely at your sides, and breathe normally. I may need to move your clothing slightly because the measurement has to be taken directly on the skin. To ensure I have the correct position, I am going to make two small marks on your skin with a washable marker where the tape measure is to go. These marks will wash off with soap and water.

Instruction: Read the measurement at the side of the body. Take the measurement at the end of a normal expiration. If the respondent will not allow measurement on the skin, take the measurement over the shirt and use F4 – Remarks to make a note.
Note: Don’t Know and Refused are not allowed.

HWM_N14A
Instruction: Record the waist circumference. (insert measurement between 20.0 and 199.0 centimetres)
Don’t Know, Refused (Go to HWM_S14)

HWM_N14B
Instruction: Re-enter the waist circumference in centimetres. (insert measurement between 20.0 and 199.0)

HWM_S14
Instruction: If the measurement could not be taken, specify the reason.
(insert respondent answer to a maximum of 80 characters)
Note: Don’t Know, Refused and Empty are not allowed.

HWM_R15
Now I’m going to measure your hip circumference. Please stand up straight with your arms hanging loosely at your sides, and breathe normally. I may need to move your clothing slightly to ensure the measurement is accurate.

Instruction: Read the measurement at the side of the body. Take the measurement at the end of a normal expiration.
Note: Don’t Know and Refused are not allowed.

HWM_N15A
Instruction: Record the hip circumference. (insert measurement between 20.0 and 199.0 centimetres)
Don’t Know, Refused (Go to HWM_S15)

HWM_N15B
Instruction: Re-enter the hip circumference in centimetres. (insert measurement between 20.0 and 199.0)

HWM_S15
Instruction: If the measurement could not be taken, specify the reason.
(insert respondent answer to a maximum of 80 characters)
Note: Don’t Know, Refused and Empty are not allowed.

Then the following variables are calculated:

body mass index
body mass index norms for respondents 18 or older
body mass index norms for respondents younger than 18
waist circumference norms for respondents aged 15 to 69
waist-to-hip ratio.

HWM_END

Skinfold measurement (SFM)

To be completed by all respondents except those meeting the exclusion criteria:

Women who are more than 12 weeks pregnant.
Respondents with BMI ≥ 30 kg/m2.
Respondents with an acute condition that prevents them from completing the measure (e.g., varicose veins, skin condition).

SFM_Q01
In order to accurately calculate your body composition score I will also measure the thickness of your skinfolds using this skinfold caliper. To measure a skinfold I will take hold of a fold of skin plus any underlying fat tissue between my fingers. Then I will place the calipers on the fold at which time you may feel a slight pinch. Let me show you how it will feel on your hand.

Instruction: Show the skinfold calipers to the respondent and demonstrate the technique on the palm of the respondent’s hand. If respondent refuses, go to SFM_END.
Note: Don’t Know is not allowed.
All respondents except those meeting the exclusion criteria at the beginning of the Skinfold Measurement (SFM) block [PHC_Q42 = 4, excluding respondents with HWMDBMI > 29.99 and females who answered PHC_Q12>12]

SFM_R02
I will be measuring skinfolds at five sites: back of the arm (triceps), front of the arm (biceps), shoulder blade (subscapular), waist (iliac crest) and on the inside of your lower leg (medial calf). At each site I will be taking 2 or 3 measurements.
The measurement must be taken directly against the skin so I may need you to move your clothing slightly to have access to the various sites. First I need to mark the location of each site using this washable marker. The marks will wash off with soap and water.

Instruction: Mark all locations. Refer to the operations manual for the complete set of procedures.
Note: Don’t Know and Refused are not allowed.

First skinfold measurements

SFM_N11
Instruction: Record the first triceps skinfold measurement to the nearest 0.2 millimetres.
(insert measurement between 0.0 and 80.0)
Don’t Know, Refused (Go to SFM_S11)
All respondents, except those meeting the exclusion criteria at the beginning of the Anthropometric Component who answered PHC_Q42 = 4, excluding respondents with HWMDBMI > 29.99 and females who answered PHC_Q12 > 12

SFM_S11
Instruction: If the measurement could not be taken, specify the reason.
(insert respondent answer to a maximum of 80 characters)
Note: Don’t Know, Refused and Empty are not allowed.

SFM_N12
Instruction: Record the first biceps skinfold measurement to the nearest 0.2 millimetres.
(insert measurement between 0.0 and 80.0)
Don’t Know, Refused (Go to SFM_S12)
All respondents, except those meeting the exclusion criteria at the beginning of the Anthropometric Component who answered PHC_Q42 = 4, excluding respondents with HWMDBMI > 29.99 and females who answered PHC_Q12 > 12

SFM_S12
Instruction: If the measurement could not be taken, specify the reason.
(insert respondent answer to a maximum of 80 characters)
Note: Don’t Know, Refused and Empty are not allowed.

SFM_N13
Instruction: Record the first subscapular skinfold measurement to the nearest 0.2 millimetres.
(insert measurement between 0.0 and 80.0)
Don’t Know, Refused (Go to SFM_S13)
All Respondents, except those meeting the exclusion criteria at the beginning of the Anthropometric Component who answered PHC_Q42 = 4 , excluding respondents with HWMDBMI > 29.99 and females who answered PHC_Q12 > 12

SFM_S13
Instruction: If the measurement could not be taken, specify the reason.
(insert respondent answer to a maximum of 80 characters)
Note: Don’t Know, Refused and Empty are not allowed.

SFM_N14
Instruction: Record the first iliac crest skinfold measurement to the nearest 0.2 millimetres.
(insert measurement between 0.0 and 80.0)
Don’t Know, Refused (Go to SFM_S14)
All respondents, except those meeting the exclusion criteria at the beginning of the Anthropometric Component who answered PHC_Q42 = 4, excluding respondents with HWMDBMI > 29.99 and females who answered PHC_Q12 > 12

SFM_S14
Instruction: If the measurement could not be taken, specify the reason.
(insert respondent answer to a maximum of 80 characters)
Note: Don’t Know, Refused and Empty are not allowed.

SFM_N15
Instruction: Record the first medial calf skinfold measurement to the nearest 0.2 millimetres.
(insert measurement between 0.0 and 80.0)
Don’t Know, Refused (Go to SFM_S15)
All respondents, except those meeting the exclusion criteria at the beginning of the Anthropometric Component who answered PHC_Q42 = 4, excluding respondents with HWMDBMI > 29.99 and females who answered PHC_Q12 > 12

SFM_S15
Instruction: If the measurement could not be taken, specify the reason.
(insert respondent answer to a maximum of 80 characters)
Note: Don’t Know, Refused and Empty are not allowed.

Second skinfold measurements

Note: This sequence of measurements is repeated a second time and recorded for all five skinfold sites. If the difference between the two skinfold measures is greater than 0.4 mm at any site, or if one of the measurements could not be taken, a third measurement is taken for the site.

Third skinfold measurements

SFM_R30
The difference between the first and second measures at [the first/second/third/fourth/fifth site(s)] is too large, so I will have to take a third measurement for [this/these site(s)].

Note: The skinfold measurement(s) is/are retaken a third time for every site where the difference between the 1st and 2nd measurement is greater than 0.4 mm

Then the following variables are calculated:

triceps skinfold average
biceps skinfold average
subscapular skinfold average
iliac crest skinfold average
medial calf skinfold average
sum of five skinfolds.
sum of five skinfolds norms for respondents 15 – 69
body composition norms for respondents 15 – 69.

SFM_END

Blood pressure component

To be completed by all respondents except those meeting the exclusion criteria:

Presence of the following on both arms: rashes, gauze dressings, casts, edema, paralysis, tubes, open sores or wounds, withered arms, a-v shunts
Blood pressure cuff too small or too large to fit on arm

Right arm exclusion

Blood has been drawn from right arm within the last week
Presence of the following: rash, gauze dressing, cast, edema, paralysis, tubes, open sores or wounds, withered arm, a-v shunt
Right mastectomy
Right arm amputation
Cast on right arm

Note: For respondents younger than 18, the anthropometric component must be completed prior to the completion of this component. If the Urine Component is not completed, the respondent should be encouraged to empty his bladder prior to the BP measurement.

Before taking the six measurements, the respondent will rest for a period of five minutes.

Blood pressure measurement (BPM)

BPM_N101
Instruction: Record how the first set of data will be captured.

Electronically
Manually (Go to BPM_Q110)
Note: Don’t Know and Refused are not allowed. [All respondents]

Automated blood pressure measurement

BPM_Q101
Now I will take your blood pressure and heart rate using an automated blood pressure cuff. During this test you will need to sit with your feet flat on the floor with your back against the back rest of the chair, and have your right arm straight on the table.

Instruction: Select the appropriate cuff size based on arm circumference, secure it on the right arm and ensure the respondent is in the correct seated position.

Note: Don’t Know is not allowed.
All respondents, except those meeting the exclusion criteria at the beginning of the Blood Pressure Component
If respondent refuses, go to BPM_Q110.

BPM_Q102
For respondents 14 or older:

The blood pressure cuff will inflate automatically once every minute, applying pressure to your arm. A total of six measures will be taken. I will stay in the room for the first measurement but will leave the room for all others. You should not move or talk during the test, and you need to keep both feet flat on the floor. It is important that you stay relaxed to ensure we get good results. Do you have any questions before we begin?

Instruction: Answer any questions as thoroughly as possible.

For respondents younger than 14:

The blood pressure cuff will fill with air, squeezing your arm a little. It will do this 6 times. During the test you cannot talk, and you need to sit really still and keep both feet flat on the floor or step. You should stay relaxed to ensure we get good results. Do you have any questions before we begin?

Instruction: Answer any questions as thoroughly as possible.
Note: Don’t Know and Refused are not allowed.

BPM_R103
Now I will start the machine.

Instruction: Press <Start> on the BPTru screen. Check that the BPTru collects the first measurement properly. Allow the BPTru to collect six measurements. Lock the fields containing the data from the BPTru. Save the measurements and go to BPM_N160.

Note: Don’t Know and Refused are not allowed.

Manual blood pressure measurement

BPM_Q110
Now I will take your blood pressure and heart rate. During this test you will need to sit with your feet flat on the floor with your back against the backrest of the chair, and have your right arm straight on the table with the palm facing up.

Instruction: Select the appropriate cuff size based on arm circumference, secure it on the right arm and ensure the respondent is in the correct seated position.

Determine the maximum inflation level.
Note: Don’t Know is not allowed.
All respondents except those meeting the exclusion criteria at the beginning of the Blood Pressure Component
If respondent refuses, go to BPM_END.

BPM_R110
For respondents 14 or older:

I will take your blood pressure 6 times, and will measure your heart rate using this heart rate monitor. Y ou should not move or talk during the test, and you need to keep both feet flat on the floor. It is important that you stay relaxed to ensure we get good results. Do you have any questions before we begin?

Instruction: Show the heart rate monitor to the respondent and help put it on. Answer any questions as thoroughly as possible.

For respondents younger than 14:

I will take your blood pressure 6 times, and will measure your heart rate using this heart rate monitor. During the test you need to sit really still, you cannot talk and you must keep your feet flat on the floor or step. You should stay relaxed to make sure that we get good results . Do you have any questions before we begin?

Instruction: Show the heart rate monitor to the respondent and help put it on. Answer any questions as thoroughly as possible.
Note: Don’t Know and Refused are not allowed.

BPM_B110
Record the blood pressure and heart rate 6 times.

BPR_N1A
Instruction: Record the systolic blood pressure measurement. (insert measurement between 30 and 300 mmHg)

BPR_N1B
Instruction: Record the diastolic blood pressure measurement. (insert measurement between 30 and 200 mmHg)
Note: Refused is not allowed.

BPR_N2
Instruction: Record the heart rate. (insert measurement between 30 and 200 beats per minute)
Note: Refused is not allowed.

BPR_N3
Instruction: Record the reason if the measurement could not be taken.

Mark all that apply.

5 Deflation too slow
6 Deflation too fast
20 Indeterminate systolic blood pressure
21 Indeterminate diastolic blood pressure
88 Other – Specify (insert answer to a maximum of 80 characters)

BPM_N160
Instruction: Check the blood pressure and heart rate data.

Accept the measurements
Redo the measurements (Go to BPM_R191)

Note: If there are large discrepancies in 3 or more of the measurements, or if the variation between any of the systolic or heart rate measurements exceeds prescribed limits, then redo the measurements.

Then the following variables are calculated:

average systolic blood pressure
average diastolic blood pressure
average resting heart rate.

[All respondents]

BPM_R191
The entire measurement sequence is repeated, up to 2 times, using the following script: If it needs to be repeated because the blood pressure is too high:

Your [blood pressure/heart rate] today is a little elevated. This sometimes happens when people are anxious about the clinic tests. I will leave you to sit and relax for five minutes then I will come back and redo the measures.

If it needs to be repeated because of a BPTRU error or too much variability between measurements:

There were too many problems with that set of measurements, so we have to do the test again. I will retake your blood pressure and heart rate, but this time I will remain in the room to monitor the results. Now I will retake your blood pressure and heart rate.

Note: Don’t Know and Refused are not allowed.

BPM_D411
Blood pressure norms for respondents 18 or older are calculated. If measures fall within normal ranges, go to BPM_END, otherwise go to go to BPM_R411.

BPM_R411
Your average blood pressure today was [average systolic BP]/[average diastolic BP] mmHg. Based on a report by the Canadian Coalition for High Blood Pressure Prevention and Control, this means your blood pressure is [above the acceptable range/moderately high/high/very high].

Instruction: Answer any questions as thoroughly as possible.
Note: Don’t Know and Refused are not allowed.

BPM_D412
Blood pressure norms for respondents younger than 18 are calculated. If measures fall within normal ranges, go to BPM_END, otherwise go to go to BPM_R412.

BPM_R412
Your average blood pressure today was [average systolic BP]/[average diastolic BP] mmHg. Based on The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents, this means your blood pressure is [high/very high].

Instruction: Answer any questions as thoroughly as possible. If the blood pressure of the respondent was still high after three measurements, the respondent will receive a letter with his report of measurements that they should take to their doctor.

BPM_END

Phlebotomy component

To be completed by all respondents except those meeting the exclusion criteria:

Respondents who have hemophilia
Respondents who have received chemotherapy within the last 4 weeks
Respondents who have any of the following on both arms: rashes; gauze dressings; casts; edema; paralysis; tubes; open sores or wounds; withered arms or limbs missing; damaged; sclerosed or occluded veins; allergies to cleansing reagents; burned or scarred tissue; shunt or IV on both arms.

Phlebotomy component introduction (PHI)

PHI_R01
Hi, my name is… Please have a seat on the bench because I need to ask you a few questions before we begin.

Note: Don’t Know and Refused are not allowed.

PHI_END

Blood collection (BDC)

BDC_Q11
In the past 2 months, that is, from [date two months ago] to yesterday, did you receive a blood transfusion?

Yes
No
All respondents, except those meeting the exclusion criteria at the beginning of the Phlebotomy Component

BDC_Q12
In the past 2 months, did you donate blood?

Yes
No (Go to BDC_Q21)
Note: Don’t Know and Refused are not allowed.
All respondents, except those meeting the exclusion criteria at the beginning of the Phlebotomy Component

BDC_B13
What was the date when you last donated blood?

Instruction: Enter the day. (insert respondent answer between 1 and 31)
Instruction: Select the month.

January
February
March
April
May
June
July
August
September
October
November
December

Instruction: Enter a four-digit year.
(insert respondent answer between 1925 and 2009)
All respondents, except those meeting the exclusion criteria at the beginning of the Phlebotomy Component

BDC_Q21
Now I am going to do the blood draw. Have you ever had blood taken?

Instruction: Explain the procedure to the respondent and try to alleviate any anxiety.
Refused (Go to BDC_END)
Note: Don’t Know is not allowed.
All respondents, except those meeting the exclusion criteria at the beginning of the Phlebotomy Component

BDC_D21
Determine the blood collection tube labels needed. Print the blood collection tube labels. Attach each label to the appropriate blood collection tube.

BDC_N23
Instruction: Ensure the blood collection tubes are in the correct order. Record which of the required tubes of blood were collected. Mark all that apply.
Note: Don’t Know is not allowed.

BDC_N24
Instruction: Record whether the respondent was seated or supine during the blood draw.

Seated
Supine
Note: Don’t Know and Refused are not allowed.
All respondents, except those meeting the exclusion criteria at the beginning of the Phlebotomy Component
If respondent refused when first tube of blood was to be drawn, go to BDC_END. If all required tubes were collected, go to BDC_END.

BDC_N25
Instruction: Record the reason if all required tubes were not collected.

Respondent refused
Respondent fainted
Unable to find vein
Blood flow stopped
Physical limitation
Other – Specify (insert reason to a maximum of 80 characters)
Note: Don’t Know and Refused are not allowed.
Respondents who did not provide all required tubes of blood

BDC_END

Activity monitor component

To be completed by all respondents except those meeting the exclusion criteria:

Respondents in a wheelchair.

Activity monitor (AM)

AM_N11
Instruction: Record whether an activity monitor is available.

Yes
No (Go to AM_END)
Note: Don’t Know and Refused are not allowed.

AM_R11
As part of this survey we will be measuring the daily activity patterns of our participants over a 7 day period. To do this, we would like you to wear an activity monitor for the next 7 days.
An activity monitor is a battery-operated electronic device that is worn on a belt around the waist (over the right hip). The monitor records all daily activities as electronic signals, and it does not need to be turned on or off. In fact, as you can see, there are no external displays or buttons.
These activity monitors are not like the step counters you may have seen offered as promotional items on cereal boxes. Our activity monitors are much more sophisticated.

Instruction: Hold up the activity monitor (on the belt) for display.
Note: Don’t Know and Refused are not allowed.

AM_Q11
Would you be willing to wear an activity monitor for the next 7 days?

Yes(Go to AM_R21)
No
Note: Don’t Know and Refused are not allowed.
All respondents not in a wheelchair

AM_N12
Instruction: Record the reason why the respondent is not willing to wear an activity monitor for the next 7 days.

Burden
Invasive
Aesthetics
Away during the collection period
Anticipating change in normal activity
Sick or laid up
Worried about losing or damaging the device
Other – Specify (insert reason up to a maximum of 80 characters)

Go to AM_END.
Note: Don’t Know and Refused are not allowed.

AM_R21
You are to put the activity monitor on every day as soon as you wake up in the morning and wear it all day until you go to bed at night. You can wear the activity monitor either over or under your clothes, but you must make sure that it is positioned over your right hip, and that the belt is snug.

Instruction: Assist the respondent in putting the belt on. Check to ensure the belt fits snugly around the waist and that the activity monitor is positioned over the right hip. Ensure the monitor is positioned top up and is in line with the supraspinale.
Note: Don’t Know and Refused are not allowed.

AM_N21
Instruction: Record whether the respondent took an activity monitor.

Yes (Go to AM_N31)
No
Note: Don’t Know and Refused are not allowed.

AM_N22
Instruction: Record the reason why the respondent did not take an activity monitor.

Burden
Invasive
Aesthetics
Away during the collection period
Anticipating change in normal activity
Sick or laid up
Worried about losing or damaging the device
Other – Specify (insert reason up to a maximum of 80characters)

Go to AM_END.
Note: Don’t Know and Refused are not allowed.

AM_N31
Instruction: To log in the serial number of the activity monitor either read the number from the monitor case and manually type this number into the answer field or use the bar code wand to scan the bar code on the monitor case. (insert serial number between A000001 and Z999999)
Note: Don’t Know and Refused are not allowed.

AM_N32
Instruction: To log in the waybill number of the pre-paid envelope either read the number from the envelope and manually type this number into the answer field or use the bar code wand to scan the bar code on the envelope. (insert waybill number between AA000000001 and ZZ999999999CA)
Note: Don’t Know and Refused are not allowed.

AM_R33
On [date 8 days after clinic visit] we would like you to put the activity monitor and the belt into this pre-paid envelope. You should put this envelope into any Canada Post mailbox at your earliest convenience.
A full description of what the activity monitor is, what it measures, how it works, and why it is important is contained in the handouts in the mail-back envelope.

Instruction: Show the handouts to the respondent.
Note: Don’t Know and Refused are not allowed.

AM_END

Spirometry component

To be completed by all respondents except those meeting the exclusion criteria:

Respondent with a stoma
Respondents with an acute respiratory condition such as cold, bronchitis, flu.
Respondents with a significant language barrier.
Women who are more than 27 weeks pregnant.
Respondents who have suffered a heart attack within the last 3 months.
Respondents who have had major surgery on chest or abdomen within the last 3 months.
Respondents taking medication for tuberculosis.
Respondents who have difficulty breathing at rest.
Respondents who have a persistent cough.

Spirometry restriction (SPR)

SPR_R11
First I need to ask a couple of health-related questions to make sure we are able to do the lung function test for you today.

SPR_Q11
Have you had a heart attack within the past 3 months?

Yes (Go to SPM_END)
No
Note: Don’t Know and Refused are not allowed.
All respondents, except those meeting the exclusion criteria at the beginning of the Spirometry Component

SPR_Q12
Have you had major surgery on your chest or abdomen in the past 3 months?

Yes (Go to SPM_END)
No
Note: Don’t Know and Refused are not allowed.
All respondents, except those meeting the exclusion criteria at the beginning of the Spirometry Component

SPR_END

Spirometry measurement (SPM)

SPM_Q021
For respondents 12 or older:

Now I’d like to measure your lung function using a basic breathing test that greatly depends on effort.

Instruction: Demonstrate the test (without using the mouthpiece).

For respondents younger than 12:

Now I would like to test your lungs to see how well they work.

Instruction: Demonstrate the test (without using the mouthpiece).
Note: Don’t Know is not allowed.
All respondents, except those meeting the exclusion criteria at the beginning of the Spirometry Component [SPR_Q11 = 2 and SPR_Q12 = 2]

SPM_N022
Instruction: Record the appropriate race adjustment for the respondent.

White
Black
Hispanic
Asian
Other
Note: Don’t Know and Refused are not allowed.
All respondents, except those meeting the exclusion criteria at the beginning of the Spirometry Component [SPR_Q11 = 2 and SPR_Q12 = 2]

SPM_N023
Instruction: Check the data to be sent to the spirometer.

Transmit the data
Note: Don’t Know and Refused are not allowed.

SPM_R024
Instruction: Open the KoKo software. Follow the instructions on importing and retrieving respondent information. In the KoKo patient information screen, chose which set of predicted norms is to be applied:

If respondent is younger than 8 use:
“Corey 1976”

If respondent is 8 years or older use:
“Hankinson (NHANES III)”

Note: Don’t Know and Refused are not allowed.
Once the predicted have been chosen, an Ethnic Group must be chosen (see Appendix IV).

SPM_Q031
For respondents 12 or older:

During the test you will need to wear a nose clip to ensure that no air escapes from your nose. You should sit up straight throughout the test, with both feet flat on the floor. Before we start the test you will put the mouthpiece in your mouth, forming a good seal, with your lips and teeth on the outside of the mouthpiece so that air cannot escape. You will then be asked to take a few normal breaths. At the end of the last normal breath, you should take a big breath in, filling your lungs with as much air as possible. Then you will immediately blast all the air out as forcefully and as quickly as you can. Do not hold your breath before blowing out. Keep blowing out until you have absolutely no air left in your lungs. You may believe there is no more air in your lungs but you must try to keep blowing out for at least 6 seconds. I will be encouraging you to keep blowing, and I will tell you when to stop. When I do, take a big breath in once again.

Respondents aged 12 and over, except those meeting the exclusion criteria at the beginning of the Spirometry Component [Respondents aged 12 and over who answered SPR_Q11 = 2 and SPR_Q12 = 2]

Instruction: Demonstrate the test (without using the mouthpiece).

For respondents younger than 12:

During the test I will have you wear a nose clip so that you breathe only through your mouth. You should sit up straight and keep both feet flat on the floor or the stool. Before we start the test you will put the mouthpiece in your mouth, with your lips and teeth on the outside of the mouthpiece, making sure that no air can escape. I will then ask you to take a few normal breaths. At the end of the last normal breath, you should take a big breath in, breathing in as much air as you can. Then you will blast out all the air as hard and as fast as possible. Do not hold your breath before blowing out. Keep blowing out until you have absolutely no air left in your lungs. You may believe there is no more air in your lungs but you must try to keep blowing out for at least 6 seconds. I will be encouraging you to keep blowing, and I will tell you when to stop. When I do, take a big breath in once again.

Instruction: Demonstrate the test (without using the mouthpiece).
Note: Don’t Know is not allowed.
Respondents aged 11 and under, except those meeting the exclusion criteria at the beginning of the Spirometry Component [ [Respondents aged 11 and under who answered SPR_Q11 = 2 and SPR_Q12 = 2]

SPM_Q032
For respondents 12 or older:

I will be giving verbal encouragement throughout the test. To get the best possible result, you really must provide a maximal effort. I need 3 good tests to record your scores but we may do as many as 8 tests to ensure we have the best tests recorded.
Do you have any questions before we begin?

Respondents aged 12 and over, except those meeting the exclusion criteria at the beginning of the Spirometry Component [Respondents aged 12 and over who answered SPR_Q11 = 2 and SPR_Q12 = 2]

For respondents younger than 12:

I will be talking to you during the test to remind you of what you are supposed to do. To make sure we get the best result, you must try to blow as hard as you can. I need you to do at least 3 good tests to record your scores but we may do as many as 8 tests to ensure we have the best one.
Do you have any questions before we begin?

Note: Don’t Know is not allowed.
Respondents aged 11 and under, except those meeting the exclusion criteria at the beginning of the Spirometry Component [ [Respondents aged 11 and under who answered SPR_Q11 = 2 and SPR_Q12 = 2]

SPM_R100
Instruction: Ensure the spirometry test results have been saved in the KOKO folder

Note: Don’t Know and Refused are not allowed.

SPM_N100
Instruction: Press <1> to save the measurements in Blaise.

Save the measurements
Note: Don’t Know and Refused are not allowed.
If there are less than 3 trials performed, go to SPM_N901. Otherwise, If SPM_N101 = Empty or SPM_N901 = RESPONSE, go to SPM_END.

SPM_N901
Instruction: Why were fewer than 3 trials performed?

Respondent unable to continue for health reasons
Respondent unable to understand technique
Respondent refuses to continue
Equipment problem
Other – Specify (insert reason to a maximum of 80 characters)
Note: Don’t Know and Refused are not allowed.
If no trials were performed, or if SPM_N901 = RESPONSE, go to SPM_END.

Otherwise, the following variables are calculated:

percent predicted Forced Vital Capacity (FVC)
percent predicted Forced Expiratory Volume (FEV1).

SPM_END

mCAFT component

To be completed by all respondents except those meeting the exclusion criteria:

Respondents who gave a positive response to PAR-Q questions 1, 2, 3 or 6 (automatic) or 4, 5 or 7 (depending upon probing). See PAR-Q in Appendix III.
Respondents taking heart rate or blood pressure medications.
Women who are more than 12 weeks pregnant.
Respondents with resting heart rate ≥ 100 bpm or resting blood pressure > 144/94 mm Hg as determined during the Blood Pressure component.
Mentally and physically impaired individuals, at the discretion of the Health Measures Specialist. Every effort should be made to be inclusive of individuals with disabilities provided that all safety precautions are taken.
Respondents who have difficulty breathing at rest.
Respondents taking medication for a breathing condition that worsens during exercise, but do not have their medication with them (as assessed during the Screening Component).
Respondents who have given a blood donation in the past 24 hours.
Respondents who appear ill or complains of fever.
Respondents who have a persistent cough.
Respondents who have lower extremity swelling.
Respondents with an insulin pump.
Respondents with a colostomy bag.
Respondents who are 70 or older.
Respondents who have opted for a home visit.

mCAFT measurement (AFT)

The starting stage and ceiling heart rate are calculated, based on the respondent’s age and sex, and are displayed on the screen. For example,

Starting stage : 2
Ceiling heart rate : 152 bpm

AFT_R10
The next test we are going to do is a stepping test to measure your fitness level. The test will require you to step up and down this set of stairs continuously to music for 3 minutes at a time. In total there are 8, 3-minute stages. You are starting at stage [1 to 8]. During the test you will wear a heart rate monitor so that I can watch your heart rate. At the end of each 3 minute stepping stage you will be asked to stop exercising. Stop where you are and I will check your heart rate to see if you should do another stage. You will continue going through the stages until your heart rate meets a ceiling value for your age and sex. Your ceiling heart rate is
[ceiling heart rate in bpm]. If your heart rate is at or above this number then I will stop the test. At the end of the test you will slowly walk around for 2 minutes. Then you will sit down and I will take your blood pressure and heart rate a few more times to make sure that you are recovering well from the test.

Instruction: Show the heart rate monitor to the respondent and help to put it on.
Note: Don’t Know and Refused are not allowed.

AFT_R11
For respondents 14 and older:

During the test you need to go up and down the stairs following the beat of the music. The stepping pattern goes like this, “step, step, up, step, step, down”. When you are stepping you should never have both feet on the first step at the same time, and you need to make sure that both feet are placed fully on the top step. If you reach the final 2 stepping stages the stepping pattern will change to a single "step up, step down" pattern. I will play the music and show you how the test is done. Do you have any questions?

For respondents younger than 14:

During the test you need to go up and down the stairs following the beat of the music. The stepping pattern goes like this, “step, step, up, step, step, down”. When you are stepping you should never have both feet on the first step at the same time, and you need to make sure that both feet are placed fully on the top step. I will play the music and show you how the test is done. Do you have any questions?

Instruction: Play the music and demonstrate the stepping pattern at respondent’s starting stage.

Note: Don’t Know and Refused are not allowed.

AFT_N11
Instruction: Record the heart rate. (insert measurement between 30 and 200 beats per minute)

Note: Record heart rate at the end of each stage up to stage 8. If the ceiling heart rate is reached at any time, stop the test and go to AFT_R21.
All respondents, except those meeting the exclusion criteria at the beginning of the mCAFT Component

AFT_R21
The test is finished. I would like you to slowly walk around for 2 minutes and then I will have you sit down so that I can take your blood pressure and heart rate again.

Note: Don’t Know and Refused are not allowed.

AFT_N22
Instruction: Record how the data will be captured.

Electronically
Manually (Go to AFT_Q31)
Note: Don’t Know and Refused are not allowed.
All respondents, except those meeting the exclusion criteria at the beginning of the mCAFT Component

Automated blood pressure measurement

AFT_Q30
Now I will take the first of two post exercise blood pressure and heart rate measurements using this automated blood pressure cuff. During this test you will need to sit with your feet flat on the floor with your back against the back rest of the chair, and have your right arm straight on the table. You should not move or talk during the measurement.

Instruction: Select the appropriate cuff size based on arm circumference, secure it on the right arm and ensure the respondent is in the correct seated position. Set the BPTru to collect a single measure (set cycle to SP). Start the BPTru 2 minutes after the respondent has completed the mCAFT. Save the measurements and go to AFT_Q40

Note: Refused (Go to AFT_Q31)
Note: Don’t Know is not allowed.
All respondents, except those meeting the exclusion criteria at the beginning of the mCAFT Component [AFT_N22 = 1 or AFT_Q30 = RF]

Manual blood pressure measurement

AFT_Q31
Now I will take the first of two post exercise blood pressure and heart rate measurements. During this test you will need to sit with your feet flat on the floor with your back against the back rest of the chair, and have your right arm straight on the table with the palm facing up. You should not move or talk during the measurement.

Instruction: Select the appropriate cuff size based on arm circumference, secure it on the right arm and ensure the respondent is in the correct seated position. Determine the maximum inflation level.

Note: Don’t Know is not allowed.
All respondents, except those meeting the exclusion criteria at the beginning of the mCAFT Component [AFT_N22 = 2 or AFT_Q30 = RF]

BPR_N1A
Instruction: Record the systolic blood pressure measurement. (insert measurement between 30 and 300 mmHg)

BPR_N1B
Instruction: Record the diastolic blood pressure measurement. (insert measurement between 30 and 200 mmHg)

BPR_N2
Instruction: Record the heart rate. (insert measurement between 30 and 200 beats per minute)

BPR_N3
Instruction: Record the reason if the measurement could not be taken.
Mark all that apply.

5 Deflation too slow
6 Deflation too fast
20 Indeterminate systolic blood pressure
21 Indeterminate diastolic blood pressure
88 Other – Specify (insert measurement to a maximum of 80 characters)

AFT_Q40
I will now take a second blood pressure and heart rate measurement.

Instruction: Begin the measurement 3.5 minutes after the respondent has completed the mCAFT.

Note: Second and subsequent measurements are captured manually or electronically following the same procedures as were completed for the first measurement.
All respondents except those meeting the exclusion criteria at the beginning of the mCAFT Component [AFT_N22 = 1, excluding refusals to AFT_Q30]
If [average systolic blood pressure] < 145 and [average diastolic blood pressure] < 95 and [resting heart rate] < 100, go to AFT_END.

AFT_R49
The entire measurement sequence is repeated up to two more times, at 6 minutes and 8 minutes after the respondent has completed the mCAFT, using the following script:

Your [blood pressure and heart rate are/blood pressure is/heart rate is] still high from doing the exercise so please sit and relax for 2 minutes and then I will take your blood pressure and heart rate again .

Then the following variables are calculated:

oxygen cost
aerobic fitness score
aerobic fitness norms for respondents aged 15 to 69
aerobic fitness norms for respondents younger than 15.

Note: Don’t Know is not allowed.
If the heart rate at any of the 8 stages was recorded as “Don’t Know” go to AFT_N81.
Otherwise, go to AFT_END.

AFT_N81
Instruction: Record the reason why the respondent did not complete the test.

Refusal
Unable to maintain proper cadence
Dizziness
Extreme leg pain
Nausea
Chest pain
Facial pallor
Other – Specify (insert reason to a maximum of 80 characters)
Note: Don’t Know and Refused are not allowed.
Respondents who did not complete all required stages

AFT_END

Grip strength component

To be completed by all respondents except those meeting the exclusion criteria:

Respondent gave a positive response(s) to PAR-Q questions 5, 6 or 7 (depending upon probing). See the PAR_Q in Appendix III.

Grip strength component introduction (GSI)

GSI_R1
Next I am going to measure your upper body strength with a hand grip dynamometer. You will perform this test two times on each hand, alternating hands each time. When performing the test you hold your hand away from your body, and squeeze the handle as hard as you can, blowing out while you squeeze.

Instruction: Demonstrate the procedure while explaining the technique.
Note: Don’t Know and Refused are not allowed.

GSI_R2
Hold the handle so that the 2nd joints of your fingers fit snugly under the handle; we can adjust the size if necessary. Remember, hold your arm straight and away from your body, and squeeze the handle as hard as you can, blowing out while you squeeze.

Note: Don’t Know and Refused are not allowed.

GSI_END

Grip strength measurement (GSM)

GSM_N11
Instruction: Record the first grip strength measurement for the right hand. (insert measurement between 0 and 120 kilograms of pressure)
All respondents, except those meeting the exclusion criteria at the beginning of the Grip Strength Component

GSM_S11
Instruction: If the measurement could not be taken, specify the reason.
(insert respondent answer to a maximum of 80 characters)
Note: Don’t Know, Refused and Empty are not allowed.

GSM_N12
Instruction: Record the first grip strength measurement for the left hand. (insert measurement between 0 and 120 kilograms of pressure)
All respondents, except those meeting the exclusion criteria at the beginning of the Grip Strength Component

GSM_S12
Instruction: If the measurement could not be taken, specify the reason.
(insert respondent answer to a maximum of 80 characters)
Note: Don’t Know, Refused and Empty are not allowed.

GSM_N21
Instruction: Record the second grip strength measurement for the right hand. (insert measurement between 0 and 120 kilograms of pressure)
All respondents, except those meeting the exclusion criteria at the beginning of the Grip Strength Component

GSM_S21
Instruction: If the measurement could not be taken, specify the reason.
(insert respondent answer to a maximum of 80 characters)
Note: Don’t Know, Refused and Empty are not allowed.

GSM_N22
Instruction: Record the second grip strength measurement for the left hand. (insert measurement between 0 and 120 kilograms of pressure)
All respondents, except those meeting the exclusion criteria at the beginning of the Grip Strength Component

GSM_S22
Instruction: If the measurement could not be taken, specify the reason.
(insert respondent answer to a maximum of 80 characters)
Note: Don’t Know, Refused and Empty are not allowed.

Then the following variables are calculated:

total hand grip strength
grip strength norms for respondents aged15 to 69
grip strength norms for respondents younger than 15.

GSM_END

Sit and reach component

To be completed by all respondents except those meeting the exclusion criteria:

Respondents who gave positive response(s) to PAR-Q questions 5 and 7 (depending upon probing). See the PAR-Q in Appendix III.
Women who are more than 12 weeks pregnant.
Respondents who are 70 or older.
Respondents who have a colostomy bag.
Respondents who opted for a home visit.

Sit and reach component introduction (SRI)

SRI_R1
The next test we’re going to do is called a sit-and-reach test, which will measure your back and hamstring flexibility. Before we start the test, we will do some stretches to loosen your leg muscles. I will do the stretches with you to show you how they are done. Sit on the floor with one leg out straight and the bottom of your other foot tucked into the straight leg. Reach forward towards the toe of your straight leg only until you feel a slight stretch in the back of your leg. You should not feel pain and you should not bounce. We will hold the stretch for 20 seconds and then we will switch to the other leg. We will do the stretch twice on each leg.

Instruction: Have the respondent sit on the mat in the modified hurdle stretch position. Do the stretch twice on each leg, holding the stretch for 20 seconds each time. Perform the stretches alongside the respondent.
Note: Don’t Know and Refused are not allowed.

SRI_R2
Before you do the test you will need to remove your shoes. I will demonstrate how to do it. When doing the test:

Sit with your legs out straight in front of you with your feet flat against the board and your legs about 6 inches or 15 cm apart. You must not bend your knees
Put your arms straight out in front of you and put your hands on top of one another
Reach forward pushing the sliding marker along the scale with your fingertips as far as possible. Do not bounce
When you are reaching forward you should breathe out and lower your head to help you reach farther
When you have reached as far as you can you must hold your reach for 2 seconds. I will count this aloud for you and tell you when to sit up again

Instruction: Demonstrate the movement while explaining the main points of the test.
Note: Don’t Know and Refused are not allowed.

SRI_R3
Do you have any questions before we begin?

Instruction: Answer any questions as thoroughly as possible.
Note: Don’t Know and Refused are not allowed.

SRI_END

Sit and reach measurement (SRM)

SRM_N01
Instruction: Record the first sit and reach attempt.
(insert measurement between 0.0 and 75.0 centimetres)
All respondents, except those meeting the exclusion criteria at the beginning of the Sit and Reach Component

SRM_S01
Instruction: If the measurement could not be taken, specify the reason.
Note: Don’t Know, Refused and Empty are not allowed.

SRM_N02
Instruction: Record the second sit and reach attempt.
(insert measurement between 0.0 and 75.0 centimetres)
All respondents, except those meeting the exclusion criteria at the beginning of the Sit and Reach Component

SRM_S02
Instruction: If the measurement could not be taken, specify the reason.
Note: Don’t Know, Refused and Empty are not allowed.

Then the following variables are calculated:

sit and reach measure
sit and reach norms for respondents aged 15 to 69
sit and reach norms for respondents younger than 15.

SRM_END

Partial curl-up component

To be completed by all respondents except those meeting the exclusion criteria:

Positive response(s) to PAR-Q questions 1, 2, 3 (automatic) and 5, 6 and 7 (depending upon probing). See the PAR-Q in Appendix III.
Women who are more than 12 weeks pregnant.
Respondents who are 70 or older.
Respondents with resting heart rate > 100 bpm or blood pressure > 144/94 mmHg as determined during the screening component.
Mentally and physically disabled individuals (at the discretion of the HMS).
Respondents who have difficulty breathing at rest.
Respondents with a persistent cough.
Respondent with lower extremity swelling.
Respondents who appears ill or complains of fever.
Respondents with a colostomy bag.
Respondents who opted for a home visit.

Partial curl-up component introduction (PCI)

PCI_R1
The next test we’re going to do is called partial curl-ups, which are similar to sit-ups or crunches. I will demonstrate how to do them correctly and then I will have you try them.

Instruction: Demonstrate a proper curl-up, and state:

When curling up, your hands should slide along the surface of the mat and your fingertips must touch the far edge of the metal strap
When curling down, your head must return to the mat
You need to curl up on a beep and down on a beep, following the metronome
You should breathe out when curling up and in when curling down
Your heels must stay in contact with the mat or floor at all times
Only good repetitions will be counted to a maximum of 25 (i.e., 1 minute at 50 bpm)
I will correct your form, but after two consecutive bad repetitions the test will be stopped.

Note: The bad repetitions need to be the same (e.g., rep.1=head does not touch the floor, rep 2=head does not touch the floor)
Note: Don’t Know and Refused are not allowed.

PCI_R2
Now I will have you lie on your back on the mat. Bend your legs to 90 degrees with your legs shoulder width apart. Keep your heels in contact with the mat or floor. I will make sure your legs are at 90 degrees before we start. Place your arms straight by your sides so that your fingertips are touching the edge of the metal strap.

Instruction: Help the respondent get into position. Use the goniometer to ensure leg angle is 90 degrees. Adjust the metal strap to meet the respondent’s fingertips.
Note: Don’t Know and Refused are not allowed.

PCI_R3
Remember, in order for a partial curl-up to be counted you must keep the correct form and timing. When doing the test, I will correct you if you do an incorrect curl-up and will allow you to continue if you can. If you are unable to correct your form we will stop the test. A maximum of 25 curl-ups will be done. Do you have any questions?

Instruction: Answer any questions as thoroughly as possible.
Note: Don’t Know and Refused are not allowed.

PCI_R4
I will play the metronome now so that you can listen to the beat. When you are ready you can begin the test.

Note: Don’t Know and Refused are not allowed.

PCI_END

Partial curl-up measurement (PCM)

PCM_N01
Instruction: Record the total number of partial curl-ups completed in one minute.
(insert measurement between 0 and 25)
All respondents, except those meeting the exclusion criteria at the beginning of the Partial Curl-Up Component

PCM_S01
Instruction: If the measurement could not be taken, specify the reason.
(insert respondent answer to a maximum of 80 characters)
Note: Don’t Know, Refused and Empty are not allowed.

PCM_D11
The partial curl-up norms for respondents aged 15 to 69 are calculated.

PCM_END

Oral health component

To be completed by all respondents.

Oral health component introduction (OHI)

OHI_R01
Hello, my name is … and I will be recording the results of your dental examination on this computer, and this is …, a licensed dentist who will be doing your dental exam today. Please sit back in this chair, relax, and make yourself as comfortable as possible.

Note: Don’t Know and Refused are not allowed.

OHI_END

Oral health questions (OHQ)

OHQ_R11
First, I have a few questions about the health of your teeth.

Note: Don’t Know and Refused are not allowed.

OHQ_Q11
Do you think you have any untreated dental conditions?

Yes
No (Go to OHQ_Q21)
Don’t Know, Refused (Go to OHQ_Q21)
All respondents, except those meeting the exclusion criteria at the beginning of the Oral Health Component

OHQ_Q12
What untreated dental condition(s) do you think you have?

Instruction: Mark all that apply.

Prevention
Fillings
Temporomandibular joint disorder (TMD)
Surgery
Periodontics
Esthetics
Endodontics
Orthodontics
Soft tissue
Prosthetics – partial or full denture
Prosthetics – implant, bridge or crown
Other – Specify (insert condition to a maximum of 80 characters)
Respondents believing they have an untreated dental condition [OHQ_Q11 = 1]

OHQ_Q21
In the past month, that is, from [date last month] to yesterday, have you had a toothache?

Yes
No
All respondents, except those meeting the exclusion criteria at the beginning of the Oral Health Component

OHQ_Q22
In the past month, have you had pain in your teeth when consuming hot or cold foods or drinks?

Yes
No
All respondents, except those meeting the exclusion criteria at the beginning of the Oral Health Component

OHQ_Q23
In the past month, have you had:
… severe tooth or mouth pain at night?

Yes
No
All respondents, except those meeting the exclusion criteria at the beginning of the Oral Health Component

OHQ_Q24
In the past month, have you had:
… pain in or around your jaw joints?

Yes
No
All respondents, except those meeting the exclusion criteria at the beginning of the Oral Health Component

OHQ_Q25
In the past month, have you had:
… other pain in your mouth?

Yes
No
All respondents, except those meeting the exclusion criteria at the beginning of the Oral Health Component

OHQ_Q26
In the past month, have you had bleeding gums when brushing your teeth?

Yes
No
All respondents, except those meeting the exclusion criteria at the beginning of the Oral Health Component

OHQ_Q27
In the past month, have you had:
… persistent dry mouth?

Yes
No
All respondents, except those meeting the exclusion criteria at the beginning of the Oral Health Component

OHQ_Q28
In the past month, have you had:
… persistent bad breath?

Yes
No
All respondents, except those meeting the exclusion criteria at the beginning of the Oral Health Component

OHQ_END

Oral health restriction (OHR)

If respondent has hemophilia or has received chemotherapy in the last four weeks, go to OHR_END.

OHR_R11
Next I need to ask a few health-related questions to make sure we are able to do the complete dental examination for you.

Note: Don’t Know and Refused are not allowed.

OHR_Q11
Do you have to take antibiotics (for example, penicillin) before you have a check-up or get dental care?

Yes (Go to OHR_D25)
No
Note: Don’t Know and Refused are not allowed.
Respondents who do not have hemophilia or have not received chemotherapy in the previous 4 weeks [PHC_Q51 = 1 or PHC_Q52 = 1]

OHR_Q12
Have you ever been diagnosed by a health professional with a heart murmur that requires you to take antibiotics for dental treatment?

Yes (Go to OHR_D25)
No
Note: Don’t Know and Refused are not allowed.
Respondents who do not have hemophilia, have not received chemotherapy in the previous 4 weeks, and have answered "no" to all previous questions in the Oral Health Restrictions (OHR) block [OHR_Q11 = 2]

OHR_Q13
Have you ever been diagnosed by a health professional with a heart valve problem?

Yes (Go to OHR_D25)
No
Note: Don’t Know and Refused are not allowed. Respondents who do not have hemophilia, have not received chemotherapy in the previous 4 weeks, and have answered "no" to all previous questions in the Oral Health Restrictions (OHR) block [OHR_Q12 = 2]

OHR_Q14
Have you ever been diagnosed by a health professional with:
… congenital heart disease?

Yes (Go to OHR_D25)
No
Note: Don’t Know and Refused are not allowed. Respondents who do not have hemophilia, have not received chemotherapy in the previous 4 weeks, and have answered "no" to all previous questions in the Oral Health Restrictions (OHR) block [OHR_Q13 = 2]

OHR_Q15
Have you ever been diagnosed by a health professional with:
… bacterial endocarditis?

Yes (Go to OHR_D25)
No
Note: Don’t Know and Refused are not allowed. Respondents who do not have hemophilia, have not received chemotherapy in the previous 4 weeks, and have answered "no" to all previous questions in the Oral Health Restrictions (OHR) block [OHR_Q14 = 2]

OHR_Q16
Have you ever been diagnosed by a health professional with:
… rheumatic fever?

Yes (Go to OHR_D25)
No
Note: Don’t Know and Refused are not allowed. Respondents who do not have hemophilia, have not received chemotherapy in the previous 4 weeks, and have answered "no" to all previous questions in the Oral Health Restrictions (OHR) block [OHR_Q15 = 2]

OHR_Q17
Have you had bypass surgery in the past year?

Yes (Go to OHR_D25)
No
Note: Don’t Know and Refused are not allowed. Respondents who do not have hemophilia, have not received chemotherapy in the previous 4 weeks, and have answered "no" to all previous questions in the Oral Health Restrictions (OHR) block [OHR_Q16 = 2]

OHR_Q18
Do you have a pacemaker or other automatic defibrillator?

Yes (Go to OHR_Q19)
No (Go to OHR_Q20)
Note: Don’t Know and Refused are not allowed. Respondents who do not have hemophilia, have not received chemotherapy in the previous 4 weeks, and have answered "no" to all previous questions in the Oral Health Restrictions (OHR) block [OHR_Q17 = 2]

OHR_Q19
Have you had your pacemaker or other automatic defibrillator for less than one year?

Yes (Go to OHR_D25)
No
Note: Don’t Know and Refused are not allowed. Respondents who have a pacemaker or other automatic defibrillator [OHR_Q18 = 1]

OHR_Q20
Do you have other artificial material in your heart, veins or arteries?

Yes (Go to OHR_D25)
No
Note: Don’t Know and Refused are not allowed. Respondents who do not have hemophilia, have not received chemotherapy in the previous 4 weeks, and have answered "no" to all previous questions in the Oral Health Restrictions (OHR) block [OHR_Q18 = 2 or OHR_Q19 = 2]

OHR_Q21
Have you ever had a joint replacement?

Yes (Go to OHR_D25)
No
Note: Don’t Know and Refused are not allowed. Respondents who do not have hemophilia, have not received chemotherapy in the previous 4 weeks, and have answered "no" to all previous questions in the Oral Health Restrictions (OHR) block [OHR_Q20 = 2]

OHR_Q22
Have you ever received an organ transplant?

Yes (Go to OHR_D25)
No
Note: Don’t Know and Refused are not allowed. Respondents who do not have hemophilia, have not received chemotherapy in the previous 4 weeks, and have answered "no" to all previous questions in the Oral Health Restrictions (OHR) block [OHR_Q21 = 2]

OHR_Q23
Do you have kidney disease that requires dialysis?

Yes (Go to OHR_D25)
No
Note: Don’t Know and Refused are not allowed. Respondents who do not have hemophilia, have not received chemotherapy in the previous 4 weeks, and have answered "no" to all previous questions in the Oral Health Restrictions (OHR) block [OHR_Q22 = 2]

OHR_Q24
Are you immuno-supressed or are you on immuno-suppression therapy? (For example, chemotherapy.)

Yes
No
Note: Don’t Know and Refused are not allowed. Respondents who do not have hemophilia, have not received chemotherapy in the previous 4 weeks, and have answered "no" to all previous questions in the Oral Health Restrictions (OHR) block [OHR_Q23 = 2]

OHR_D25
If respondent answered yes to any of the Oral Health Restriction questions, probing will not be performed.

OHR_END

Oral health examination (OHE)

The probing portion of the oral health exam is to be completed by all respondents except those meeting the exclusion criteria:

Respondents with hemophilia
Respondents who have had chemotherapy within the past 4 weeks
Respondents who answer “yes” to any question in the Oral Health Restrictions block (OHR)
Respondents who are younger than 15

OHE_R11
Now I’m going to do a simple dental examination. The only instruments I will use to look at your mouth and teeth are a hand mirror and these explorers. You should not feel any pain and no x-rays will be taken. I just want to get a sense of the health of your teeth and mouth.

Instruction: Show the instruments to the respondent. If necessary, demonstrate the explorers on the respondent’s fingernail.
Note: Don’t Know and Refused are not allowed.

OHE_N11
Instruction: Record the dental status of the respondent.

Dentate – both arches
Dentate – upper arch only
Dentate – lower arch only
Edentulous with one or more implants
Edentulous
Note: Don’t Know is not allowed.
All respondents, except those meeting the exclusion criteria at the beginning of the Oral Health Component
If respondent refuses, go to OHE_END.

OHE_N12
Instruction: Record the prosthetic status of the upper arch of the respondent.

Mark all that apply.

No prosthetics
Fixed bridge
Implant
Partial denture – acrylic
Partial denture – cast chrome
Full denture
Note: Don’t Know and Refused are not allowed.
All respondents, except those meeting the exclusion criteria at the beginning of the Oral Health Component

OHE_N13
Instruction: Record the prosthetic status of the lower arch of the respondent.

Mark all that apply.

No prosthetics
Fixed bridge
Implant
Partial denture – acrylic
Partial denture – cast chrome
Full denture
Note: Don’t Know and Refused are not allowed.
All respondents, except those meeting the exclusion criteria at the beginning of the Oral Health Component

OHE_N14
Instruction: Record the mucosal status of the respondent.

Mark all that apply.

No mucosal abnormalities
Angular chelitis
Mucosal white patches
Denture stomatitis
Denture induced hyperplasia (epulis)
Glossitis
Sinus or fistula
Aphthous ulcer
Traumatic or unspecified ulcer
Other - Specify (insert status to a maximum of 80 characters)
Note: Don’t Know and Refused are not allowed.
All respondents, except those meeting the exclusion criteria at the beginning of the Oral Health Component
If OHE_N14 = 3, go to OHE_N15. If OHE_N11 = 4 or 5, go to OHE_N51. If CON_AGE > 12, go to OHE_N21.

OHE_N15
Instruction: Record the type of mucosal white patches.

Leukoplakia
Lichen planus
Candidiasis
Note: Don’t Know and Refused are not allowed. [OHE_N14C = 1]
If OHE_N11 = 4 or 5, go to OHE_N51. If respondent is older than 12, go to OHE_N21.

OHE_N20
Instruction: Record the fluorosis score for the most affected pair of teeth for teeth 12, 11, 21 or 22. If the two teeth are not equally affected, record the score for the less affected of the two.

Normal
Questionable
Very mild
Mild
Moderate
Severe
All 4 anterior teeth absent
[Respondents aged less than 12 who answered OHE_N11 = (1, 2, 3)]
If OHE_N11 > 1, OHE_N12 = 6 (Upper arch full denture) and OHE_N13 = 6 (Lower arch full denture), go to OHE_N23.

OHE_N21
Instruction: Record all occlusal conditions that are present.

Mark all that apply.

Acceptable occlusion
Anterior crossbite
Severe crowding
Severe spacing
Posterior crossbite
Anterior open bite (> 1 mm)
Excessive overbite (100% or more)
Excessive overjet (> 9 mm)
Midline shift (> 4 mm)
Note: Refused is not allowed. [OHE_N11 = 1]
If OHE_N12 = 6 (Upper arch full denture) and OHE_N13 = 6 (Lower arch full denture), go to OHE_N23.

OHE_N22
Instruction: Record the current orthodontic treatment status of the respondent.

No orthodontic treatment
Removable appliances
Fixed appliances
Both fixed and removable appliances
Retainer – post completion
Note: Don’t Know and Refused are not allowed. [OHE_N11 = (1, 2, 3)]
If OHE_N22 > 1, go to OHE_N31. If OHE_N12 = 6 (Upper arch full denture) and OHE_N13 = 6 (Lower arch full denture), go to OHE_N51.

OHE_N23
Instruction: Record whether the respondent has received orthodontic treatment in the past.

Yes
No
Note: Don’t Know and Refused are not allowed.
[OHE_N11 = (1, 2, 3) and OHE_N22 = 1]
If OHE_N12 = 6 (Upper arch full denture) and OHE_N13 = 6 (Lower arch full denture), go to OHE_N51.

OHE_N31
Instruction: Record the worst score for each tooth.

Gingivitis:

No inflammation
Mild inflammation
Moderate inflammation
Severe inflammation
Tooth missing

Teeth Recorded:

Tooth 16 (55)

Tooth 12 (52)

Tooth 24 (64)

Tooth 36 (75)

Tooth 32 (72)

Tooth 44 (84)

Note: Teeth numbered in brackets indicate primary (baby) teeth and all other teeth numbers indicate permanent teeth.
Note: Don’t Know and Refused are not allowed. [OHE_N11 = (1, 2)]

OHE_N32
Instruction: Record the worst score for each condition for each sextant (by tooth or pair of teeth).

Debris:

No soft debris or stain
Less than 1/3 of surface covered
1/3 to 2/3 of surface covered
More than 2/3 of surface covered
Teeth missing

Calculus:

No calculus
Less than 1/3 of surface covered
1/3 to 2/3 of surface covered
More than 2/3 of surface covered

Attachment loss: (insert distance in millimetres between 0 and 12)

Probing score: (insert depth in millimetres between 0 and 9)

Teeth Recorded:

Teeth 17 & 16 (55)

Tooth 11 (51)

Teeth 26 & 27 (65)

Teeth 37 & 36 (75)

Tooth 31 (71)

Teeth 46 & 47 (85)

Note: Don’t Know is not allowed, except for Attachment loss and Probing score.
Note: Refused is not allowed, expect for Probing score.

OHE_N41
For baby teeth, display the following list of categories: Instruction: Record the condition of each tooth in the appropriate box.

1. Sound – never decayed or restored

2. Sound – crown sealed, never decayed or otherwise restored

3. Missing – due to orthodontic treatment

4. Missing – due to trauma

5. Missing – due to caries or periodontal disease

6. Unerupted tooth, congenitally missing or unexposed root

7. Decayed severely

8. Decayed – pit and fissure caries

9. Decayed – smooth surface caries

10. Decayed – both smooth surface and pit and fissure caries

12. Filled with amalgam, no other decay

13. Filled with other material (resin, GIC, inlay, crown), no other decay

14. Filled with amalgam and other material (resin, GIC, inlay, crown), no other decay

15. Filled with amalgam, no other decay, but filling is defective and needs replacement

16. Filled with other material (resin, GIC, inlay, crown) but filling is defective and needs replacement

17. Filled with amalgam and other material (resin, GIC, inlay, crown) but filling is defective and needs replacement

20. Fractured due to trauma

21. Other

OHE_N41
For crowns of adult teeth, display the following list of categories: Instruction: Record the condition of each tooth in the appropriate box.

1. Sound – never decayed or restored

2. Sound – crown sealed, never decayed or otherwise restored

3. Missing – due to orthodontic treatment

4. Missing – due to trauma

5. Missing – due to caries or periodontal disease

6. Unerupted tooth, congenitally missing or unexposed root

7. Decayed severely

8. Decayed – pit and fissure caries

9. Decayed – smooth surface caries

10. Decayed – both smooth surface and pit and fissure caries

12. Filled with amalgam, no other decay

13. Filled with other material (resin, GIC, inlay, crown), no other decay

14. Filled with amalgam and other material (resin, GIC, inlay, crown), no other decay

15. Filled with amalgam, no other decay, but filling is defective and needs replacement

16. Filled with other material (resin, GIC, inlay, crown) but filling is defective and needs replacement

17. Filled with amalgam and other material (resin, GIC, inlay, crown) but filling is defective and needs replacement

18. Bridge abutment, special crown or veneer

19. Implant

20. Fractured due to trauma

21. Other

OHE_N41
For roots of adult teeth, display the following list of categories. Data entry for respondents younger than 18 is not possible.
Instruction: Record the condition of each tooth in the appropriate box.

1. Sound – never decayed or restored

3. Missing – due to orthodontic treatment

4. Missing – due to trauma

5. Missing – due to caries or periodontal disease

6. Unerupted tooth, congenitally missing or unexposed root

7. Decayed severely

11. Decayed – smooth surface caries

12. Filled with amalgam, no other decay

13. Filled with other material (resin, GIC, inlay, crown), no other decay

14. Filled with amalgam and other material (resin, GIC, inlay, crown), no other decay

15. Filled with amalgam, no other decay, but filling is defective and needs replacement

16. Filled with other material (resin, GIC, inlay, crown) but filling is defective and needs replacement

17. Filled with amalgam and other material (resin, GIC, inlay, crown) but filling is defective and needs replacement

19. Implant

20. Fractured due to trauma

21. Other

Note: Data are recorded for each tooth whether or not present.

OHE_N42
Instruction: Count and record the number of tooth surfaces with amalgam fillings. (insert measurement between 0 and 95)
Note: Don’t Know, Refused and Empty are not allowed. [OHE_N11 = (1, 2, 3)]

OHE_N43
Instruction: Record the condition of each tooth in the appropriate box.

No evidence of traumatic injury
Unrestored enamel fracture – does not involve dentin
Unrestored enamel fracture – involves dentin
Untreated damage – dark discolouration, swelling, fistula
Restored fracture – full crown
Restored fracture – other restoration
Lingual restoration plus history of root canal treatment
Other

Teeth Recorded :

Teeth 12 & 11

Teeth 21 & 22

Teeth 32 & 31

Teeth 41 & 42
Note: Don’t Know and Refused are not allowed.

OHE_N51
Instruction: Record the prosthetic needs of the upper arch of the respondent.

Mark all that apply.

No prosthetics needed
Fixed bridge
Implant
Denture repair or reline
New partial denture
New full denture
Note: Don’t Know and Refused are not allowed.
All respondents, except those meeting the exclusion criteria at the beginning of the Oral Health Component

OHE_N52
Instruction: Record the prosthetic status of the lower arch of the respondent.

Mark all that apply.

No prosthetics needed
Fixed bridge
Implant
Denture repair or reline
New partial denture
New full denture
Note: Don’t Know and Refused are not allowed.
All respondents, except those meeting the exclusion criteria at the beginning of the Oral Health Component

OHE_N53
Instruction: Record the treatment currently needed by the respondent.

Mark all that apply.

No treatment needed
Prevention
Fillings
Temporomandibular joint disorder (TMD)
Surgery
Periodontics
Esthetics
Endodontics
Orthodontics
Soft tissue
Other – Specify (insert treatment to a maximum of 80 characters)
Note: Don’t Know and Refused are not allowed.
All respondents, except those meeting the exclusion criteria at the beginning of the Oral Health Component

OHE_R60
We have now completed the examination. Thank you for your participation.

If OHE_N53 = 1, go to OHE_N71. If OHE_N53 = 3, go to OHE_N61. If OHE_N53 = 4, go to OHE_N62. If OHE_N53 = 5, go to OHE_N63. If OHE_N53 = 6, go to OHE_N64. If OHE_N53 = 8, go to OHE_N65. If OHE_N53 = 9, go to OHE_N66. If OHE_N53 = 10, go to OHE_N67. If OHE_N53 = 11, go to OHE_N68. Otherwise go to OHE_N71.

OHE_N61
Instruction: Record whether the respondent needs fillings urgently (i.e., within a week).

Yes
No
Note: Don’t Know and Refused are not allowed.
[OHE_N53 = 3]

OHE_N62
Instruction: Record whether the respondent needs treatment for Temporomandibular joint disorder (TMD) urgently (i.e., within a week).

Yes
No
Note: Don’t Know and Refused are not allowed.
[OHE_N53 = 4]

OHE_N63
Instruction: Record whether the respondent needs surgery urgently (i.e., within a week).

Yes
No
Note: Don’t Know and Refused are not allowed.
[OHE_N53 = 5]

OHE_N64
Instruction: Record whether the respondent needs periodontics urgently (i.e., within a week).

Yes
No
Note: Don’t Know and Refused are not allowed.
[OHE_N53 = 6]

OHE_N65
Instruction: Record whether the respondent needs endodontics urgently (i.e., within a week).

Yes
No
Note: Don’t Know and Refused are not allowed.
[OHE_N53 = 8]

OHE_N66
Instruction: Record whether the respondent needs orthodontics urgently (i.e., within a week).

Yes
No
Note: Don’t Know and Refused are not allowed.
[OHE_N53 = 9]

OHE_N67
Instruction: Record whether the respondent needs soft tissue treatment urgently (i.e., within a week).

Yes
No
Note: Don’t Know and Refused are not allowed.
[OHE_N53 = 10]

OHE_N68
Instruction: Record whether the respondent needs other treatment urgently (i.e., within a week).

Yes
No
Note: Don’t Know and Refused are not allowed.
[OHE_N53 = 11]

OHE_N71
Instruction: Was a serious medical condition that requires immediate attention discovered during the dental examination?

Yes
No (Go to OHE_END)
Note: Don’t Know and Refused are not allowed.
All respondents, except those meeting the exclusion criteria at the beginning of the Oral Health Component

OHE_N72
Instruction: Record the serious medical condition discovered during the dental examination.

Oral lesion
Severe acute infection
Other – Specify (insert condition to a maximum of 80 characters)
Note: Don’t Know and Refused are not allowed. All respondents found to have a serious medical condition that requires immediate attention discovered during the dental examination [OHE_N71 = 1]

OHE_END

Lab component

The Lab Component does not require the presence of the respondent but is completed at the mobile clinic during, or soon after, the respondent’s visit. (Mobile clinic/lab components include initial blood and urine splitting, and complete blood count (CBC) processing.) Respondent specimens are sent for further analysis to three reference laboratories specializing in nutritional analysis, environmental contaminant analysis and infectious disease analysis. The National Microbiology Laboratory in Winnipeg is the storage laboratory for the Canadian Health Measures Survey.

Respondents who so request receive a report of their blood and urine tests 8-12 weeks after the clinic visit.

Report of measurements

Once all of the clinic components have been completed, the following additional variables are calculated:

musculoskeletal fitness norms for respondents aged 15 to 69
back fitness norms for respondents aged 15 to 69.

Then a “Report of Measurements” is produced for the respondent.

Instruction: Print the Report of Measurements (sample attached in Appendix V) and associated letters to physicians for urgent conditions (samples attached in Appendix VI) for blood pressure, and oral health.

RM_END

Exit component

To be completed by all respondents.

Exit component introduction (ECI)

ECI_R01
Before you leave, we have a few administrative questions.

[WARNING: “The respondent should speak with the dentist before leaving the clinic.”]
Note: The above text will only appear if an oral health results report has been generated in the report of measurements component, inform the respondent that he must speak to the dentist before leaving the clinic.

ECI_END

Exit consent questions (ECQ)

Data linking

ECQ_R11
We are seeking your permission to combine information collected during the Canadian Health Measures Survey with health information from your [provincial/territorial] ministry of health or cancer/vital statistics registrars. This would include information on past and continuing use of services provided at hospitals, clinics, and doctor’s offices, or other health services provided by the [province/territory], but it does not include personal medical information held by your doctor.

ECQ_R12
Information collected during the Canadian Health Measures Survey will include:

the responses you provided to the interviewer at your home
the results of the physical measures tests that you did today
[the information that will result from your activity monitor, which you will return to Statistics Canada]
[the results of tests to be done in the future on your blood and urine samples, collected today]
[the results of tests to be done in the future on your DNA sample]

ECQ_Q13
The linkage will be done by Statistics Canada, and the results will be used for statistical purposes only.
Do we have your permission?

Yes
No (Go to ECQ_R21)
Don’t Know, Refused (Go to ECQ_R21)

All respondents

ECQ_Q14
Having a [provincial/territorial] health number will assist Statistics Canada in linking the survey data to the [provincial/territorial] health information.
Do you have a(n) [province/territory name] health number?

Yes (Go to ECQ_Q16)
No
Don’t Know, Refused (Go to ECQ_R21)

All respondents

ECQ_Q15
For which [province/territory] is your health number?

10. Newfoundland and Labrador

11. Prince Edward Island

12. Nova Scotia

13. New Brunswick

24. Quebec

35. Ontario

46. Manitoba

47. Saskatchewan

48. Alberta

59. British Columbia

60. Yukon

61. Northwest Territories

62. Nunavut

88. Does not have a [provincial/territorial] health number

Don’t Know, Refused (Go to ECQ_R21)

All respondents

ECQ_Q16
What is your health number?

Instruction: Enter a health number. Do not insert blanks, hyphens or commas between the numbers. (insert respondent Health Number)
All respondents who have a health number

Data sharing

ECQ_R21
Statistics Canada would like to share the information collected during the Canadian Health Measures Survey with Health Canada and the Public Health Agency of Canada. [Your name, address, telephone number and health number / Your name, address and telephone number] will not be shared.

ECQ_Q22
Health Canada and the Public Health Agency of Canada will keep the information confidential, and use it for statistical purposes only.
Do you agree to share the information?

Yes
No
All respondents

ECQ_END

Appendices

Appendix I - Respondent verification form

Welcome

CONFIDENTIAL WHEN COMPLETED

Your participation is important to us. Please check all of the information shown below to ensure it is accurate. If you find mistakes, please tell the Coordinator or write the correct information on this form and return it to the Coordinator

Date (yyyy/mm/dd): 2007/03/14
Identification Number: 23456789
Name: Jane Doe
Date of birth (yyyy/mm/dd): 1958/02/10
Sex: Female
Preferred official language: English
Corrections:
Name:
- First name
- Last name
Date of birth:
Sex:
- Male
- Female
Preferred official language:
- English
- French
For office use only:
- Entered by:
- Verified by:

Appendix II - Consent forms

English assent form for respondents 6 to 13

Assent Form

Confidential when completed

Date (yyyy/mm/dd): 2007/03/14
Identification Number: 23456789
Name: Jane Doe
Age at clinic exam: 4
Gender: Female

The clinic portion of this survey has some tests for you to do. We also want to keep some of your blood and urine for tests that will happen later.
You do not have to do any part of the survey that you do not want to do.
If you want to take part in this survey, write or print your name below.

Name of respondent

Signature of participant
- Date
Name of witness (please print)
Signature of witness
- Date
For office use only:
- Entered by:
- Verified by:

English consent form for parents of respondents 6 to 13

Consent Form

Confidential when completed

Date (yyyy/mm/dd): 2007/03/14
Identification Number: 23456789
Name of participant: John Doe
Age at clinic exam: 10
Gender: Male

I have read and understood the information provided to me in the Information and Consent Booklet for the Canadian Health Measures Survey. By marking the boxes below and signing this form, I am choosing to consent (“Yes”) or not consent (“No”) to the following for [respondent’s first name]:

participating in the physical measure tests, including providing samples of his blood and urine
- Yes
- No
receiving a copy of his Report of Laboratory Tests
- Yes
- No
storage of his blood and urine for use in future health studies
- Yes
- No

I have had time to decide on allowing [respondent’s first name] to participate in the clinic portion of the survey. I understand that even though I have consented to some or all of the items on this form, I can still withdraw [respondent’s first name] from any part of this survey or subsequent studies at any time until he reaches 14 years of age. From that point onwards, [respondent’s first name] can decide to withdraw.

Name of parent/guardian (please print)
Signature of parent/guardian
- Date
Name of witness (please print)
Signature of witness
- Date
For office use only:
- Entered by:
- Verified by:

English consent form for respondents 14 to 19 (with storage)

Consent Form

Confidential when completed

Date (yyyy/mm/dd): 2007/03/14
Identification Number: 23456789
Name: Peter Doe
Age at clinic exam: 15
Gender: Male

participating in the physical measure tests, including providing samples of my blood and urine
- Yes
- No
receiving a copy of my Report of Laboratory Tests
- Yes
- No
allowing Statistics Canada to test my blood for the Hepatitis B and C viruses and to contact me, as well as the appropriate provincial authorities, if the results are positive
- Yes
- No
storage of my blood and urine for use in future health studies
- Yes
- No

I have had time to decide on participating in the clinic portion of the survey. I understand that even though I have consented to some or all of the items on this form, I can still withdraw from any part of this survey or subsequent studies at any time.

Name of respondent
Signature of participant
- Date
Name of witness (please print)
Signature of witness
- Date
For office use only:
- Entered by:
- Verified by:

English consent form for respondents 20+ (with storage)

Consent Form

Confidential when completed

Date (yyyy/mm/dd): 2007/03/14
Identification Number: 23456789
Name: Susan Doe
Age at clinic exam: 22
Gender: Female

participating in the physical measure tests, including providing samples of my blood and urine
- Yes
- No
receiving a copy of my Report of Laboratory Tests
- Yes
- No
allowing Statistics Canada to test my blood for the Hepatitis B and C viruses and to contact me, as well as the appropriate provincial authorities, if the results are positive
- Yes
- No
storage of my blood and urine for use in future health studies
- Yes
- No
storage of my DNA for use in future health studies
- Yes
- No

Name of respondent
Signature of participant
- Date
Name of witness (please print)
Signature of witness
- Date
For office use only:
- Entered by:
- Verified by:

Appendix III ― PAR-Q

PAR-Q & YOU (A questionnaire for people aged 15 to 69)

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active very day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active.

If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor.

Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly: check Yes or No.

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
- Yes
- No
Do you feel pain in your chest when you do physical activity?
- Yes
- No
In the past month, have you had chest pain when you were not doing physical activity?
- Yes
- No
Do you lose your balance because of dizziness or do you ever lose consciousness?
- Yes
- No
Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?
- Yes
- No
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?
- Yes
- No
Do you know any other reason you should not do physical activity?
- Yes
- No

If you answered Yes to one or more questions
Talk with your doctor by phone or in person Before you start becoming physically active or Before you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered Yes.

You may be able to do any activity you want – as long as you start slowly and build up gradually. Or, you may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice.
Find out which community programs are safe and helpful for you.

No to all questions
If you answered No honestly to all PAR-Q questions, you can be reasonably sure that you can:

start becoming much more physically active – begin slowly and build up gradually. This is the safest and easiest way to go.
take part in a fitness appraisal – this is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively. It is also highly recommended that you have your blood pressure evaluated. If your reading is over 144/94, talk with your doctor before you can start becoming much more physically active.

Delay becoming more active:

if you are not feeling well because of a temporary illness such as a cold or a fever – wait until you feel better; or
if you are or may be pregnant – talk to your doctor before you start becoming more active.

Please note:
If your health changes so that you answer Yes to any of the above questions, tell your fitness or health professional. Ask whether you should change your physical activity plan.

Informed use of the PAR-Q:
The Canadian Society for Exercise Physiology, Health Canada, and their agents assume no liability for persons who undertake physical activity, and if in doubt after completing this questionnaire, consult your doctor prior to physical activity.

No changes permitted. You are encourages to photocopy the PAR-Q but only if you use the entire form.

Note:
If the PAR-Q is being given to a person before he or she participates in a physical activity program or a fitness appraisal, this section may be used for legal or administrative purposes. “I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.”

Name
Signature
- Date
Signature of parent
Witness
or Guardian (for participants under the age of majority)

Note:
This physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if your condition changes so that you would answer Yes to any of the seven questions.

Appendix IV- Spirometry predicted norms

The appropriate predicted equation
- 6-7 years = Corey 1976
  - Predicteds
    - For respondents aged 6-7 the ‘Predicteds’ used are from ‘Corey 1976’
    - Ethnic Group for COREY 1976
    - Race adjustment Group
      1. White
      2. Black
      3. Hispanic
      4. Asian
      5. Other
- The appropriate predicted equation
  - 8+ years = Hankinson (NHANES III)
    - Predicteds
      - For respondents 8 years and older, the ‘Predicteds’ used are from ‘Hankinson (NHANES III)
      - Ethnic Group for HANKINSON (NHANES III):
      - Race adjustment Group
        White
        
        Black
        
        Hispanic
        
        Asian
        
        Other
Appendix V - Sample report of measurements

Report of measurements

Section A: Demographic information
- Date of appointment: 2007/03/14
- Name of respondent: John Doe
- Age of respondent at clinic exam: 50
- Gender of respondent: Male
Section B: Blood pressure and heart rate
- Resting Heart Rate: 85 bpm
- Average Systolic Blood Pressure: 145 mmHg
- Average Diastolic Blood Pressure: 112 mmHg
Your blood pressure today is high.YOU SHOULD SEE A DOCTOR WITHIN THE NEXT WEEK TO HAVE YOUR BLOOD PRESSURE RECHECKED.

Section C: Anthropometric measures

Body measurements
- Standing Height:
  - 172 cm
  - 5 ft 8 in
- Sitting Height:
  - 86 cm
  - 2 ft 10 in
- Weight:
  - 104.5 kg
  - 230 lb
- Waist Circumference:
  - 120 cm
  - 47 in
- Hip Circumference:
  - 115 cm
  - 45 in
- Waist-to-Hip Ratio: 1.04
- Sum of five skinfold measurements: Not measured
Composite measures
- Body Mass Index (BMI): 35.32 kg/m²
Your body mass index score classifies you as obese. If you are very obese, you may have a very high risk of developing health problems. For an accurate classification, BMI should be interpreted along with other body composition scores.

Body Composition:
(calculated based on waist circumference, sum of five skinfold measurements, and BMI)

Your body composition falls within a range that is generally associated with considerable health risk. We suggest that you see a doctor or regulated health professional to follow-up on your results.

Section D: Lung function (Spirometry)
- Forced Vital Capacity (FVC):
  - Measured: 3.90 L
  - Predicted: 5.09 L
  - % Predicted: 76.6 %
- Forced Expiratory Volume (FEV₁):
  - Measured: 2.25L
  - Predicted: 3.74L
  - % Predicted: 60.2 %
- FEV₁/FVC:
  - Measured: 0.57
Your lung function score today is outside the normal range for your age and sex. We suggest that you see a doctor or regulated health professional to follow-up on your results.

Section E: Fitness and strength tests

Modified Canadian aerobic fitness test (mCAFT)
- Aerobic Fitness Score: Not calculated
Grip strength
- Total hand grip strength: 77 kg
- Your score for your age and sex is fair.
Sit and reach
- Distance reached: 7.5 cm
- Your score for your age and sex is poor.
Partial curl-ups
- Number of partial curl-ups completed: 0
- Your score for your age and sex is poor.
Composite measures

Musculoskeletal Fitness:
(calculated based on grip strength, sit and reach, and partial curl-ups)

Your musculoskeletal fitness falls within a range that is generally associated with considerable health risk. We suggest that you see a doctor or regulated health professional to follow-up on your results.

Back Fitness:
(calculated based on waist circumference, sit and reach, and partial curl-ups)
Your back fitness falls within a range that is generally associated with considerable back health risk. We suggest that you see a doctor or regulated health professional to follow-up on your results.
Section F: Oral health

During the oral health examination today, the dentist had some concerns about the health of your teeth and/or mouth. You are encouraged to visit a dental professional within a week.
- These measurements were obtained as part of a survey and do not represent a medical diagnosis. The messages regarding these measurements are generic. Your results should be discussed with a doctor or a regulated health professional.
Appendix VI― Sample letters to health care provider

Blood pressure test results report
- Date of appointment: 2007/03/14
- Name: John Doe
- Result of blood pressure test: 145 / 112 mmHg
  Your blood pressure today is high. You should see a doctor within the next week to have your blood pressure rechecked.
  Note: Based on a report by the Canadian Coalition for High Blood Pressure Prevention and Control, 1994
To whom it may concern:

John Doe was recently a participant in the Canadian Health Measures Survey (CHMS) conducted by Statistics Canada. The CHMS is a national survey that collects information about the general health and health behaviours of Canadians. The information gathered through direct measures of health is essential to evaluate the extent of such major health concerns as diabetes, obesity, hypertension and cardiovascular disease. The results from this survey will also provide researchers with important and precise information about health issues that affect all Canadians.

The survey was conducted in two phases: an interview at the household and a visit to a CHMS clinic. At the clinic, fully trained health professionals took direct measures of health such as blood pressure, height, weight, spirometry, blood and urine samples, physical fitness tests and an oral health examination.

At the clinic a CHMS health measures specialist performed blood pressure testing using an automated blood pressure device (BPTru). After five minutes of quiet rest in a screening room, six blood pressure measurements were taken at one minute intervals, and the average of the last five measurements was calculated.

The tests performed as part of the CHMS are not intended to be used for diagnostic purposes. We have recommended that John Doe follow-up on any abnormal test results with a doctor or other regulated health professional.

If you have any questions about the CHMS please contact us, toll-free, at 1-888-253-1087, or visit our website at http://www.statcan.ca.

Sincerely,

CHMS Health Measures Specialist

Oral examination results report
- Date of appointment: 2007/03/14
- Name: John Doe
- Result of oral examination: a severe acute infection
To whom it may concern:

John Doe was recently a participant in the Canadian Health Measures Survey (CHMS) conducted by Statistics Canada. The CHMS is a national survey that collects information about the general health and health behaviours of Canadians. The information gathered through direct measures of health is essential to evaluate the extent of such major health concerns as diabetes, obesity, hypertension and cardiovascular disease. The results from this survey will also provide researchers with important and precise information about health issues that affect all Canadians.

The survey was conducted in two phases: an interview at the household and a visit to a CHMS clinic. At the clinic, fully trained health professionals took direct measures of health such as blood pressure, height, weight, spirometry, blood and urine samples, physical fitness tests and an oral health examination.

At the clinic a CHMS dentist performed an oral examination and noticed a severe acute infection in John Doe ’s mouth. This is a serious medical condition requiring immediate attention from either a dental or a medical professional.

The tests performed as part of the CHMS are not intended to be used for diagnostic purposes. We have recommended that John Doe follow-up on any abnormal test results with a doctor or other regulated health professional.

If you have any questions about the CHMS please contact us, toll-free, at 1-888-253-1087, or visit our website at http://www.statcan.ca.

Sincerely,

CHMS Dentist

Frequently Asked Questions (FAQs)

What is the purpose of the Quarterly Industry Revenue Indices?
What data are produced by QIRI?
How does QIRI determine which industries to survey?
Why are data for only some industries available?
Will more industries be available in future?
What is the North American Industrial Classification System (NAICS)?
What is an index?
Why are the data indexed?
How are quarterly indices annualized?
How reliable are the data?
What are the data sources for QIRI?
What is the difference between simple and complex units?
Why are the data adjusted for seasonality?

What is the purpose of the Quarterly Industry Revenue Indices?
The Quarterly Industry Revenue Indices (QIRI) provide quarterly indexed rates of change in operating revenues for selected industries in business and consumer services in order to track their quarterly economic performance. As there are few sub-annual output measures for the services industries, the QIRI fills this gap for policy makers requiring more timely information to better assess current economic conditions. The need for such an indicator arises from the fact that services-producing industries now account for approximately 70% of Canadian gross domestic product (GDP).

In a paper prepared for Statistics Canada's 2005 Economic Conference, a rationale for sub-annual indicators of service industries was provided based on an examination of pertinent research and reviewing existing sub-annual data sources at Statistics Canada (Fiori, McKeown & Taktek, 2005).¹Despite its dominance in developed economies, the services sector has been less analyzed than the goods-producing sector due to data and measurement limitations. Statistics Canada has relied heavily on employment statistics to measure the output of the services sector, particularly at the sub-annual level. Estimates of monthly GDP for industries representing more than one-third of the economy use employment (a lagging indicator) either exclusively or partly as an indicator for lack of better data. Excluding distributive services (NAICS 41, 44 to 45 and 48 to 49) and non-commercial real estate, finance and insurance services (from NAICS 52 to 53), employment is a principal indicator for the services sector.

Services industries have become important leading indicators of economic changes. In the past decade a series of slowdowns and shocks have affected the Canadian economy, e.g., the bursting of the IT bubble, the 9/11 terrorist attack in 2001, SARS, and the 2008-09 global financial crisis. All these shocks are transmitted rapidly to the whole economy and in particular to the services sector. Policy makers recognize the importance of having a better grasp of the size of the services sector and more timely current indicators, so that they can develop and make adjustments to policy. At the sub-annual level, improved indicators of service industries' output would help to better monitor and assess current economic conditions.

What data are produced by QIRI?
The QIRI provides new sub-annual information to help monitor, on a timely basis, the performance of a subset of service industries. The focus of the program is on the tracking of the current trend of the production activity in these service industries and on the short-term evolution of operating revenue. Therefore the primary output of the program consists of quarter-to-quarter movements. Given this emphasis on movements, and specially the identification of turning points, it was decided to not publish levels (for revenue – the observed variable) at this time, but rather publish an index in current dollars of quarterly revenue movements with a base year of 2007. This simplifies the statistical process significantly and in particular removes the problem of possible confidentiality conflicts while allowing for the reconciliation to annual program levels to be completed at a later date.

How does QIRI determine which industries to survey?
Service Industries Division has the mandate to collect and disseminate estimates on a large portion of Canada's service sector. The issue of what industries to select for sub-annual output indicators involved a variety of considerations:

System of National Accounts needs (GDP improvements, sub-annual data gaps). For example, the SNA identified sub-annual information from NAICS 8111 – Automotive repair and maintenance - as being a high priority for GST development;
GST applicability. Research was also aimed at how the GST applied to goods and services along industrial lines. For example, with the GST, certain products are GST-exempt (exports) while others are zero-rated (basic groceries).
Data coherence and comparability. An important factor to consider in what industries to select was internal data coherence at Statistics Canada and the ability to compare data internationally.

After appropriate consultations, the following industries in the services sector were selected to be included in the QIRI:

*NAICS (North American Industrial Classification System)*
NAICS	Industry
5111	Newspaper, periodical, book and directory publishers
5312	Offices of real estate agents and brokers
5322	Consumer goods rental
5323	General rental centres
5412	Accounting, tax preparation, bookkeeping and payroll services
5413	Architectural, engineering and related services
5414	Specialized design services
5416	Management, scientific and technical consulting services
5418	Advertising, public relations and related services
5613	Employment services
5621	Waste collection
5622	Waste treatment and disposal
5629	Remediation and other waste management services
7131	Amusement parks and arcades
7139	Other amusement and recreation
7211	Traveller accommodation
8111	Automotive repair and maintenance
8112	Electronic and Precision Equipment Repair and Maintenance
8113	Commercial and industrial machinery and equipment repair and maintenance
8121	Personal care services
8122	Funeral services
8123	Dry cleaning and laundry services

Why are data for only some of industries available?
The purpose of QIRI was to provide timely estimates for the service sector of the Canadian economy. In conjunction with Service Industries Division's annual program, QIRI has chosen to release these industries based on several criteria, such as data quality and coherence with the annual program. QIRI is very much an ongoing initiative, and more industries will be released by this program in the future.

Will more industries be available in future?
Yes. QIRI is an ongoing initiative to provide timely estimates of industries in the services sector. As the program evolves over time, data on more industries will be made available.

What is the North American Industrial Classification System (NAICS)?
NAICS is method of classifying businesses that was developed as a partnership between various statistical agencies in Canada, the United States and Mexico. QIRI uses NAICS 2007 as its classification system. More detailed information on NAICS can be found at:
Industry classifications

What is an index?
An index shows the rate of change in a period in relation to a fixed base period. In this case, the four quarters of 2007 are equal to 400 and are used to calculate the change in operating revenue in relation to 2007. This index shows quarterly rates of change by industry.

Why are the data indexed?
QIRI data show changes in operating revenues expressed as indices. Indices are calculated from the aggregate industry revenue data, by 4-digit NAICS and by province, with the average operating revenue for the base year (2007) equal to 100. The use of an index presents a clearer view of the underlying trend and helps identify turning points in the observed industries.

Publishing only indices (as opposed to levels) simplifies the process by eliminating confidentially and dominance concerns and the requirement to benchmark to annual data. Benchmarking is the process by which a sub-annual survey series is made consistent with an annual survey series. Benchmarking is applied to reduce confusion resulting from having two different sets of numbers. It is desirable for estimates from two different surveys to be consistent and coherent, but coherence does not necessarily imply full numerical consistency. Where annual and sub-annual surveys cover the same industries, the former may target detailed measures of levels and the latter, measurement of short-term trends.

Although benchmarking would ideally be applied only to correct for sampling variability, there are conceptual, methodological and operational sources of incoherence between surveys. While conceptual and methodological differences between surveys can be removed, the need for coherence must be balanced with the need for design efficiency. Operational differences are often present for a good reason, including the need to accommodate respondents.

For these reasons, the decision was taken to not benchmark QIRI data to annual data. Instead, a reconciliation process will be undertaken at a later date between the QIRI data and the data from the annual surveys.

How are quarterly indices annualized?
To annualize quarterly indices, add the four quarters of a given year and divide by four. As 2007 is the base year, it should always equal 100, though there may be a small variance due to rounding.

How reliable are the data?
Due to the unique nature of the program, a criterion for data quality evaluation for QIRI had to be designed. Normally a survey program will evaluate the reliability of their data using the coefficients of variation of a particular data point to determine whether the data point is reliable enough to be released. As this program incorporates a census of an entire industry, either through survey or administrative data, a new method of data evaluation was required. The three criteria that determine the quality of the data are the revision rate between revised and preliminary data, the coefficient of variation due to imputation and the response rate to the census survey. A score is determined based on these criteria which are as follows:

A: Excellent
B: Very good
C: Good
D: Acceptable
E: Poor, use with caution.

These data quality indicators appear directly in the data tables available on CANSIM for each data point and can be used by the data user to determine the reliability of the data.

What are the data sources for QIRI?
The QIRI program has two major data components. For simple units (those which operate in only one province and one NAICS), only GST data are used. These tend to be smaller businesses. GST sales revenue is considered a very good proxy for operating revenue. For complex units (those which operate in more than one province and/or in more than one NAICS), a survey is used to collect information from respondents on operating revenue by province. Complex units tend to be larger businesses. Since all in-scope complex enterprises are surveyed, the survey is, in fact, a full census. These data are combined and aggregated and then converted into an index.

What is the difference between simple and complex units?
For the purposes of QIRI a simple unit is one that undertakes only one business activity at the 4-digit NAICS level and conducts this business activity in only one province. A complex unit either undertakes more than one business activity at the 4-digit NAICS and/or operates in more than one province.

Why are the data adjusted for seasonality?
Socio-economic time series can be broken down into five main components: the trend-cycle, seasonality, the trading-day effect, the Easter holiday effect and the irregular component.

The trend represents the long-term change in the series, whereas the cycle represents a smooth, quasi-periodic movement about the trend, showing a succession of growth and decline phases (e.g., the business cycle). These two components—the trend and the cycle—are estimated together, and the trend-cycle reflects the fundamental evolution of the series. The other components reflect short-term transient movements.

The seasonal component represents quarterly fluctuations that recur more or less regularly from one year to the next. Seasonal variations are caused by the direct and indirect effects of the climatic seasons, institutional factors (attributable to social conventions or administrative rules; e.g., Christmas) and technological factors.

Lastly, the irregular component includes all other more or less erratic fluctuations not taken into account in the preceding components. It is a residual that includes errors of measurement on the variable itself as well as unusual events (e.g., strikes, drought, floods, major power blackout or other unexpected events causing variations in respondents' activities).

The seasonal and irregular components conceal the fundamental trend-cycle component of the series. Seasonal adjustment (correction of seasonal variation) removes the seasonal, trading-day and Easter holiday effect components from the series, and it thus helps reveal the trend-cycle. While seasonal adjustment permits a better understanding of the underlying trend-cycle of a series, the seasonally adjusted series still contains an irregular component. Slight quarter-to-quarter variations in the seasonally adjusted series may be simple irregular movements. To get a better idea of the underlying trend, users should examine a few quarters of the seasonally adjusted series.

The QIRI series are seasonally adjusted by 4-digit NAICS and by province. National totals by 4-digit NAICS are also directly seasonally adjusted. Because of the nature of the computations involved, seasonally adjusted provincial and territorial series might not sum up to their seasonally adjusted national total. To correct these discrepancies, a reconciliation (raking) process is applied and the additivity is restored by slightly modifying the provincial/territorial series. Seasonally adjusted series are expressed as an index with the base year (2007) equal to 100. Indexing can hide the additivity of the provincial/territorial series to their national total.

Note:

Jerry Fiori, Larry McKeown & Nathalie Taktek, The growing importance of the service industries: The need for sub-annual indicators, Statistics Canada, Catalogue no. 11F0024MIE2005000, May 2005.

Reporting Guide for the 2009 Radio and Television Annual Return (Short Form)

This Reporting Guide is to assist in the completion of the Annual Return of "Programming Undertaking" License (Form No. 5-5300-377.1)

Survey objective

This survey collects financial and operating data for the statistical measurement and analysis of the Radio and Television Broadcasting industry. These data will be aggregated to produce national and regional estimates of the performance of your industry. Those estimates are used by the regulator and policy departments, the private sector, international organizations, academics, analysts and the general public to better understand this sector's contribution to the Canadian economy. Selected results will be published in Statistics Canada Catalogue numbers 56-207-X and 56-208-X.

Confidentiality statement

This survey is conducted under the authority of the Statistics Act, Revised Statutes of Canada 1985, Chapter S19. Completion of this questionnaire is a legal requirement under this Act. Statistics Canada is prohibited by law from publishing or releasing any statistics which would divulge information obtained from this survey relating to any identifiable business without the previous written consent of that business. The data on this questionnaire will be treated in confidence, used for statistical purposes and published in aggregate form only. The confidentiality provisions of the Statistics Act are not affected by the Access to Information Act or any other legislation. Please note that Statistics Canada does not share any individual responses with the Canada Revenue Agency.

Agreements and regulations

In order to avoid duplication and ease the burden on respondents, Statistics Canada has entered into the following data sharing agreements concerning this Radio and Television Survey:

A. Under section 11 of the Statistics Act with the "Institut de la statistique du Québec" for the sharing of information from this survey for broadcasting undertakings in Quebec. The Quebec Statistics Act includes the authority for the collection of this information and the same provisions for confidentiality and penalties for disclosure of information as the Federal Statistics Act;

B. Under section 12 of the Statistics Act with the Canadian Radio-television and Telecommunications Commission (CRTC) for all broadcasting undertakings in Canada. This information is required by the Commission under the authority of the Broadcasting Act and the regulations and conditions of licence thereunder. Statistics Canada is collecting the information on behalf of the Commission. The Commission will retain a copy of the questionnaire thus satisfying the requirements of the Television Broadcasting Regulations 1987 and Radio Regulations 1986 or conditions of licence for all broadcasters in Canada to provide this type of information to the Commission on or before November 30 of each year for the year ending on the previous August 31; and

C. Under section 12 of the Statistics Act with the Federal Department of Canadian Heritage for all broadcasting undertakings in Canada, the "Ministère de la Culture, des Communications et de la Condition féminine" for broadcasting undertakings in Quebec, and the Ontario Ministry of Economic Development and Trade for broadcasting undertakings in Ontario. The agreements we have with these agencies require that they keep the information confidential and only use it for statistical and research purposes. In the case of the agreements with these three agencies, respondents may object to the sharing of their information by giving notice in writing to the Chief Statistician and returning the letter of objection in a separate envelope addressed to: Chief, Telecommunication and Broadcasting Section, Business Special Surveys and Technology Statistics Division, Statistics Canada, Main Building, 150 Tunney's Pasture Driveway, Room 1506, Ottawa, Canada, K1A 0T6, Telephone: (613) 951-1891, Facsimile: (613) 951-0009, E-Mail: heidi.ertl@statcan.gc.ca

Change of ownership

When a change of ownership has been approved by the CRTC, within 90 days thereof, the former licensee will file with StatisticsCanada a copy of an annual return covering the period of operations from September 1 to the day of transfer. The new licensee will file an annual return from the day of transfer to August 31. In some cases, the new licensee elects to file an annual return for the full broadcast year. In either case, the licensee should indicate on the return, which period they are filing.

Completion of the return

This annual return is to be completed by those persons licensed (i.e.: the "licensee") by the CRTC to operate a non-profit radio or a non-profit television programming undertaking(s) which earned less than $2.0 million in total revenues. These undertakings, hereafter referred to as "television stations", include conventional television stations, licensed rebroadcasting stations and television networks and "radio stations" which include radio stations and networks as set out in the Television Broadcasting Regulations, 1987 and Radio Regulations, 1986.

The reporting period to be covered by this annual return is the broadcasting year which is the 12-month period from September 1, 2008 to August 31, 2009.

Page 2 of this return requests information specific to the licensee and only needs to be completed once regardless of the number of undertakings reporting in the return.

Page 3 of this return requests information specific to the operating results of the licensed undertakings reporting in the return and a separate page 3 must be completed for each undertaking.

CRTC "Alcohol Advertising" form: All licensees must complete this form.

Important: If you are missing any part of this 3 page reporting guide or the 2 page annual return, or if the cover page's listing of undertakings is not consistent with your organizational structure, please contact Statistics Canada immediately at the address listed on page 2 of this guide.

The return is to be typed or legibly written. A postage paid addressed envelope is enclosed for your convenience. If you have any queries regarding this questionnaire, please contact the:
Unit Head
Broadcasting Section,
Business Special Surveys and Technology Statistics Division, Statistics Canada,
100 Tunney's Pasture Driveway, Ottawa, Canada, K1A 0T6
Telephone: (613) 951-0390 Facsimile: (613) 951-9920.
E-mail: dany.gravel@statcan.gc.ca

Financial statements

Subject to (i) and (ii) below, for those completing a paper copy of the questionnaire, please submit three copies of the licensee's audited Financial Statements for the 12-month period ending August 31, 2009 along with the three copies of the annual return:

(i) subject to (ii) below, all licensees of radio and/or television programming undertakings, including networks, must file audited financial statements at the licensee level for the 12 month period ending August 31, 2009 (see the Appendix on page 3 of this guide).

(ii) other than licensees who are public companies, all licensees of radio and/or television programming and network undertakings who do not have a condition of licence related to financial performance and who do not have total advertising revenues of more than $10 million for all of their licensed undertakings combined may, in lieu of audited financial statements, file non-audited financial statements at the licensee level for the 12 month period ending August 31, 2009, (see the Appendix on page 3 of this guide).

CRTC File Number, Call Sign and CRTC Undertaking Number

The CRTC file number, the call sign and CRTC Undertaking number should be entered at the bottom of pages 2 and 3. This information has been pre-printed on the cover of the questionnaire. The CRTC file number is the seven digit number while the CRTC undertaking number is nine digits in length.

Page 3: Financial summary

1. Revenue

Line 1.1 "Local time sales" should include revenue from the sale of air time by local sales representatives, net of advertising agency commissions and trade discounts. The fair market value of bartered contra, sponsorship or any other non-monetary transactions should also be included on this line.

Line 1.2 "National time sales" should include revenue for national advertising, net of any advertising agency commissions and trade discounts. National sales are usually commissionable to the station's national representative.

Line 1.3 "Network payments to station" - For the network, it should include net payments made to the affiliates as a reduction of the revenue. For the affiliates it should include their share of the network net payments, or the reverse as the case may be.

Line 1.4 "Sales/Syndication of programs" should include revenue for syndication of programs and program rights to other broadcasting stations and revenue received from the sale of programs and production services. Do not include revenue from promotional services.

Line 1.5(a) "Corporate grants" should include revenues received from corporations, associations, foundations and/or individuals, either in support of the general broadcasting operation, or in underwriting specific initiatives. Contributors should not have received commercial spot time as a result of making a grant, although they may have been identified in a brief on-air credit recognizing their support. Grants received from sectors of government should not be included here, but reported under Government grants. Grants for which commercial announcements were made as a result of a contribution should not be reported here, but included in Local time sales or National time sales, as the case may be.

Line 1.5(b) "Government grants" should include revenues received from sectors of government (federal, provincial, local or foreign), either in support of the general broadcasting operation, or for specific initiatives. Contributors should not have received commercial spot time as a result of making a grant, although they may have been identified in a brief on-air credit recognizing their support. Grants for which commercial announcements were made as a result of a contribution should not be reported here, but included in Local time sales or National time sales, as the case may be.

Line 1.5(c) "Subsidiary communications" should include revenues received from the sale of broadcast activity such as SCA, SCMO and VBI.

SCA or SCMO is defined as the technique that involves the unused spectrum of the frequency assigned to FM radio stations to be utilized for a variety of services such as the transmittal of background music services to commercial establishments.

VBI (vertical blanking interval) is an integral part of every television signal but does not contain any part of the video picture. VBI can be used for the distribution of a variety of special services such as close captioning for the hearing impaired.

Line 1.5(d) "Other revenue" should include revenue received from the use of talent, services, technical facilities, management fees and other revenue not credited to accounts previously noted.

2. Expenses

Line 2.1 "Programming and production" expenses should include those expenses attributable to acquiring, producing and preparing the station's programs.

Line 2.2 "Technical" expenses should include those expenses attributable to providing and maintaining the technical facilities necessary for the presentation and production of the station's programs.

Line 2.3 "Sales and promotion" expenses should include those expenses attributable to selling, advertising or promotion, directed toward prospective advertisers and audiences on behalf of the station.

Line 2.4 "Administration and general" expenses should include the salaries and wages of the system management, including those engaged in the accounting function.

Line 2.6 "Operating income (loss) - before interest, depreciation and other expenses" is determined by subtracting total expenses, (line 2.5), from total revenue (line 1.6).

Line 2.8 "Interest expense" should include those expenses incurred on the station's obligations including notes, bonds and mortgages.

Line 2.9 "Other expenses" should include any other broadcasting expenses not already allocated.

Line 4 "Salaries and other staff benefits" should include payments for regular hours worked, overtime, vacation and holidays, and commissions paid to staff under the sales and promotion category, the taxable items shown on employees' T4 slip, the cost to the employer of providing retirement pensions to employees, whether or not under the Canada Pension Plan, Quebec Pension Plan or other government pension plans and the cost of providing benefits such as group medical, group life, employment insurance, workers' compensation and other employee benefits. Do not include costs of room and board or any other payments of this type.

Line 5 "Average number of employees" should be the typical weekly average of full and equivalent part-time employees. Where there are part-time employees include them as equivalent full time employees by calculating their work time in proportion to a typical full week's work. Non-Staff commissioned sales representatives should not be included as employees.

Appendix

1. Audited Financial Statements: (to be completed by licensee filing an audited financial statement)

a) Licenses of radio undertakings having total advertising revenues of more than $10 million for all of their licensed radio undertakings combined for the August 31 broadcast year being filed, must file audited financial statements along with the annual return.

b) Licensees of television programming and network undertakings having a condition of licence related to financial performance and having total advertising revenue of more than $10 million for all of their licensed television undertakings combined for the August 31 broadcast year being filed, must file audited financial statements along with their annual return.

2. Non-audited Financial Statements: (to be completed by licensee filing non-audited financial statements)
Although not subject to an audit by the licensee's external auditors, they must nevertheless be prepared in accordance with Generally Accepted Accounting Principles (G.A.A.P.)* and be signed and dated by the licensee as follows:

I, (Name) (Title) am authorized to certify on behalf of (Licensee) that these financial statements have been prepared in accordance with Generally Accepted Accounting Principles (G.A.A.P.) and are true and complete in all respects to the best of my knowledge and belief.

(Signature) (Date)

* Where the financial statements have not been prepared in accordance with G.A.A.P., please indicate the areas involved and how you treated them.

3. Licensees otherwise required to file audited financial statements and whose fiscal year end does not coincide with August 31 may, as an alternative to filing audited statements as at August 31, file non-audited financial statements at the licensee level for the 12 month period ending August 31 on which the licensee's auditor has performed a "Review Engagement" in accordance with section 8200 of the Canadian Institute of Chartered Accountant's handbook (the "C.I.C.A. handbook"). Licensees who elect to provide Review Engagement financial statements must also file, with their annual return, their audited financial statements for the most recently completed fiscal year ending immediately prior to the 31 August of the annual return being filed.

4. Licensees otherwise required to file audited financial statements and whose statements are included in the audited consolidated statements of a Parent company may, where audited statements at the licensee level are not prepared, file financial statements as follows:

a) where the year-end of the Parent is August 31, file non-audited statements at the licensee level and the audited consolidated statements of the Parent both for the 12 month period ending August 31,

b) where the year-end of the Parent is other than August 31, file non-audited financial statements at the licensee level for the 12 month period ending August 31 on which the licensee's auditor has performed a Review Engagement and the audited consolidated financial statements for the Parent company's most recently completed fiscal year ending immediately prior to the August 31 of the annual return being filed.

Form 6

Confidential when completed

Collected under the authority of the Statistics Act, Revised Statutes of Canada, 1985, Chapter S19.

La version française de ce questionnaire est disponible.

The purpose of this annual survey is to collect information on the production and value of greenhouse products, nursery stock, sod produced and Christmas trees in Canada. Your figures are kept strictly confidential and are grouped with others for statistical purposes. The results are publicly released in May and are used by producer associations and governments to assess the economic health of the greenhouse, sod and nursery production industries.

Instructions to greenhouse/nursery/sod operator

This questionnaire is to assist you in answering a telephone survey. Complete this form and keep it by your telephone. An interviewer from Statistics Canada will telephone you between January 11, 2010 and January 31, 2010 for this information. Do not mail this questionnaire. It is for your records.
Please answer all questions that apply to your operation.
Use your records if possible. Otherwise, enter your best estimate.
Thank you for your cooperation.

For your records only, do not mail

Review the information on the label. If any information is incorrect or missing, please make the necessary corrections in the boxes below.

Farm Name (if applicable)

Corporation Name (if applicable)

Surname or Family Name
Usual First Name and Initial
Area Code
Telephone
Rural Route
Box Number
Number and Street Name
Postal Code
Post Office (name of city, town or village where mail is received)
Email Address (if applicable)

Partner's Name (if applicable)
Area Code
Telephone

Partner's Name (if applicable)
Area Code
Telephone

Part I - Type of production

1. Did you grow greenhouse, nursery, sod products or Christmas trees in 2009?

Yes
No (If no, go to comments)

2. Which of the following products did you grow in 2009? (check all that apply)
a. Greenhouse products (vegetables, fruits, flowers and plants) (Go to Part II)
b. Nursery products and Christmas trees (trees and plants) (Go to Part III)
c. Sod (Go to Part IV)

Part II - Greenhouse operations (See explanatory notes)

C. Area and number of months of operation

3. Will you be reporting your greenhouse area in:

Square feet
Square metres

4. What was your total greenhouse area under glass in 2009? See explanatory notes
5. What was your total greenhouse area under rigid plastic or fibreglass in 2009?
6. What was your total greenhouse area under poly-film in 2009?
7. What was your total greenhouse area in 2009?
8. How many months was your greenhouse in operation in 2009?

Greenhouse vegetables and fruits

Did you grow and sell vegetables or fruits in 2009? (exclude vegetable bedding plants)
Yes
No (If no, go to Question 12)

D. Area, production and value of greenhouse vegetables and fruits - 2009

10. Report area and sales of greenhouse vegetables and fruits in 2009 below

Area
Value of sales

f. Total area and gross sales of vegetables and fruits

Greenhouse flowers and plants

12. Did you grow and sell flowers or plants in 2009? (include bedding plants)

Yes
No (If no, go to Section K)

F. Indoor and outdoor potted plants, finished products

13. Did you produce and sell potted plants in 2009?

Yes
No (If no, go to Question 15)

14. y. Total potted plants (indoor and outdoor) produced and sold
z. Total gross sales of finished potted plants

G. Cuttings and tree seedlings

15. Did you produce and sell cuttings or tree seedlings in 2009?

Yes
No (If no, go to Question 17)

Total number of plants

16. f. Total cuttings produced and sold
g. Tree seedlings produced and sold
h. Total gross sales of cuttings and tree seedlings

H. Vegetable and ornamental bedding plants

17. Did you produce and sell bedding plants in 2009? Include plants ready for transplant by the purchaser into gardens, fields, containers and baskets.

Yes
No (If no, go to Question 18)

a. Total number of ornamental bedding plants
a1. Total gross sales of ornamental bedding plants

b. Total number of vegetable bedding plants
b1. Total gross sales of vegetable bedding plants

I. Cut flowers

18. Did you produce and sell cut flowers in 2009? (exclude dried cut flowers)

Yes
No (If no, go to Question 20)

m. Total stems produced and sold
n. Total gross sales of cut flowers

J. Sales for greenhouse flowers and plants only (before sales tax)

20. Please report your total sales of flowers and plants.
a. Sales of flowers and plants produced in your greenhouse (Sum of [codes 276, 179, 274, 275 and 154])
b. Resales of flowers and plants (exclude sales reported in question 20a. Include sales of flowers and plants that your operation imported or purchased from other greenhouses for resale.)
c. Total sales of flowers and plants (20a plus 20b).

K. Plant material purchases (before sales tax)

If you operate both a greenhouse and a nursery and are unable to provide a breakdown of expenditures of plant material or labour separate from your greenhouse and nursery, you will be able to report your values together during the interview.

21. a. What were your total expenses in 2009 on flowers, plants, cuttings, seedlings, seeds or bulbs for growing on?

b. What percentage of your expenditures reported in the previous question were purchases from other greenhouses or nurseries within your province?

22. Did you buy flowers, plants, cuttings, seedlings, seeds or bulbs in 2009 for immediate resale?

Yes
No (If no, go to Question 25)

23. What were your expenses in 2009 on flowers, plants, cuttings, seedlings, seeds and bulbs for immediate resale?

24. Total expenditures on plant material in 2009 (sum of codes 123 and 124)

L. Labour

Please include owners and family workers in the following labour questions

25. How many seasonal workers did your greenhouse employ (less than 8 months) in 2009?

26. How many permanent workers (full-time and part-time) did your greenhouse employ (8 months and more) in 2009?

27. What was your total payroll (including owners' salaries) in 2009?

M. Other greenhouse expenses

28. d. What were your total fuel expenses (natural gas, heating oil, other fuel) in 2009?
29. Electricity (lighting, airflow fans and heating)
30. Other crop expenses (include fertilizer, pesticides, growing mediums; exclude plant material purchases)
31. Other operating expenses (interest, land taxes, insurance, packaging, repairs to farm buildings, machinery, agricultural equipment and vehicles and contract work)
32. Total operating expenses in 2009 (sum of codes 125, 122, 121, 2024, 114 and 112)

Part III - Nursery operations (See explanatory notes)

33. Did you cut and sell Christmas trees that were grown on this operation in 2009?

Yes
No (If no, go to Question 36)

34. Will you report Christmas tree area in:

acres
hectares
arpents

Total area
Cut trees
Dollar value

35. Report your area, production and sales of Christmas trees cut on your operation. (Include naturally established or planted areas, regardless of stage of growth, that are pruned or managed with the use of fertilizer or pesticides.)
Christmas trees producers that did not grow nursery products, go to question 48.

N. Nursery operations

36. Did you produce or sell nursery products in 2009?

Yes
No (If no, go to Question 51)

37. Will you report your nursery area in:

acres
hectares
arpents

38. Please include land owned or rented in the following questions.
a. Field area used for growing nursery stock in 2009
b. Container area used for growing nursery stock in 2009
c. What was your total area used for growing nursery stock in 2009? (sum of codes 603 and 2029)

39. Did your nursery operation use a cold frame or non heated covering tunnels for production?

O. Production and sales of field and container grown nursery stock

40. Report your nursery field and container sales in 2009 (exclude stock sold for resale, unsold inventory, Christmas trees and landscaping activites)

If any plants produced in the nursery operation were not sold in 2009, go to Question 41b.

l. Total gross sales of field and container grown nursery stock

P. Sales of nursery stock (before sales tax)

41. a. What were your total nursery sales for stock started by your firm or purchased for growing on in 2009? (sum of codes 541 and 456)
b. What were your total nursery sales of stock purchased for immediate resale in 2009? (exclude sales from landscaping activities)
c. Total dollar sales of nursery stock in 2009 (sum of codes 217 and 218)

Q. Nursery purchases of plant material (before sales tax)

43. In 2009 did your nursery operation purchase any ornamental or fruit trees, nursery stock, bedding plants, seedlings, cuttings or bulbs?

Yes
No (If no, go to Question 48)

44. a. What were your expenses in 2009 on plant material for growing on?

b. What percentage of your expenditures reported in the previous question were purchases from other greenhouses or nurseries within your province?

45. Did you buy nursery stock for immediate resale in 2009?

Yes
No (If no, go to Question 48)

46. What were your expenses in 2009 on nursery stock for immediate resale?

47. Total expenses on plant material in 2009 (sum of codes 230 and 231)

R. Labour and total operating expenses for nursery operation only

48. Please include owners and family workers in the following labour questions.
a. How many seasonal workers did your nursery operation employ (less than 8 months) in 2009?

b. How many permanent workers (full-time and part-time) did your nursery operation employ (8 months and more) in 2009?

c. What was your total payroll? (including owners' salaries) in 2009?

49. What were your other nursery operating expenses in 2009? (Include fertilizer, pesticides, land taxes, interest, insurance, repairs, fuel and electricity. Exclude plant material purchases and labour costs.)

50. What were your total operating expenses in 2009? (sum of codes 232, 216 and 2057)

Part IV - Sod operations (See explanatory notes)

S. Area and sales of sod

51. Did you grow sod in 2009?

Yes
No (If no, go to Comments)

52. Will you report your area of sod grown in:

acres
hectares
arpents

53. a. What was your total sod area grown in 2009?

b. How much of your total sod area was grown for sale in 2009?

54. What was your gross revenue from sod grown for sale on your operation in 2009?

55. Did you buy sod for immediate resale in 2009?

Yes
No (If no, go to Question 58)

56. a. What were your expenses on sod for immediate resale in 2009? (before sales tax)

b. What percentage of your expenditures reported in the previous question were purchases from other sod farms within your province?

57. What was your gross revenue from sod purchased for immediate resale in 2009? (before sales tax)

T. Labour and total operating expenses for sod operations only

58. Please include owners and family workers in the following labour questions
a. How many seasonal workers did your sod operation employ (less than 8 months) in 2009?

b. How many permanent workers (full-time and part-time) did your sod operation employ (8 months and more) in 2009?

c. What was your total payroll (including owners' salaries) in 2009?

59. What were your other operating expenses for your sod operation in 2009? (Include fertilizer, pesticides, land taxes, interest, insurance, repairs, fuel and electricity. Exclude sod purchases and labour costs.)

60. What were your total operating expenses for your sod operation in 2009? (sum of codes 633, 2060 and 2061)

Agreement to share information

Note to residents of Newfoundland and Labrador, New Brunswick, Ontario, Manitoba, Saskatchewan and British Columbia:

To avoid duplication of enquiry this survey is conducted under a co-operative agreement with the Newfoundland and Labrador Department of Forest Resources and Agri-Food, the New Brunswick Ministry of Agriculture and Rural Development, the Ontario Ministry of Agriculture, Food and Rural Affairs, Manitoba Agriculture, Food and Rural Initiatives, the Saskatchewan Department of Agriculture and the British Columbia Ministry of Agriculture and Fisheries pursuant to Section 12 of the Statistics Act (SC 1985, Chap. S19). Address any comments or questions to the Agriculture Division, Statistics Canada, Ottawa, Ontario, K1A 0T6.

The information collected and shared will be kept confidential and used only for statistical purposes. Any information shared with a provincial ministry of agriculture is released in aggregate form only. The provincial ministry of agriculture must guarantee the confidentiality of all shared data.

Statistics Canada does not provide the respondent's name or address to any provincial ministry of agriculture.

Do you agree to share this information?

To residents of Quebec:

To avoid duplication of enquiry, this survey is conducted under a co-operative agreement to share information in accordance with Section 11 of the Statistics Act, with Statistics Canada and l'Institut de la statistique du Québec.

Comments:

2009 Annual Greenhouse, Sod and Nursery Survey- Explanatory Notes

The purpose of the enclosed questionnaire is to gather information about the greenhouse, sod, nursery and Christmas trees industries in Canada. These explanatory notes are provided to answer any questions you may have while completing this survey. If your operation is involved in “service” related activities such as landscape contracting or laying sod, please exclude the figures related to the non-agricultural portion of your operation from the attached survey.

Part II: Greenhouse operations

Section C- Area and months in operation

Note: The area and plants (including vegetable plugs) covered by cold frames or covering tunnels should not be included in the greenhouse section of the survey. This is not considered to be part of the greenhouse area. A cold frame is not a greenhouse.

Question C4: Report only the area under glass.
Exclude: area surrounding the greenhouse(s), i.e., nursery, retail garden centre, wheat field, etc .
Question C5: Include all other types of enclosed protection used for growing plants, i.e., rigid insulation, mine shafts, barns, shelters. Report poly-film plastic area in C6.
Question C6: Report total area under poly-film or polyethylene. Poly film is a thick, flexible, translucent material that is used to build the greenhouse walls and roof.
Question C8: Exclude months when operator was not actively growing plants i.e., fumigation period.

Section D- Area, Production and Value of Greenhouse Vegetables and Fruit- 2009

Question D10: Report edible product ready to consume.
Exclude: bedding plants, tobacco, ginseng, asparagus or mushrooms.

Multiple crop plantings:
If you produced multiple crop plantings of the same greenhouse vegetable/fruit in the same greenhouse space, report area only once, but report all values ( i.e., if 1000 ft2 were used for the 1st tomato crop that was worth $1,000 and the same area was used for the 2nd tomato crop planting that was worth $1,500 - report 1000 ft2 and $2,500.).

If you produced multiple crop plantings of two or more greenhouse vegetables in the same greenhouse space, use the following format ( i.e., if you use 2000 ft2 to grow tomatoes for your 1st crop and switch to cucumbers half way through the summer [using the same space, 2000 ft2 ], you should report your total area as 4000 ft2 [2000 ft2 for tomatoes and 2000 ft2 for cucumbers]).

Section F- Indoor and Outdoor Potted Plants, Finished Products

Question F14: Please report the number of potted plants you grew and sold from your greenhouse. Please report Canadian production of ornamental finished potted plants only.
Include: hanging pots which refers to any type of hanging basket (plastic, peat moss, wicker, ceramic, etc .)
Exclude: resale merchandise (plants that were bought and resold immediately without much care or maintenance), nursery stock (potted fall mums grown and sold from a nursery or potted shrubs such as Azaleas or Heather), lilies grown in a field and Christmas trees sold in pots

Section G- Cuttings and Tree Seedlings

Question G16: Report your propagating material i.e., greenhouse grown cuttings (rooted or vegetative), tree seedlings (exclude nursery product grown in cold frame or non heated tunnel) and any other cuttings you grew and sold (exclude resale).
Exclude: ornamental and vegetable bedding plants (this material should be reported in section H)

Section H- Ornamental and Vegetable Bedding Plants

Questions H17a, a1, H17b, b1: Report total number of bedding plants sold in cell packs, trays or flats ready for transplant into gardens, fields, containers, baskets, pots or larger cell packs by the purchaser (exclude resale).

Section I-Cut Flowers

Exclude: resale, dried cut flowers and cut flowers grown and cut from the field

Section J- Sales of Greenhouse Flowers and Plants

Question J20C: Report all sales of flowers and plants that were either, produced and sold by your operation, or imported or bought within Canada and resold immediately and revenue from “renting out” plants in sales to other channels
Exclude: non-plant material such as garden centre products ( i.e., fertilizer, peat moss, vermiculite, soil, seeds, etc .)

Section K- Plant Material Purchases

* If you operate both a greenhouse and a nursery and are unable to provide a breakdown of expenditures of plant material or labour separate from your greenhouse and nursery, you will be able to report your values together during the interview.

Question K21a: Report purchases for growing on (starting a plant/seedling in your greenhouse by caring and maintaining for it by seeding, transplanting, fertilizing, etc . until it becomes a sellable product).
Exclude: flowers, plants, cuttings, seedlings, seeds, and bulbs purchased for resale (refer to question K23 for definition)
Question K21b: Only the percentage of expenditures on plant material used for growing on purchased from other greenhouses, nurseries, wholesalers or other channels from within your province should be reported in this question.

Question K23: Report purchases for resale (buying and selling a plant within a short time period with minimal maintenance).

Section L- Labour

Questions L25 and L26: Only employees involved in the growing, maintaining and harvesting of greenhouse vegetables, fruits and plants should be reported here.
Include: the labour of the owner and family help
Exclude: all labour used for retailing, clerical help and contract work ( i.e., truck driver, landscaper)
Question L27: If you operate both a greenhouse and a nursery, please provide the labour, wages and benefits for the greenhouse portion only in this section.
Include: paid benefits such as medical insurance, workers compensation, employment insurance, and pension plans
Exclude: wages and benefits paid to employees involved in retail, clerical help and contract work ( i.e., truck driver, landscaper)

Section M- Other Greenhouse Expenses

Question M30: What were your crop expenses on fertilizer, pesticides and growing mediums such as soil, peat moss, vermiculite, perlite, sand, styrofoam and sawdust?
Question M32: Report total operating expenses here (sum of codes 125, 122, 121, 2024, 114 and 112).

Part III: Nursery operations

Please exclude from this portion of the questionnaire figures relating to the greenhouse portion (if applicable) of your operation (see Part II: Greenhouse notes).

Question 35: For Christmas Trees, report naturally established or planted areas, regardless of stage of growth, that are pruned or managed with the use of fertilizer or pesticides.

Section N- Nursery Area

Question N38: Only land used for growing or maintaining nursery stock during 2009 should be included. Report nursery container area (any plant sold in a container from your nursery) in code 2029 and field area in code 603.

Question N39: The area and plants (including vegetable plugs) covered by cold frames or covering tunnels should be reported in the nursery section of the survey. This is not considered to be part of the greenhouse area.

Section O- Production and Sales of Field and Container grown Nursery Stock

Nursery Stock Field Value-2009
Question O40: Please report any field-grown trees, shrubs, vines, perennials, small fruit trees and any other field-grown nursery stock produced and sold.
Include: all balled and burlapped, bare root and field potted stock
Exclude: resale, container-grown nursery stock, Christmas trees (without the root system intact), greenhouse production, unsold inventory, value received for landscaping services

Container
Include: all container sizes (less than 1 gallon, 1 gallon, 2 gallon and/or greater than 2 gallon)

Section P- 2009 Dollar Sales of Nursery Stock (before sales tax)

Question P41a: Growing on- starting a plant/seedling on your nursery operation by caring and maintaining through seeding, transplanting, fertilizing, etc . until it becomes a sellable product
Question P41b: Resale- the process of buying a tree, shrub, plant, seed, seedling, cutting, etc . and selling it within a short time period with minimal care or maintenance
Question P41c: Report total sales of nursery stock in 2009 here (codes 217 plus 218 equals 219)

Section Q- Nursery Plant Purchases

Question Q44: Enter the dollar value of stock purchased specifically for growing on.

Question Q46: Enter the dollar value of stock purchased specifically for immediate resale and not for cultivation purposes.

Section R and T Labour (Nursery and Sod Operations)

Questions R48a, R48b, T58a and T58b: Permanent and Seasonal workers

Include: the number of workers in your operation involved in growing, maintaining and harvesting nursery stock and/or sod.
Exclude: labour for retail services (sales clerks in garden centres, labour for contract work, laying sod, landscaping or installing shrubs at client’s homes).

Question R48c and T58c: Total Payroll

Include: benefits such as medical insurance, worker’s compensation, employment insurance, pension plans as well as owners, management and family members’ salaries.
Exclude: wages for retail or contract work not related to the nursery and/or sod operation

Part IV: Sod Operations

Section S- Sod

Question S54: Report all revenue from all sod grown for sale
Question S56a: Report all sod purchased specifically for immediate resale and not cultivated by your firm.

Form 6

Confidential when completed

Collected under the authority of the Statistics Act, Revised Statutes of Canada, 1985, Chapter S19.

La version française de ce questionnaire est disponible.

Instructions to greenhouse/nursery/sod operator

1. This questionnaire is to assist you in answering a telephone survey. Complete this form and keep it by your telephone. An interviewer from Statistics Canada will telephone you between January 11, 2010 and January 31, 2010 for this information. Do not mail this questionnaire. It is for your records.
2. Please answer all questions that apply to your operation.
3. Use your records if possible. Otherwise, enter your best estimate.
4. Thank you for your cooperation.
For your records only, do not mail

Review the information on the label. If any information is incorrect or missing, please make the necessary corrections in the boxes below.

Farm Name (if applicable)

Corporation Name (if applicable)

Surname or Family Name
Usual First Name and Initial
Area Code
Telephone
Rural Route
Box Number
Number and Street Name
Postal Code
Post Office (name of city, town or village where mail is received)
Email Address (if applicable)

Partner's Name (if applicable)
Area Code
Telephone

Partner's Name (if applicable)
Area Code
Telephone

Part I - Type of production

1. Did you grow greenhouse, nursery, sod products or Christmas trees in 2009?

Yes
No (If no, go to comments)

Part II - Greenhouse operations (See explanatory notes)

C. Area and number of months of operation

3. Will you be reporting your greenhouse area in:

Square feet
Square metres

4. What was your total greenhouse area under glass in 2009?
5. What was your total greenhouse area under rigid plastic or fibreglass in 2009?
6. What was your total greenhouse area under poly-film in 2009?
7. What was your total greenhouse area in 2009?
8. How many months was your greenhouse in operation in 2009?

Greenhouse vegetables and fruits

9. Did you grow and sell vegetables or fruits in 2009? (exclude vegetable bedding plants)

Yes
No (If no, go to Question 12)

D. Area, production and value of greenhouse vegetables and fruits - 2009

10. Report area, production and sales of greenhouse vegetables and fruits in 2009 in the table below

Will you be reporting production in:

kilograms
pounds
dozen
heads

	Area	Production	Value of sales
a. Greenhouse tomatoes
b. Greenhouse cucumbers
c. Greenhouse peppers
d. Greenhouse lettuce
e. Other greenhouse vegetables or fruits (please specify)
f. Total area and gross sales of vegetables and fruits

E. Sales of greenhouse vegetables and fruits (before sales tax)

11. Report your total sales (Code 190) according to the manner in which they were sold.
Will you be reporting sales in:

dollar value
percentage

a. Sales to domestic wholesalers
b. Sales to mass market chain stores
c. Sales to other greenhouses
d. Exported sales made directly by your firm
e. Sales to the public from your greenhouse, roadside stand or other outlets
f. Sales to other channels
g. Total vegetable and fruit sales (code 1016 = 190)

Greenhouse flowers and plants

12. Did you grow and sell flowers or plants in 2009? (include bedding plants)

Yes
No (If no, go to Section K)

F. Indoor and outdoor potted plants, finished products

13. Did you produce and sell potted plants in 2009?

Yes
No (If no, go to Question 15)

Total number of pots and total gross sales of finished potted plants dollar value

14. Indoor potted plants
a. Azaleas
b. Lilies
c. Poinsettias
d. African Violets
e. Tropical Foliage and green plants (include ferns, exclude hanging pots)
f. Gerberas
g. Miniature Roses
h. Orchids
i. Kalanchoe
j. Chrysanthemums (potted mums)
k. Primula
l. Cyclamen
n. Indoor Hanging Pots
o. Other indoor plants

Outdoor potted plants
p. Begonias
q. Chrysanthemums (garden)
r. Geraniums (in pots only)
s. Impatiens
t. Petunias
u. Herbaceous Perennials
v. Argyranthemum
w. Outdoor Hanging Pots
x. Other outdoor plants in pots
y. Total potted plants (indoor and outdoor) produced and sold
z. Total gross sales of finished potted plants

G. Cuttings and tree seedlings

15. Did you produce and sell cuttings or tree seedlings in 2009?

Yes
No (If no, go to Question 17)

Total number of plants dollar value

16. a. Chrysanthemums
b. Poinsettias
c. Geraniums
d. Impatiens (only double and New Guinea)
e. Other cuttings
f. Total cuttings produced and sold
g. Tree seedlings produced and sold
h. Total number of plants and total gross sales of cuttings and tree seedlings dollar value

H. Vegetable and ornamental bedding plants

17. Did you produce and sell bedding plants in 2009? Include plants ready for transplant by the purchaser into gardens, fields, containers and baskets.

Yes
No (If no, go to Question 18)

Total number of plants dollar value

a. Total number of ornamental bedding plants
a1. Total gross sales of ornamental bedding plants

b. Total number of vegetable bedding plants
b1. Total gross sales of vegetable bedding plants

I. Cut flowers

18. Did you produce and sell cut flowers in 2009? (exclude dried cut flowers)

Yes
No (If no, go to Question 20)

Total number of stems and total gross sales of cut flowers dollar value

19. a. Alstroemeria
b. Chrysanthemums (Standard and sprays)
c. Daffodils
d. Freesia
e. Gerbera
f. Iris
g. Lilies
h. Roses
i. Snapdragons
j. Tulips
k. Lisianthus
l. Other cut flowers
m. Total stems produced and sold
n. Total gross sales of cut flowers

J. Distribution of sales for greenhouse flowers and plants only (before sales tax)

Sales dollar value

Report your total sales (code 137), according to the manner in which they were sold dollar value or percentage of sales

Will you be reporting sales in:

dollar value
percentage

Sales to retail florists ( e.g. , flower shops, garden centres)
Sales to domestic wholesalers (including Dutch Auction Clock System)
Sales to mass market chain stores
Sales to other greenhouses
Exported sales made directly by your firm
Sales made directly to the public from your greenhouse or road side stands
Sales to government and other public institutions ( e.g. , municipalities, school boards or provinces)
Sales to other channels

K. Plant material purchases (before sales tax)

21. a. What were your total expenses in 2009 on flowers, plants, cuttings, seedlings, seeds or bulbs for growing on?

b. What percentage of your expenditures reported in the previous question were purchases from other greenhouses or nurseries within your province?

22. Did you buy flowers, plants, cuttings, seedlings, seeds or bulbs in 2009 for immediate resale?

Yes
No (If no, go to Question 25)

23. What were your expenses in 2008 on flowers, plants, cuttings, seedlings, seeds and bulbs for immediate resale?

24. Total expenditures on plant material in 2009 (sum of codes 123 and 124)

L. Labour

Please include owners and family workers in the following labour questions

25. How many seasonal workers did your greenhouse employ ( less than 8 months) in 2009?

26. How many permanent workers (full-time and part-time) did your greenhouse employ (8 months and more) in 2009?

27. What was your total payroll (including owners' salaries) in 2009?

M. Other greenhouse expenses

28. Fuel expenses
a. Natural Gas
b. Heating oil
c. Other types of heating fuel ( i.e. coal, wood chips) (specify)
d. Total fuel expenses in 2009 (sum of codes 115, 116 and 117)
29. Electricity (lighting, airflow fans and heating)
30. Other crop expenses (include fertilizer, pesticides, growing mediums; exclude plant material purchases)
31. Other operating expenses (interest, land taxes, insurance, packaging, repairs to farm buildings, machinery, agricultural equipment and vehicles and contract work)
32. Total operating expenses in 2009 (sum of codes 125, 122, 121, 2024, 114 and 112)

Part III - Nursery operations (See explanatory notes)

33. Did you cut and sell Christmas trees that were grown on this operation in 2009?

Yes
No (If no, go to Question 36)

34. Will you report Christmas tree area in:

acres
hectares
arpents

Total area
Number of cut trees
Dollar value

N. Nursery operations

36. Did you grow or sell nursery products in 2009?

Yes
No (If no, go to Question 51)

37. Will you report your nursery area in:

acres
hectares
arpents

39. Did your nursery operation use a cold frame or non heated covering tunnels for production?

O. Production and sales of field and container grown nursery stock

40. Report your nursery field and container production and sales in 2009 (exclude stock sold for resale, unsold inventory, Christmas trees and landscaping activites)

Field Grown Number of plants
Container Grown Number of plants

If any plants produced in the nursery operation were not 2009, go to Question 41b.
a. Trees - Conifer
b. Trees - Fruit
c. Trees - Shade/Ornamental
d. Shrubs - Evergreen, Conifer
e. Shrubs - Evergreen, Broadleaf
f. Shrubs - Deciduous (include Roses)
g. Vines
h. Perennials, Annuals
i. Small fruit bushes (e.g., raspberry bush)
j. Tree Seedlings
k. Other
l. Total gross sales of field and container grown nursery stock

P. Sales of nursery stock (before sales tax)

Sales

41. a. What were your total nursery sales for stock started by your firm or purchased for growing on in 2009? (sum of codes 541 and 456)

b. What were your total nursery sales of stock purchased for immediate resale in 2009? (exclude sales from landscaping activities)

c. Total dollar sales of nursery stock in 2009 (sum of codes 217 and 218)

42. Report your total sales (code 219) according to the manner in which they were sold.

Will you be reporting sales in:

dollar value
percentage

a. Direct sales to the public
b. Fruit stock sold to fruit growers
c. Nursery stock sold to landscape contractors
d. Nursery stock sold to garden centres
e. Nursery stock sold to mass merchandisers (chain stores)
f. Nursery stock sold to other growers
g. Exported sales made directly by your firm
h. Sales to public agencies (municipalities, school boards, provinces)
i. Sales to other channels ( e.g. forestry firms)

Q. Nursery purchases of plant material (before sales tax)

43. in 2009 did your nursery operation purchase any ornamental or fruit trees, nursery stock, bedding plants, seedlings, cuttings or bulbs?

Yes
No (If no, go to Question 48)

44. a. What were your expenses in 2009 on plant material for growing on?

b. What percentage of your expenditures reported 3 in the previous question were purchases from other greenhouses or nurseries within your province?

45. Did you buy nursery stock for immediate resale in 2009?

Yes
No (If no, go to Question 48)

46. What were your expenses in 2009 on nursery stock for immediate resale?

47. Total expenses on plant material in 2009 (sum of codes 230 and 231)

R. Labour and total operating expenses for nursery operation only

48. Please include owners and family workers in the following labour questions.
a. How many seasonal workers did your nursery operation employ (less than 8 months) in 2009?

b. How many permanent workers (full-time and part-time) did your nursery operation employ (8 months or more) in 2009?

c. What was your total payroll? (including owners' salaries) in 2009?

49. What were your other nursery operating expenses in 2009?(Include fertilizer, pesticides, land taxes, interest, insurance, repairs, fuel and electricity. Exclude plant material purchases and labour costs.)

50. What were your total operating expenses in 2009? (sum of codes 232, 216 and 2057)

Part IV - sod operations (See explanatory notes)

S. Area and sales of sod

51. Did you grow sod in 2009?

Yes
No (If no, go to Comments)

52. Will you report your area of sod grown in:

acres
hectares
arpents

53. a. What was your total sod area

b. How much of your total sod area was grown for sale in 2009?

54. What was your gross revenue from sod grown for sale on your operation in 2009?

55. Did you buy sod for immediate resale in 2009?

Yes
No (If no, go to Question 58)

56. a. What were your expenses on sod for immediate resale in 2009? (before sales tax)

b. What percentage of your expenditures reported in the previous question were purchases from other sod farms within your province?

57. What was your gross revenue from sod purchased for immediate resale in 2009? (before sales tax)

T. Labour and total operating expenses for sod operations only

58. Please include owners and family workers in the following labour questions

a. How many seasonal workers did your sod operation employ (less than 8 months) in 2009?

b. How many permanent workers (full-time and part-time) did your sod operation employ (8 months and more) in 2009?

c. What was your total payroll (including owners' salaries) in 2009?

60. What were your total operating expenses for your sod operation in 2009? (sum of codes 633, 2060 and 2061)

Agreement to share information

Note to residents of Newfoundland and Labrador, New Brunswick, Ontario, Manitoba, Saskatchewan and British Columbia:

To avoid duplication of enquiry this survey is conducted under a co-operative agreement with the Newfoundland and Labrador Department of Forest Resources and Agri-Food, the New Brunswick Ministry of Agriculture and Rural Development, the Ontario Ministry of Agriculture, Food and Rural Affairs, Manitoba Agriculture, Food and Rural Initiatives, the Saskatchewan Department of Agriculture and the British Columbia Ministry of Agriculture and Fisheries pursuant to Section 12 of the Statistics Act (SC 1985, Chap. S19). Address any comments or questions to the Agriculture Division, Statistics Canada, Ottawa, Ontario, K1A 0T6.

Statistics Canada does not provide the respondent's name or address to any provincial ministry of agriculture.

Do you agree to share this information?

To residents of Quebec:
To avoid duplication of enquiry, this survey is conducted under a co-operative agreement to share information in accordance with Section 11 of the Statistics Act, with Statistics Canada and l'Institut de la statistique du Québec.

Comments:

2009 Annual Greenhouse, Sod And Nursery Survey - Explanatory Notes

The purpose of the enclosed questionnaire is to gather information about the greenhouse, sod, nursery and Christmas trees industries in Canada. These explanatory notes are provided to answer any questions you may have while completing this survey. If your operation is involved in "service" related activities such as landscape contracting or laying sod, please exclude the figures related to the non-agricultural portion of your operation from the attached survey.

Part II: Greenhouse operations

Section C- Area and months in operation

Note The area and plants (including vegetable plugs) covered by cold frames or covering tunnels should not be included in the greenhouse section of the survey. This is not considered to be part of the greenhouse area. A cold frame is not a greenhouse.

Question C4: Report only the area under glass.
Exclude: area surrounding the greenhouse(s), i.e. nursery, retail garden centre, wheat field, etc .
Question C5: Include all other types of enclosed protection used for growing plants, i.e. rigid insulation, mine shafts, barns, shelters. Report poly-film plastic area in C6.
Question C6: Report total area under poly-film or polyethylene. Poly film is a thick, flexible, translucent material that is used to build the greenhouse walls and roof.
Question C8: Exclude months when operator was not actively growing plants i.e. fumigation period.

Section D- Area, Production and Value of Greenhouse Vegetables and Fruit - 2009
Question D10: Report edible product ready to consume.
Exclude: bedding plants, tobacco, ginseng, asparagus or mushrooms.

Multiple crop plantings:
If you produced multiple crop plantings of the same greenhouse vegetable/fruit in the same greenhouse space, report area only once, but report all production and value ( i.e. if 1000 ft² were used for the 1st tomato crop planting producing 2000 lbs and the same area was used for the 2nd tomato crop planting producing 1500 lbs -report 1000 ft² and 3500 lbs .).

If you produced multiple crop plantings of two or more greenhouse vegetables in the same greenhouse space, use the following format ( i.e. if you use 2000 ft² to grow tomatoes for your 1st crop and switch to cucumbers ½ way through the summer [using the same space, 2000 ft²], you should report your total area as 4000 ft² [2000 ft² for tomatoes and 2000 ft² for cucumbers]).

Please report other greenhouse vegetables and fruit (not listed in questions 10a-d) in 10e.

Section E- Sales of Greenhouse Vegetables and Fruit
Question E11: Please report which avenues you sold your vegetables and fruit through, be it wholesalers, mass market chain stores, through the export market, to the public, etc .

Section F- Indoor and Outdoor Potted Plants, Finished Products
Question F14: Please report the number of potted plants you grew and sold from your greenhouse. Please report Canadian production of ornamental finished potted plants only.
For the purpose of this survey, the term "hanging pots" refers to any type of hanging basket (plastic, peat moss, wicker, ceramic, etc .)
Exclude: resale merchandise (plants that were bought and resold immediately without much care or maintenance), nursery stock (potted fall mums grown and sold from a nursery or potted shrubs such as Azaleas or Heather), lilies grown in a field and Christmas trees sold in pots

Section G- Cuttings and Tree Seedlings
Question G16: Report your propagating material i.e. greenhouse grown cuttings (rooted or vegetative), tree seedlings (exclude nursery product grown in cold frame or non heated tunnel) and any other cuttings you grew and sold (exclude resale).
Exclude: ornamental and vegetable bedding plants (this material should be reported in section H)

Section H- Ornamental and Vegetable Bedding Plants
Questions H17a, a1, H17b, b1: Report total number of bedding plants sold in cell packs, trays or flats ready for transplant into gardens, fields, containers, baskets, pots or larger cell packs by the purchaser (exclude resale).

Section I-Cut Flowers
Exclude: resale, dried cut flowers and cut flowers grown and cut from the field

Section J- Sales of Greenhouse Flowers and Plants
Question J20C: Report all sales of flowers and plants that were either, produced and sold by your operation, or imported or bought within Canada and resold immediately and revenue from "renting out" plants in sales to other channels
Exclude: non-plant material such as garden centre products ( i.e. fertilizer, peat moss, vermiculite, soil, seeds, etc .)

Section K- Plant Material Purchases

*If you operate both a greenhouse and a nursery and are unable to provide a breakdown of expenditures of plant material or labour separate from your greenhouse and nursery, you will be able to report your values together during the interview.

Question K21a: Report purchases for growing on (starting a plant/seedling in your greenhouse by caring and maintaining for it by seeding, transplanting, fertilizing, etc . until it becomes a sellable product).
Exclude: flowers, plants, cuttings, seedlings, seeds, and bulbs purchased for resale (refer to question K23 for definition)
Question K21b: Only the percentage of expenditures on plant material used for growing on purchased from other greenhouses, nurseries, wholesalers or other channels from within your province should be reported in this question.

Question K23: Report purchases for resale (buying and selling a plant within a short time period with minimal maintenance).

Section L- Labour
Questions L25 and L26: Only employees involved in the growing, maintaining and harvesting of greenhouse vegetables, fruits and plants should be reported here.
Include: the labour of the owner and family help
Exclude: all labour used for retailing, clerical help and contract work ( i.e. truck driver, landscaper)
Question L27: If you operate both a greenhouse and a nursery, please provide the labour, wages and benefits for the greenhouse portion only in this section.
Include: paid benefits such as medical insurance, workers compensation, employment insurance, and pension plans
Exclude: wages and benefits paid to employees involved in retail, clerical help and contract work ( i.e. truck driver, landscaper)

Section M- Other Greenhouse Expenses
Question M28: Please specify whether you used natural gas, heating oil or another type of fuel, such as wood or coal. Please write in the name of the other fuel you used. Please report your total fuel expense under code 121*
Question M30: What were your crop expenses on fertilizer, pesticides and growing mediums such as soil, peat moss, vermiculite, perlite, sand, styrofoam and sawdust?
Question M32: Report total operating expenses here (sum of codes 125, 122, 121, 2024, 114 and 112).

*Note- The total of 115, 116 and 117 should equal code 121

Part III: Nursery operations

Please exclude from this portion of the questionnaire figures relating to the greenhouse portion (if applicable) of your operation (see Part II: Greenhouse notes).

Question 35:For Christmas Trees, report naturally established or planted areas, regardless of stage of growth, that are pruned or managed with the use of fertilizer or pesticides.

Section N- Nursery Area
Question N38: Only land used for growing or maintaining nursery stock during 2009 should be included. Report nursery container area (any plant sold in a container from your nursery) in code 2029 and field area in code 603.
Question N39: The area and plants (including vegetable plugs) covered by cold frames or covering tunnels should be reported in the nursery section of the survey. This is not considered to be part of the greenhouse area.

Section O- Production and Sales of Field and Container grown Nursery Stock

Nursery Stock Field Value-2009
Question O40: Please report any field-grown trees, shrubs, vines, perennials, small fruit trees and any other field-grown nursery stock produced and sold.
Include: all balled and burlapped, bare root and field potted stock
Exclude: resale, container-grown nursery stock, Christmas trees (without the root system intact), greenhouse production, unsold inventory, value received for landscaping services

Container
Include: all container sizes (less than 1 gallon, 1 gallon, 2 gallon and/or greater than 2 gallon)

Section P- 2009 Dollar Sales of Nursery Stock (before sales tax)
Question P41a: Growing on- starting a plant/seedling on your nursery operation by caring and maintaining through seeding, transplanting, fertilizing, etc . until it becomes a sellable product (codes 541 + 456 = 217)
Question P41b: Resale- the process of buying a tree, shrub, plant, seed, seedling, cutting, etc . and selling it within a short time period with minimal care or maintenance
Question P41c: Report total sales of nursery stock in 2009 here (codes 217 + 218 = 219*)
Question P42i: Include revenue from rentals, sales to brokers and forestry firms

Section Q- Nursery Plant Purchases
Question Q44: Enter the dollar value of stock purchased specifically for growing on.
Question Q46: Enter the dollar value of stock purchased specifically for immediate resale and not for cultivation purposes.

Section R and T Labour (Nursery and Sod Operations)
Questions R48a, R48b, T58a and T58b: Permanent and Seasonal workers
Include: the number of workers in your operation involved in growing, maintaining and harvesting nursery stock and/or sod.
Exclude: labour for retail services (sales clerks in garden centres, labour for contract work, laying sod, landscaping or installing shrubs at client’s homes).

Question R48c and T58c: Total Payroll
Include: benefits such as medical insurance, worker's compensation, employment insurance, pension plans as well as owners, management and family members' salaries.
Exclude: wages for retail or contract work not related to the nursery and/or sod operation

Part IV: Sod Operations

Section S- Sod
Question S54: Report all revenue from all sod grown for sale
Question S56a: Report all sod purchased specifically for immediate resale and not cultivated by your firm.

2009 Annual Return of "Broadcasting Distribution" Licensee

For the fiscal period ended August 31, 2009

Confidential when completed

Collected under the authority of the Statistics Act, Revised Statutes of Canada, 1985, Chapter S19.

Keep one copy of this return for your files and mail 3 completed copies (including financial statements) by November 30, 2009 to:

Chief, Industry Statistics and Analysis, Broadcast Analysis, Canadian Radio-television and Telecommunications Commission (CRTC), Ottawa, K1A 0N2.

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

See page 1, Reporting Guide for notice of agreements made by Statistics Canada under Sections 11 and 12 of the Statistics Act with other federal and provincial government bodies concerning information contained in the Annual Return.

Si vous préférez un questionnaire en français, veuillez cocher

Upon receipt of this annual return, please review the systems listed below. If the list is different from your organizational structure. please contact the Chief, Broadcasting Section, Business Special Surveys and Technology Statistics Division, Statistics Canada, Ottawa, Telephone: (613) 951-1891; Fax: (613) 951-0009.

STC
CRTC FILE
ATTN:
System Number
Location
Prov.
CRTC ID
Additional CRTC Forms

in co-operation with the Canadian Radio-television and Telecommunications Commission

SECTION 1 LICENSEE (COMPANY) INFORMATION

Enquiries concerning this return may be referred to Dany Gravel, Business Special Surveys and Technology Statistics Division, Statistics Canada, Ottawa, Telephone: (613) 951-0390; Fax: (613) 951-9920; E-mail: dany.gravel@statcan.gc.ca

Complete name of licensee:
Mailing address of the licensee:
Street and Number
City and Province
Postal Code
Telephone
Fax
E-mail
Person to be contacted in connection with this return:
Mr. Mrs. Miss Ms.
Name
Title
Address (if different from licensee address)
Street and Number
City and Province
Postal Code
Telephone
Fax
E-mail
If, during the period covered by this return, the licensee conducted business under a name or address other than that listed in 1 or 2, please indicate:
Name
Street and Number
City and Province
Postal Code
If the information in this return is for a period other than 12 months ending August 31, 2009, please indicate:
From To
Reasons:
If any undertaking(s) reported in this return was acquired or sold during the reference year ending August 31, 2009, please indicate the undertaking(s) and the name(s) of the previous owner(s)/purchaser(s):
Date(s) of transaction(s):
Type of business organization:
Incorporated company, shares publicly traded
Sole proprietorship/partnership
Co-operative
Incorporated company, shares NOT publicly traded
Non-profit organization
Military Unit
Other (specify)
MANAGEMENT CERTIFICATION
I, (Name) (Title), am authorized to certify on behalf of (Licensee) that the information shown on this return and all the attachments thereto are true and complete in all respects to the best of my knowledge and belief.
(Signature) (Date) (Telephone and Area Code)
Date received
(Official use only)
CRTC File Number
STC File Number

INTERNATIONAL PAYMENTS AND RECEIPTS

Please complete one form per licensee (company)

(See Guide)

Record 40

Non-merchandise charges related to broadcasting operations
Receipts from non-residents
Business services
($'000 Canadian)

Program rights and royalties
1. United States
2. United Kingdom
3. France
4. European Union (excl. U.K. and France)
5. Japan
6. OECD countries (excl. Japan, United States and E.U.)
7. All other countries
TOTAL

Advertising
1. United States
2. United Kingdom
3. France
4. European Union (excl. U.K. and France)
5. Japan
6. OECD countries (excl. Japan, United States and E.U.)
7. All other countries
TOTAL

Other
1. United States
2. United Kingdom
3. France
4. European Union (excl. U.K. and France)
5. Japan
6. OECD countries (excl. Japan, United States and E.U.)
7. All other countries
TOTAL

Interest and dividends
1. United States
2. United Kingdom
3. France
4. European Union (excl. U.K. and France)
5. Japan
6. OECD countries (excl. Japan, United States and E.U.)
7. All other countries
TOTAL

Record 41

Payments to non-residents
Business services
($'000 Canadian)

Program rights and royalties
1. United States
2. United Kingdom
3. France
4. European Union (excl. U.K. and France)
5. Japan
6. OECD countries (excl. Japan, United States and E.U.)
7. All other countries
TOTAL

Advertising
1. United States
2. United Kingdom
3. France
4. European Union (excl. U.K. and France)
5. Japan
6. OECD countries (excl. Japan, United States and E.U.)
7. All other countries
TOTAL

Other
1. United States
2. United Kingdom
3. France
4. European Union (excl. U.K. and France)
5. Japan
6. OECD countries (excl. Japan, United States and E.U.)
7. All other countries
TOTAL

Interest and dividends
1. United States
2. United Kingdom
3. France
4. European Union (excl. U.K. and France)
5. Japan
6. OECD countries (excl. Japan, United States and E.U.)
7. All other countries
TOTAL

CRTC File Number
STC File Number

Summary of revenues and expenses

For year ended August 31, 2009

Please report the results for all systems (exempted and non-exempted) within the Province.
(See Guide for details)

Province:

Record 90

$(omit cents)

Basic and Non-Basic Programming Services

Revenue
1. Subscription
2. Connection (install. and reconnect)
3. Community channel and facilities rental
4. Digital Addressable Digital Video Compression (DVC) Decoders - Rental
5. Digital Addressable DVC Decoders - Net Sales
6. Other (specify)
7. Total Revenue
Expenses
1. Programming (community)
2. Affiliation Payments
3. Technical
4. Sales and Promotion
5. Administration and General
6. Total Expenses
1. Operating Income (loss)

Exempt Programming Services

Revenue
1. Subscription
2. Connection (install. & reconnect)
3. Community channel and facilities rental
4. Digital Addressable Digital Video Compression (DVC) Decoders - Rental
5. Digital Addressable DVC Decoders - Net Sales
6. Other (specify)
7. Total Revenue
Expenses
1. Programming (community)
2. Affiliation Payments
3. Technical
4. Sales and Promotion
5. Administration and General
6. Total Expenses
1. Operating Income (loss)

Non-Programming Services

Revenue
1. Subscription
2. Connection (install. & reconnect)
3. Community channel and facilities rental
4. Digital Addressable Digital Video Compression (DVC) Decoders - Rental
5. Digital Addressable DVC Decoders - Net Sales
6. Other (specify)
7. Total Revenue
Expenses
2. Affiliation Payments
3. Technical
4. Sales and Promotion
5. Administration and General
6. Total Expenses
1. Operating Income (loss)

Total All Services

1. Subscription
2. Connection (install. & reconnect)
3. Community channel and facilities rental
4. Digital Addressable Digital Video Compression (DVC) Decoders - Rental
5. Digital Addressable DVC Decoders - Net Sales
6. Other (specify)
7. Total Revenue
Expenses
1. Programming (community)
2. Affiliation Payments
3. Technical
4. Sales and Promotion
5. Administration and General
6. Total Expenses
1. Operating Income (loss)
2. Less: Depreciation
3. Less: Interest
4. Other adjustments - Income (expense)
5. Net income (loss) before income taxes
6. Provision for income taxes
7. Net income (loss) after income taxes

GROSS REVENUE FROM EXEMPT PROGRAMMING & NON-PROGRAMMING SERVICES

Record 71

EXEMPT PROGRAMMING

Licensee Revenue

Classified advertising
Teleshopping/general services
Infomercials
Games services
Other exempt
Total (should equal sum of cells 27 on line 1.7 above)

Affiliate Entity Revenue

Classified advertising
Teleshopping/general services
Infomercials
Games services
Other exempt
Total (should equal sum of cells 27 on line 1.7 above)

Total Revenue

Classified advertising
Teleshopping/general services
Infomercials
Games services
Other exempt
Total (should equal sum of cells 27 on line 1.7 above)

NON-PROGRAMMING SERVICES
Licensee Revenue

Channel lease
Internet access services
Telephony
Other telecommunications services (incl. security)
Other (specify)
Total (should equal sum of cells 47 on line 1.7 above)

Affiliate Entity Revenue

Channel lease
Internet access services
Telephony
Other telecommunications services (incl. security)
Other (specify)
Total (should equal sum of cells 47 on line 1.7 above)

Total Revenue

Channel lease
Internet access services
Telephony
Other telecommunications services (incl. security)
Other (specify)
Total (should equal sum of cells 47 on line 1.7 above)

CRTC File Number
STC File Number

EMPLOYMENT INFORMATION

For year ended August 31, 2009

Record 92

Please report the results for all systems (exempted and non-exempted) within the Province.
Province:
Total Remuneration
($ omit cents)

Salaries and Wages (include sales commissions and talent fees paid to employees), fringe benefits and directors fees

Programming and production
Technical
Sales and promotion
Administration and general
Total

Average number of employees (the typical weekly average of full & equivalent part time employees)

Programming and production
Technical
Sales and promotion
Administration and general
Total

Fringe Benefits (included in line 1 column 5 above)

Total

SUMMARY OF FIXED ASSETS

Please report assets for each Province in which you operate.

Record 93

Province of operation

Classification of Fixed Assets
$(omit cents)

Historical cost of assets in use at August 31, 2009

Land
Buildings (Include land improvements)
Head-end and components-earth receiving station & associated plant
Distribution system plant/transmitters/transponders
Cost of subscriber drops and devices including descramblers
Test equipment and tools
Furniture and fixtures
Other property, plant and equipment
Cable casting equipment/local program production equipment
Leasehold improvements (except cable system plant)
Automobiles and trucks
Computers
Total

Accumulated depreciation at August 31, 2009

Land
Buildings (Include land improvements)
Head-end and components-earth receiving station & associated plant
Distribution system plant/transmitters/transponders
Cost of subscriber drops and devices including descramblers
Test equipment and tools
Furniture and fixtures
Other property, plant and equipment
Cable casting equipment/local program production equipment
Leasehold improvements (except cable system plant)
Automobiles and trucks
Computers
Total

Additions to fixed assets 2009

Land
Buildings (Include land improvements)
Head-end and components-earth receiving station & associated plant
Distribution system plant/transmitters/transponders
Cost of subscriber drops and devices including descramblers
Test equipment and tools
Furniture and fixtures
Other property, plant and equipment
Cable casting equipment/local program production equipment
Leasehold improvements (except cable system plant)
Automobiles and trucks
Computers
Total

CRTC File Number
STC File Number

AFFILIATION PAYMENTS AND SUBSCRIBERS

Please report the results for all systems (exempted and non-exempted) within the Province

Province:

Record 72

1. Affiliation payments summary

Pay Services
Number of subscribers
1. Canadian Pay Services
2. Non-Canadian Pay Services

Affiliation payments
$ (omit cents)
1. Canadian Pay Services
2. Non-Canadian Pay Services
3. Total - Pay Services

Record 73

Specialty Services
Number of subscribers
1. Canadian Specialty Services
2. Non-Canadian Speciality Services

Affiliation payments
$ (omit cents)

Canadian Specialty Services
Non-Canadian Speciality Services
Total - Speciality Services
Total - Affiliation Payments (should be equal to Cell 9 Page 4)

CABLE

Record 91

2. Cable

Number of Direct subscribers to basic cable services
Number of Indirect subscribers to basic cable services
Total number of direct and indirect subscribers to basic cable services
Number of households with access to cable services (homes passed)
Number of households in licensed area

INTERNET

Cable modem, satellite or Multipoint Distribution System (MDS)

Record 77

3. Internet

This Company

Number of subscribers to high speed internet access services
Revenues from high speed internet access services
Number of households with access to high speed internet services

Affiliate

Number of subscribers to high speed internet access services
Revenues from high speed internet access services
Number of households with access to high speed internet services

DIGITAL TELEVISION

REC 76

4. Digital Television

Number of subscribers to digital cable services
Revenues from digital services
Number of households with access to digital television

VIDEO-ON-DEMAND

REC 78

5. Video on demand

Number of households with access to Video-on-demand

TELEPHONE

REC 79

6. Telephone

Number of subscribers to telephone services by cable
Revenues from telephone services by cable
Number of households with access to telephone services by cable

CRTC File Number
STC File Number

REPORTING SUMMARY FOR COMBINED UNDERTAKINGS

For each province, please complete the detailed revenue by system (including exempted systems), for all class 1, 2 and 3..

IMPORTANT: Do not combine the systems that operate in different provinces.
Province:
Number of exempted systems

CRTC Undertaking Number

Exempted Y/N
Number of subscribers basic service
Total basic and non-basic revenue
Exempt programming revenue
Non-programming revenue
Total all services revenue

Total of all systems

Total number of subscribers basic services. Should be equal to line 2.3, p. 6
Total basic and non-basic revenue. Should be equal to line 1.7, col (1), p. 4
Total exempt programming revenue. Should be equal to line 1.7, col (2), p. 4
Total non-programming revenue. Should be equal to line 1.7, col (3), p. 4
Total all services revenue. Should be equal to line 1.7, col (4), p. 4

CRTC File Number

Documentation

The documentation for the SPSD/M is necessarily extensive due to the complex nature of the database and model. The majority of the documentation is of a reference nature providing definitions of parameters and variables or descriptions of algorithms and programs. The documentation is written and organized in such a way as to provide the analyst first with a conceptual and functional understanding of the product and its use, and then where to find and how to use the detailed operational specifications included in the manuals. The documentation is consequently organized into fourteen separate guides and grouped into three volumes as follows:

Introduction Manual
Subject	Description
Introduction and Overview	Basic concepts and tutorial examples
How to Run the SPSM	Description of the operation of the SPSM
Addendum	Modifications since the last version
How to Use SPSD/M Help	Information relating to the use of the on-line help facility

SPSD/M User's Manual
Subject	Description
Commodity Tax User's Guide	Description and utilization of the commodity tax (COMTAX) Input/Output model
SPSM User's Guide	Reference manual for black-box use
X-tab User's Guide	Reference manual and tutorial
SPSM Programmer's Guide	Reference manual for glass-box use
Growth and Validation Guide	Reference for Aging and Benchmarking SPSD/M
Tools User's Guide	How to use various included software aids

SPSD/M Reference Manual
Subject	Description
Algorithm Guide	Description of the tax/social programs and their specific implementation in the SPSM
Parameter Guide	Detailed descriptions of all parameters
Variable Guide	Detailed description of all variables
Database Creation Guide	Detailed description of the creation and contents of the database

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The model algorithms

The SPSD/M comes with the necessary algorithms and parameters to simulate over 20 years of the Canadian tax/transfer system.

The central program, the SPSM, is a micro-simulation based model which calculates taxes and transfers for individuals and families as appropriate. These calculations are performed for everyone on the SPSD and then aggregated to obtain estimates. The SPSM is a static impact model and is therefore not intended to simulate how an individual's behaviour is likely to change in response to various policy options. A second program, the commodity tax model (COMTAX) is a macro-economic Input/Output based model. COMTAX is intended to provide estimates of effective federal and provincial tax rates by province and commodity type. This model is required because many commodity taxes are levied at intermediate stages of production, not at the final retail stage. Rates calculated by the COMTAX model can be input as parameters into the SPSM to obtain estimates of the commodity taxes paid by any given household.

The SPSM is driven by over 2,000 parameters that control three main processes. Control parameters specify input and output files for a specific model run and are used to activate model software facilities. Database adjustment parameters control the inflation or deflation of money items on the database. Tax/transfer parameters control the specific functioning of the tax and transfer programs. Perusing the included lists of the tax/transfer parameters can give the user a feel for the scope of options available in the tax/transfer algorithms.

The SPSM is written and compiled using the C++ programming language. Changes to the tax/transfer system can be made in two distinct ways: the "black-box" or the "glass box" mode. When using the model in the black-box mode, changes to one or more parameters are specified during a user-friendly dialogue. In this mode the user can change levels and rates affecting various benefits, taxes, and eligibility requirements, and can also specify the population that will be modeled. Most applications are developed using this black-box mode. The glass-box mode is designed for use by persons who wish to develop entirely new algorithms or adjust existing algorithms. Glass-box users can write a new, (or modify an existing) algorithm in the C++ programming language and then recompile the complete system using a simple one word command. The user need not be a C++ language expert in order to use the model in glass-box mode, but should be experienced with some high level computer language. The user requires Microsoft C++ to use the model in glass-box mode.

A set of database adjustment algorithms are included with the model. These algorithms allow the user to "grow" the money items on the current database to some future or past year. The user can select a series of growth rates which are then applied by the model. For most variables a set of province specific growth rates are applied. However for certain important or complex variables more complicated rates are applied. For example, employment earnings are grown by rates specific to the province of employment and sex of the individual. These algorithms can be used independently of or in conjunction with alternate yearly demographic weights included with the database.

In the historical time period, the growth factors reproduce, on a provincial basis, the growth of the conceptually closest benchmark series in the System of National Accounts (SNA). In future years, the growth factors reproduce the growth seen in an average of public and private sector forecasts at a Canada level.

Model Algorithm Highlights

Personal Income Taxes

Taxation algorithms to represent more than 20 tax years
Major deduction/tax credit items
Payroll deductions (CPP/QPP, EI contributions)
Provincial tax algorithms (Tax on Tax and Tax on Income)

Cash Transfers

Unemployment/Employment Insurance Benefits
- Detailed treatment of eligibility and benefits by:
  - type (regular, maternity, fishing, sickness, parental)
Old Age Security benefits including partial benefits
Guaranteed income supplement benefits including partial benefits
Provincial GIS supplement programs
Canada Child Benefit and Child Tax Benefit
Goods and Services Tax Credit
Provincial tax credit programs

Database Adjustment Algorithms

Scaling available for all income and expenditure variables by province
Wages and Salaries by province and sex
CPP/QPP Income by age

Commodity Tax Model

Eleven different tax types accounted for including:
- Federal Custom Import Duties
- Federal Goods and Services Tax
- Provincial profits on liquor commissions and liquor gallonage tax
- Federal Excise Taxes and Duties
- Provincial Amusement Taxes
- Provincial Gasoline Taxes
- Provincial Sales Taxes
- Provincial Tobacco Taxes
- Provincial Environmental Taxes
Determination of expenditures net of "original" taxes

Selected Parameters Controlling Government Transfer Algorithms

Employment Insurance
- EI contribution rate on earnings
- Maximum insurable earnings
- Minimum waiting period all claims
- Maximum number of weeks - regular
- Maximum number of weeks - maternity
- Maximum duration of an EI claim
- EI reform option
Benefit Rates
- Benefit rate for basic phase
- Benefit rate for quitters in basic phase
Repayment (through tax system)
- EI benefit recovery base amount factor
Federal Goods and Services Tax Credit
- GST credit amount for filer
- GST credit amount
- GST credit reduction rate
- GST additional credit amount
- GST additional credit rate of net income
Federal Child Tax Benefit
- Basic child benefit (per child)
- Child care expense reduction rate
- Federal child benefits family income turndown
- Family income reduction rate
- Child benefits earned income supplement rate
- Child benefits earning supplement reduction rate
- Child benefits earned income supplement
- Child benefits earning supplement cut-in level
- Child benefits earning supplement turndown level
- Flag for WIS dependent on number of children
- Earnings where WIS phase-in is at maximum
- Enriched WIS for each children
- WIS reduction rate for families with children
- Deflator to calculate previous year income
Canada Child Benefit
- Canada Child benefit per child
- Family income Canada Child Benefit turndown
- Canada Child Benefit reduction rate
Old Age Security (OAS)/Guaranteed Income Supplement (GIS)
- Old age security flag
- OAS take-back phase in
- Basic OAS
- OAS reduction rate
- Family income OAS turndown
- Federal GIS/SPA/ESPA flag
- Basic GIS supplement - single
- Basic GIS supplement - married
- Basic GIS portion of extended SPA
- CPI deflator to calculate previous year income
- Basic GIS reduction level: single pensioners
- Basic GIS reduction level: married pensioners
- SPA reduction point: one married/widowed
- Basic GIS reduction rate: single pensioners
- Basic GIS reduction rate: married pensioners
- OAS portion of SPA taxback rate
Take-up Rates by Income Group
- GIS take-up rate: single pensioner
- GIS take-up rate: pensioner couple
- GIS take-up rate: one pensioner couple
- SPA take-up rate by income group
- Extended SPA take-up rate by income group
Provincial GIS Supplementation Programs
- Provincial GIS top-up flag
- Ontario GIS supplement: single pensioners
- Ontario GIS supplement: married pensioners
- Manitoba GIS supplement: single pensioners
- Manitoba GIS supplement reduction point: single
- Saskatchewan GIS supplement: single pensioners
- Alberta GIS supplement maximum annual benefit
- British Columbia GIS supplement: single
- British Columbia GIS supplement married
Social Assistance Parameters
- SA for elderly calculation method
- Federal social assistance flag

Selected Parameters Controlling Federal Personal Tax and Commodity Tax Algorithms

Calculation of Total Income
- Capital gains inclusion rate
- Federal dividend gross-up rate
Deductions from Total Income
- Employment Expense Deduction
- Child Care Expense Deduction
Non-refundable Tax Credits
- Basic Personal Amount
- Age Amount
- Married Amount
- Married Equivalent Amount
- Pension Income Amount
- Caregiver Amount
- CPP/QPP Contributions
- Employment Insurance Contributions
- Medical Expenses
- Interest on Student Loans Amount
- Tuition and Education Amounts
- Charitable Donation Amount
Deductions from Net Income
- Capital Gains Deduction
Federal Taxes
- Federal tax table
- Federal non-refundable tax credit rate
- Federal dividend tax credit rate
- Federal Alternate Minimum Tax
- Quebec Tax Abatement
Commodity Taxes
- Federal custom import duties
- Federal excise duties
- Federal goods and services tax
- Federal excise taxes
- Provincial liquor gallonage tax
- Provincial profits on liquor commissions
- Provincial gasoline tax
- Provincial amusement tax
- Provincial tobacco tax
- Provincial sales tax
- Provincial environmental tax

Selected Parameters for Provincial Tax Algorithms

Parameters Common to all Provinces (excluding Quebec)
- Provincial tax fraction
- Provincial tax on taxable income table
- Provincial alternative minimum tax
- Provincial dividend tax credit
- Provincial non-refundable tax credits
  - Basic Personal Amount
  - Age Amount
  - Married Amount
  - Married Equivalent Amount
  - Pension Income Amount
  - Caregiver Amount
  - CPP/QPP Contributions
  - Employment Insurance Contributions
  - Medical Expenses
  - Interest on Student Loans Amount
  - Tuition and Education Amounts
  - Charitable Donation Amount
Newfoundland
- Sales Tax Credit
- Political Contribution tax credit
- Provincial surtax
- Low-income tax reduction
- Labour-sponsored funds tax credit
Prince Edward Island
- Political contribution tax credit
- Provincial surtax
- Low-income tax reduction
- Labour-sponsored funds tax credit
Nova Scotia
- Political Contribution tax credit
- Provincial surtax
- Low-income tax reduction
- Labour-sponsored funds tax credit
New Brunswick
- Political Contribution tax credit
- Provincial surtax
- Low-income tax reduction
- Labour-sponsored funds tax credit
Quebec
- Child care expenses
- Living alone exemption/amount
- Disability deduction/amount
- Income tax table
- Dividend tax credit
- Quebec sales tax credit
- Child Assistance refundable tax credit
- Work Premium refundable tax credit
- Basic Personal Amount
- Age Amount
- Married Amount
- Married Equivalent Amount
- Pension Income Amount
- CPP/QPP Contributions
- Employment Insurance Contributions
- Interest on Student Loans Amount
- Tuition and Education Amounts
- Charitable Donation Amount
- Property tax credit
- Political contribution tax credit
- Medical expense tax credit
- Alternative Minimum Tax
- Contribution to the Health Services Fund
Ontario
- Political Contribution tax credit
- Provincial surtax
- Tax reduction
- Labour-sponsored funds tax credit
- Property tax credit
- Seniors property tax credit
- Sales tax credit
- Seniors sales tax credit
- Ontario Health Premium
Manitoba
- Political Contribution tax credit
- Provincial surtax
- Tax reduction
- Labour-sponsored funds tax credit
- Personal tax credit
- Property tax credit
Saskatchewan
- Political Contribution tax credit
- Provincial surtax
- Tax reduction
- Labour-sponsored funds tax credit
- Sales tax credit
Alberta
- Political Contribution tax credit
- Provincial surtax
- Tax reduction
- Labour-sponsored funds tax credit
- Sales tax credit
- Alberta Health Care Insurance Plan premium
British Columbia
- Political Contribution tax credit
- Provincial surtax
- Tax reduction
- Labour-sponsored funds tax credit
- Sales tax credit
- British Columbia Medical Services Plan premium

The Model Software

The SPSD/M comes with a powerful software support environment designed to enhance the range, speed and ease of policy analysis in both black-box and glass-box modes of use. The comprehensive and flexible set of outputs allow for detailed verification of algorithms and results. The software has been designed to work in an integrated fashion at many different family levels (e.g. household, census family, individual,etc.). A user-friendly interface allows the analyst to view and modify parameters, run simulations and examine results. An on-line help facility provides information on the use of the model dialogue as well as a handy reference to variable and parameter descriptions and lists. Some highlights of the model software are given below.

A generalized expression facility allows the user to create new variables.
The user can specify a database subset in terms of any combination of database or modeled variables (e.g. all Ontarians with income below $40,000).
Marginal tax rate analyses can be performed in a single execution of the model.
Two distinct tax/transfer systems can be run simultaneously. Base and variant runs may be differentiated on the basis of parameter inputs, alternate algorithms (glass-box), or both.
Comprehensive set of default tables includes dollar amounts and persons reporting for over 40 variables with breakdowns by province, income class, family type, and proportion above or below specified income levels.
Built-in custom tabulation routines allow users to specify custom n-dimensional tables with database, model, or user defined variables and statistics. The user is given full control over formats, precision and labeling of the tables.
Database output interfaces allow the user to create custom files in compressed binary format, ASCII format or as a documented SAS file. These files are for subsequent analysis using the SPSM or other software packages and may contain any database or modeled variables.

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Date modified:: 2022-08-18

Product description

The Social Policy Simulation Database and Model (SPSD/M) is a tool designed to assist those interested in analyzing the financial interactions of governments and individuals in Canada. It can help one to assess the cost implications or income redistributive effects of changes in the personal taxation and cash transfer system. As the name implies, SPSD/M consists of two integrated parts: a database (SPSD), and a model (SPSM). The SPSD is a non-confidential, statistically representative database of individuals in their family context, with enough information on each individual to compute taxes paid to and cash transfers received from government. The SPSM is a static accounting model which processes each individual and family on the SPSD, calculates taxes and transfers using legislated or proposed programs and algorithms, and reports on the results. A sophisticated software environment gives the user a high degree of control over the inputs and outputs to the model and can allow the user to modify existing programs or test proposals for entirely new programs. The model comes with full documentation including an on-line help facility.

Users and Applications

The SPSD/M has been been used in hundreds of sites across Canada. These sites have diverse research interests in the area of income tax-transfer and commodity tax systems in Canada as well as varied experience in micro-simulation. Our growing client base includes federal departments, provincial governments, universities, interest groups, corporate divisions, and private consultants.

The diverse applications of the SPSD/M can be seen in the following examples of studies and published research reports:

Costing out proposals for amendments to the Income Tax Act affecting the tax treatment of seniors and the disabled
Estimating the fiscal viability of major personal tax reform options, including three flat tax scenarios
The comparison low income (poverty) measures and their effect on the estimates of the number of poor
An Analysis of the Distributional Impact of the Goods and Services Tax
Married and Unmarried Couples: The Tax Question
Taxes and Transfers in Rural Canada
Equivalencies in Canadian Public Policy
When the Baby Boom Grows Old: Impact on Canada's Public Sector

Some potential uses of the model are illustrated by the following list of questions which may be answered using the SPSM:

How large an increase in the federal Child Tax Benefit could be financed by allocating an additional $500 million to the program?
Which province would have the most advantageous tax structure for an individual with $45,000 earned income, 2 children and $15,000 of investment income?
What is the after-tax value of the major federal child support programs on a per child basis, and how are these benefits distributed across family types and income groups?
How many individuals otherwise paying no tax would have to pay tax under various minimum tax systems, and what would additional government revenues be?
How much money would be needed to raise all low income families and persons to Statistics Canada's low income cut-offs in 2014?
How much would average household "consumable" income rise if a province elminated its gasoline taxes?
How much would federal government revenue rise by if there was an increase in the GST rate?

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Date modified:: 2022-08-18

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Date modified:: 2025-04-07

Final audit report Audit of Asset Protection and Life Cycle Management

Note

Table of contents

Prescription medications

Over-the-Counter medications

Health product and herbal remedies

First skinfold measurements

Second skinfold measurements

Third skinfold measurements

Data linking

Data sharing

English consent form for respondents 14 to 19 (with storage)

Note:

Survey objective

Confidentiality statement

Agreements and regulations

Change of ownership

Completion of the return

Financial statements

CRTC File Number, Call Sign and CRTC Undertaking Number

Page 3: Financial summary

1. Revenue

2. Expenses

Appendix

Form 6

Instructions to greenhouse/nursery/sod operator

Part I - Type of production

Part II - Greenhouse operations (See explanatory notes)

C. Area and number of months of operation

D. Area, production and value of greenhouse vegetables and fruits - 2009

F. Indoor and outdoor potted plants, finished products

G. Cuttings and tree seedlings

H. Vegetable and ornamental bedding plants

I. Cut flowers

J. Sales for greenhouse flowers and plants only (before sales tax)

K. Plant material purchases (before sales tax)

L. Labour

M. Other greenhouse expenses

Part III - Nursery operations (See explanatory notes)

N. Nursery operations

O. Production and sales of field and container grown nursery stock

P. Sales of nursery stock (before sales tax)

Q. Nursery purchases of plant material (before sales tax)

R. Labour and total operating expenses for nursery operation only

Part IV - Sod operations (See explanatory notes)

S. Area and sales of sod

T. Labour and total operating expenses for sod operations only

2009 Annual Greenhouse, Sod and Nursery Survey- Explanatory Notes

Part II: Greenhouse operations

Section C- Area and months in operation

Section D- Area, Production and Value of Greenhouse Vegetables and Fruit- 2009

Section F- Indoor and Outdoor Potted Plants, Finished Products

Section G- Cuttings and Tree Seedlings

Section H- Ornamental and Vegetable Bedding Plants

Section I-Cut Flowers

Section J- Sales of Greenhouse Flowers and Plants

Section K- Plant Material Purchases

Section L- Labour

Section M- Other Greenhouse Expenses

Part III: Nursery operations

Section N- Nursery Area

Section O- Production and Sales of Field and Container grown Nursery Stock

Section P- 2009 Dollar Sales of Nursery Stock (before sales tax)

Final audit report
Audit of Asset Protection and Life Cycle Management