Archived - Homicide Survey - Victim Questionnaire: 2009

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Canadian Centre for Justice Statistics

Please provide information as of time of the incident for each victim.

See instructions below for items indicated with an asterix (*) or refer to the "Scoring Guide for the Homicide Survey" available on the CCJS Extranet Website.

Exempt from Access Under any Legislation

  1. Incident file number
  2. Victim number
  3. Name of victim
    • Surname
    • Given name(s)
    • Alias; or
    • Unknown
  4. Gender of victim
    • Male
    • Female
      Was the victim pregnant?
      • Yes
      • No
      • Unknown
    • Unknown
  5. Date of birth of victim
    • Year/Month/Day
    If victim's date of birth is unknown, estimate the age at time of incident
    • Years; or
      • Less than 1 year of age (includes newborn)
      • Unknown
  6. Marital status of victim
    • Single (never married)
    • Married (legal)
    • Common-law /cohabitation
    • Divorced
    • Separated (legal or informal)
    • Widowed
    • Unknown;
  7. Aboriginal origin of victim
    • Not collected / released by police force
    • Non-aboriginal origin
    • North American Indian
    • Métis
    • Inuit / Eskimo
    • Unknown
  8. Employment status of victim (check one only; if more than one applies, check the response closest to the top of the list)
    • Illegal activities(e.g. prostitute, drug dealer, gang member)
    • Employed (includes full time, part-time, casual, self-employed)
    • Unemployed
    • Unknown
    Not in labour force:
    • Less than 15 years of age (Go to Question 11)
    • Student (Go to Question 11)
    • Retired (Go to Question 11)
    • Homemaker (Go to Question 11)
    • Other - specify (e.g., social assistance, disability (Go to Question 11)
  9. Occupation of victim (enter most recent occupation or other occupation directly related to the homicide)
    • Specify; or
    • Unknown
  10. Victim's death associated with their profession (e.g., police officer, taxi driver, prostitute, drug trafficker, etc.)
    • Yes;
    • No; or
    • Unknown;
  11. Was this victim randomly selected? *
    • Yes;
    • No; or
    • Unknown
  12. Victim's previous conviction for criminal activities
    • No previous conviction
    Most serious conviction:
    • Homicide
    • Robbery
    • Other violent offence
    • Property offence
    • Drug offence
    • Other Criminal Code or Federal / Provincial Statute offence
    • Unknown
    Source of information (e.g., CPIC, your own information system, etc.)
  13. Primary method used to cause death
    • Shooting
    • Stabbing
    • Beating / blow(s)
    • Strangulation, suffocation, drowning
    • Poisoning or lethal injection
    • Smoke inhalation, burns (fire, liquid, acid)
    • Exposure, hypothermia
    • Shaken Baby Syndrome
    • Other cause – specify
    • Unknown
  14. Weapon used to kill victim (check one only)
    • No weapon used (Go to Question 21)
    • Fully automatic firearm
    • Sawed-off rifle / shotgun
    • Handgun (semi-automatic / revolver)
    • Rifle / shotgun
    • Firearm-like weapon
    • Other firearm - type unknown
    • Knife (Go to Question 20)
    • Other piercing / cutting instrument (Go to Question 20)
    • Club or blunt instrument (Go to Question 20)
    • Explosives (Go to Question 21)
    • Fire, boiling liquid, acid (Go to Question 21)
    • Ligature (e.g., rope, belt, cable) (Go to Question 21)
    • Poison, drugs, gas, fumes (Go to Question 21)
    • Motor vehicle (Go to Question 21)
    • Other weapon –specify (Go to Question 20)
    • Other weapon - type unknown (Go to Question 21)
    • Hands, feet, etc. (Go to Question 21)
    • Unknown (Go to Question 21)
  15. Was the firearm recovered?
    • Yes;
    • No (Go to Question 18)
    • Unknown
  16. Status of the recovered firearm
    • In possession of owner, loaned /borrowed
    • Stolen
    • Lost or missing
    • Unknown
  17. Was the firearm registered with the Canadian Firearm Registry?
    • Yes (Indicate Certificate number)
    • No
    • Unknown
  18. Owner of the firearm
    • Chargeable suspect
    • Victim
    • Other
    • Unknown
  19. Does chargeable suspect possess a valid Firearms License?
    • Yes
    • No
    • Unknown
  20. Classification of the identified weapon
    • Restricted
    • Prohibited
    • Neither restricted nor prohibited
    • Unknown
  21. Consumption of alcohol, drug or intoxicating substance by victim (check one only)
    • No alcohol or drug consumed (Go to Question 23)
    • Both alcohol and drug consumption
    • Alcohol consumption only
    • Drug consumption only (Go to Question 23)
    • Consumption of intoxicating substance - inhalant, etc. (Go to Question 23)
    • Consumption of intoxicant - type unknown (Go to Question 23)
    • Unknown (Go to Question 23)
  22. Blood-alcohol level of victim (milligrams of alcohol per 100 millilitres of blood)
    • Indicate quantity; or
    • Unknown
  23. Victim was first to use or first to threaten to use physical force or violence in this incident
    • Yes
    • No
    • Unknown
  24. Closest Chargeable Suspect - Victim Relationship * (code the closest relationship between any of the chargeable suspects and this victim)
    • Chargeable suspect number (Question 2 on Charged / Suspect-Chargeable Questionnaire) ; or
    • No chargeable suspect (End)
    Victim killed by:
    Spousal relationship
    • Husband (legally married)
    • Common-law husband
    • Separated husband (legal)
    • Separated common-law husband
    • Divorced husband
    • Wife (legally married)
    • Common-law wife
    • Separated wife (legal)
    • Separated common-law wife
    • Divorced wife
    • Same-sex spouse (legal or common-law)
    • Ex-same-sex spouse (separated or divorced)
    Other family relationship
    • Father
    • Step-father
    • Mother
    • Step-mother
    • Son
    • Step-son
    • Daughter
    • Step-daughter
    • Brother
    • Sister
    • Other family
    Other intimate relationship
    • Boyfriend
    • Girlfriend
    • Same sex relationship
    • Extra-marital lover
    • Ex-boyfriend /girlfriend
    • Other intimate relationship
    Acquaintance
    • Close friend
    • Neighbour
    • Authority figure*
    • Business relationship
    • Criminal relationship*
    • Casual acquaintance
    • Stranger
    • Other – specify
    • Unknown

Instructions

The investigating officer is the ideal person to complete this form.

*11. Random homicide - A homicide that does not aim to target one specific individual. If solved, it will normally involve the killing of a stranger who is engaging in the normal course of their daily lives or who is "in the wrong place at the wrong time". A homicide may be considered random even if the victim is selected from a pre-determined group as long as all members of the group have an equal chance of being chosen. For example, if a perpetrator is seeking to kill a female child this homicide may be random if all female children were at risk.

24. Authority figure - e.g., teacher, doctor, baby-sitter, priest, etc.

Criminal relationship - refers to a relationship between a prostitute and client, drug trafficker and drug user, etc.

Thank you for your cooperation

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