Statistics Canada
2001 Census
[p. 1]
Ce questionnaire est disponible en français 1 800 591-2001
FED ____
EA ____
VN ____
CCD ____
VR Line No. _ _ _
Map Block No. _ _
Form type
No. of persons ____
Questionnaire No.____ of ____
TD ____
UD _
NH/S _
FR _
TR _
Forms 3____
Coll.____
Count yourself in! May 15, 2001
For over 300 years, the census has painted a picture of our people and the places in which we live. This census, on May 15, 2001, will continue the tradition by providing information needed by community groups, businesses and governments to develop plans for education and training, seniors' housing, day care, fire protection, public transport, and many other programs that are important to all of us.
As Canada's national statistics agency, Statistics Canada uses census data for producing statistical tables, analytical reports and for selecting samples or following up respondents for some of our surveys. These uses are strictly for statistical purposes and no one outside of the agency can have access to your identifiable information.
By law, Statistics Canada must take a census every five years, and every household must fill in a census form. Also, by law, Statistics Canada must protect the confidentiality of the personal information you provide. Our employees, including census takers, are personally liable to fines or imprisonment should they break the confidentiality of your information.
Please complete your census form and mail it back on May 15, 2001.
Thank you for your cooperation.
Ivan P. Fellegi
Chief Statistician of Canada
This information is collected under the authority of the Statistics Act, R.S.C. 1985, c. S-19, and must be provided by law.
Confidential when completed
STEP A: Begin here by printing your address
Apt. No. ____
City, town, village, Indian reserve ____
Province/territory ____
Postal code ___ ___
Area code ___
Telephone number ___ - ____
For information and instructions see the Guide.
Call us free of charge: 1 800 591-2001
TTY/ TDD users call: 1 877 881-8301
[p. 2]
Whom to include in step B
Everyone who usually lives here, at this address: including newborn babies and room-mates;
Students: students who return to live with their parents during the year should be included at their parents' address, even if they live elsewhere while attending school or working at a summer job;
Children in joint custody: children in joint custody who live here most of the time. Children who spend equal time with each parent should be included in the home of the parent where they are staying on May 15, 2001;
Absent spouses: spouses or common-law partners who live elsewhere while working or studying but who return here periodically;
Landed immigrants: landed immigrants who usually live at this address;
Refugees: persons claiming refugee status and family members living here with them;
Persons from another country with a work, student or minister's permit: persons from another country who have an employment authorization, a student authorization or a Minister's permit, and family members living here with them;
Persons in institutions: persons who usually live here but are now in an institution (such
as a home for the aged, a hospital or a prison), if they have been there less than six months;
Persons with no other home: persons staying here on May 15, 2001, who have no
usual home elsewhere.
Do not include in step B
Persons who have their usual home at another address in Canada and who are staying here temporarily (for example, persons visiting or persons who have their secondary residence here, at this address);
Residents of another country visiting Canada (for example, on a business trip or on vacation);
Government representatives of another country or members of the Armed Forces of another country and family members.
If all persons staying at this address on May 15, 2001, have their usual home elsewhere in Canada or are visitors, government or military representatives of another country, mark this circle ... 01 [ ] Do not complete this questionnaire. Mail it in the enclosed postage-paid envelope.
[p. 3]
STEP B: List below all persons who usually live here, at this address, as of May 15, 2001, even if they are temporarily away. Don't forget to include yourself!
Begin the list with an adult followed, if applicable, by that person's spouse or common-law partner and by their children who usually live here. Continue with all other persons who usually live here. Children should be listed immediately after their parent(s).
Family name
____ Person 2
____ Person 3
____ Person 4
____ Person 5
____ Person 6
____ Person 7
____ Person 8
____ Person 9
____ Person 10
Given name
____ Person 2
____ Person 3
____ Person 4
____ Person 5
____ Person 6
____ Person 7
____ Person 8
____ Person 9
____ Person 10
Initial
____ Person 2
____ Person 3
____ Person 4
____ Person 5
____ Person 6
____ Person 7
____ Person 8
____ Person 9
____ Person 10
If you need more space, use the "Comments" section on page 32.
STEP C: Did you leave anyone out of Step B because you were not sure the person should be listed?
For example: a person living at this address who has another home; a person temporarily away.
[] Yes
Name ____
Relationship ____
Reason ____
If you need more space, use the "Comments" section on page 32.
STEP D: Is anyone listed in Step B a farm operator?
[] No
[] Yes
STEP E: Copy the names from Step B to Question 1, on the top of the next page.
[Note: the following questions are asked with enough space provided for up to six householders to answer the questions.]
Given name ____
Initial ____
[] Female
Day _ _
Month _ _
Year _ _ _ _
[] Never
[] Legally married (and not separated)
[] Separated, but still legally married
[] Divorced
[] Widowed
5. Is this person living with a common-law partner?
[] Yes
[] No
Mark "x" or specify one response only.
Stepchildren, adopted children and children of a common-law partner should be considered sons and daughters.
If none of the choices apply, use the "other" box to indicate this person's relationship to Person 1. Examples of "other" relationships to Person 1: grandparent, cousin, niece or nephew, lodger's husband or wife, room-mate's daughter or son, employee.
[] Person 1
[] Husband or wife of Person 1
[] Common-law partner (opposite-sex) of Person 1
[] Common-law partner (same-sex) of Person 1
[] Son or daughter or Person 1
[] Son-in-law or daughter-in-law of Person 1
[] Grandchild of Person 1
[] Father or mother of Person 1
[] Father-in-law or mother-in-law of Person 1
[] Brother or sister of Person 1
[] Brother-in-law or sister-in-law of Person 1
[] Lodger or boarder
[] Room-mate
[] Other, specify ____
[p. 5]
[Space to fill out answers from questions on page 4 for household members 3 through 6.]
[p. 6]
7. Does this person have any difficulty hearing, seeing, communicating, walking, climbing stairs, bending, learning or doing any similar activities?
[] Yes, often
[] No
8. Does a physical condition or mental condition or health problem reduce the amount or the kind of activity this person can do:
[] Yes, often
[] No
[] Yes, often
[] No
[] Not applicable
[] Yes, often
[] No
Socio-cultural information
[] Born in Canada, specify province or territory ____
[] Born outside Canada, specify country ____
"Canada, by naturalization" refers to the process by which an immigrant is granted citizenship of Canada, under the Citizenship Act.
[] Canada, by birth
[] Canada, by naturalization
[] Other country, specify ____
[] No - Go to question 13
[] Yes
12. In what year did this person first become a landed immigrant?
If exact year is not known, enter best estimate.
Year _ _ _ _
[p. 7]
[Space to fill out answers from questions on page 6 for household members 3 through 6.]
[p. 8]
[] English only
[] French only
[] Both English and French
[] Neither English nor French
Or specify other language(s) [below]
________
[] French
[] Other, specify ____
[] Yes, English
[] Yes, French
[] Yes, other -- specify ____
[] English
[] French
[] Other, specify ____
17. To which ethnic or cultural group(s) did this person's ancestors belong?
Specify as many groups as applicable [below]
________
[p. 9]
[Space to fill out answers from questions on page 8 for household members 3 through 6.]
[p. 10]
[] No - continue with the next question
[] Yes, North American Indian - go to question 20
[] Yes, Métis - go to question 20
[] Yes, Inuit (Eskimo) - go to question 20
19. Is this person:
Mark "x" more than one or specify, if applicable.
This information is collected to support programs that promote equal opportunity for everyone to share in the social, cultural and economic life of Canada.
[] White
[] Chinese
[] South Asian (e.g., East Indian, Pakistani, Sri Lankan, etc.)
[] Black
[] Filipino
[] Latin American
[] Southeast Asian (e.g., Cambodian, Indonesian, Laotian, Vietnamese, etc.)
[] Arab
[] West Asian (e.g., Afghan, Iranian, etc.)
[] Japanese
[] 15 Korean
[] 16 Other, specify ____
[] Yes, member of an Indian Band/First Nation - go to next line
[] Specify Indian Band/First Nation (for example, Musqueam) ____
[] Yes, Treaty Indian or Registered Indian
For example, Roman Catholic, Ukrainian Catholic, United Church, Anglican, Lutheran, Baptist, Greek Orthodox, Jewish, Islam, Buddhist, Hindu, Sikh, etc.
[] Specify one denomination or religion only ____
[] No religion
[p. 11]
[Space to fill out answers from questions on page 10 for household members 3 through 6.]
[p. 12]
Continue only for each person aged 15 and over.
Mobility
Note: For those who mark circle 03: Please give the name of the city or town rather than the metropolitan area of which it is a part. For example: Saanich rather than Victoria (metropolitan area); St. Albert rather than Edmonton (metropolitan area); Laval rather than Montreal (metropolitan area).
[] Lived at the same address as now
[] Lived at a different address in the same city, town, village, township, municipality or Indian reserve
[] Lived in a different city, town, village, township, municipality or Indian reserve in Canada. [Fill out 04, 05, and 06 below.] Specify name of:
Province/territory ____
Postal code _ _ _ _ _ _
Note: For those who mark circle 11: Please give the name of the city or town rather than the metropolitan area of which it is a part. For example: Saanich rather than Victoria (metropolitan area); St. Albert rather than Edmonton (metropolitan area); Laval rather than Montreal (metropolitan area).
[] Lived at the same address as now
[] Lived at a different address in the same city, town, village, township, municipality or Indian reserve
[] Lived in a different city, town, village, township, municipality or Indian reserve in Canada. [Fill out 04, 05, and 06 below.] Specify name of:
Province/territory ____
[p. 13]
[Space to fill out answers from questions on page 12 for household members 3 through 6.]
[p. 14]
Remember, these questions are only for persons aged 15 and over.
Education
In the case where the person has attended secondary school in the province of Quebec, include the total number of years of elementary and secondary schooling.
Number (1 to 13) of grades of secondary or elementary school _ _
Or
[] Never attended school or attended kindergarten only
[] Less than 1 year (of completed courses)
[] Number of completed years at university _ _
[] None
[] Less than 1 year (of completed courses)
[] Number of completed years at community colleges, trade schools, CEGEPs, etc. _ _
Mark "x" one circle only.
[] No, did not attend in the past nine months
[] Yes, full time
[] Yes, part time, day or evening
[p. 15]
[Space to fill out answers from questions on page 14 for household members 3 through 6.]
[p. 16]
Remember, these questions are only for persons aged 15 and over.
Mark "x" as many circles as applicable.
[] None - go to question 32
[] Secondary (high) school graduation certificate or equivalent
[] Trades certificate or diploma
[] Other non-university certificate or diploma (obtained at community college, CEGEP, technical institute, etc.)
[] University certificate or diploma below bachelor level
[] Bachelor's degree(s) (e.g., B.A., B.Sc., LL.B.)
[] University certificate or diploma above bachelor level
[] Master's degree(s) (e.g., M.A., M.Sc., M.Ed.)
[] Degree in medicine, dentistry, veterinary medicine or optometry (M.D., D.D.S., D.M.D., D.V.M., O.D.)
[] Earned doctorate (e.g., Ph.D., D.Sc., D.Ed.)
[Question 31 was asked of persons 15+ who have ever obtained certificates, diplomas or degrees, per question 30.]
Major field of study or training ________
Or
[] This person's highest qualification is a secondary (high) school graduation certificate
[p. 17]
[Space to fill out answers from questions on page 16 for household members 3 through 6.]
[p. 18]
Remember, these questions are only for persons aged 15 and over.
Place of birth of parents
(a) Father
[] Born outside Canada, specify country ____
[] Born outside Canada, specify country ____
Note: Last week refers to Sunday, May 6 to Saturday, May 12, 2001.
In Question 33, report all time spent on each activity, even if two or more activities took place at the same time. See the Guide for examples.
33. Last week, how many hours did this person spend doing the following activities:
Some examples include: preparing meals, washing the car, doing laundry, cutting the grass, shopping, household planning, etc.
[] Less than 5 hours
[] 5 to 14 hours
[] 15 to 29 hours
[] 30 to 59 hours
[] 60 hours or more
Some examples include: bathing or playing with young children, driving children to sports activities or helping them with homework, talking with teens about their problems, etc.
[] Less than 5 hours
[] 5 to 14 hours
[] 15 to 29 hours
[] 30 to 59 hours
[] 60 hours or more
Some examples include: providing personal care to a senior family member, visiting seniors, talking with them on the telephone, helping them with shopping, banking or with taking medicine, etc.
[] Less than 5 hours
[] 5 to 9 hours
[] 10 to 19 hours
[] 20 hours or more
[p. 19]
[Space to fill out answers from questions on page 18 for household members 3 through 6.]
[p. 20]
Remember, these questions are only for persons aged 15 and over.
Labor market activities
Number of hours (to the nearest hour) - go to Question 40 ____
[] None - continue with the next question
[] No
[] Yes, on temporary lay-off from a job to which this person expects to return
[] Yes, on vacation, ill, on strike or locked out, or absent for other reasons
36. Last week, did this person have definite arrangements to start a new job within the next four weeks?
[] Yes
37. Did this person look for paid work during the past four weeks?
Mark "x" one circle only.
[] No
[] Yes, looked for full-time work
[] Yes, looked for part-time work (less than 30 hours per week)
38. Could this person have started a job last week had one been available?
[] Yes, could have started a job
[] No, already had a job
[] No, because of temporary illness or disability
[] No, because of personal or family responsibilities
[] No, going to school
[] No, other reasons
[] In 2001 - continue with the next question
[] In 2000 - continue with the next question
[] Before 2000 - go to Question 51
[] Never - go to Question 51
[p. 21]
[Space to fill out answers from questions on page 20 for household members 3 through 6.]
[p. 22]
Note: Questions 40 to 48 refer to this person's job or business last week. If this person held no job last week, answer for the job of longest duration since January 1, 2000. If this person held more than one job last week, answer for the job at which he/she worked the most hours.
[Questions 40-50 were asked of persons who have worked for pay after 2000, per question 39.]
40. For whom did this person work?
Name of firm, government agency, etc. ________
Section, plant, department, etc. (if applicable) ________
41. What kind of business, industry or service was this?
Kind of business, industry or service ________
_ _ _ _
42. What was this person's work or occupation?
Occupation ________
43. In this work, what were this person's main activities?
Main activities ________
_ _ _ _
[p. 23]
[Space to fill out answers from questions on page 22 for household members 3 through 6.]
[p. 24]
Remember, these questions are only for persons aged 15 and over.
[] Working for wages, salary, tips or commission? - go to Question 46
[] Working without pay for his/her spouse or another relative in a family farm or business? - go to Question 46
[] Self-employed without paid help (alone or in partnership)?
[] Self-employed with paid help (alone or in partnership)?
45. If self-employed, was this person's farm or business incorporated?
[] No
[] Yes
Please give the name of the city or town rather than the metropolitan area of which it is a part. For example: Saanich rather than Victoria (metropolitan area); St. Albert rather than Edmonton (metropolitan area); Laval rather than Montréal (metropolitan area).
If the address of work is different than the address of the employer, please provide the address where this person actually works (e.g., school teachers should provide the address of their school, not the address of the school board).
[] Worked at home (including farms) - go to Question 48
[] Worked outside Canada - go to Question 48
[] No fixed workplace address - go to Question 47
[] Worked at the address specified below: Specify complete address
City, town, village, township, municipality or Indian reserve ____
Province/territory ____
Postal code _ _ _ _ _ _
[p. 25]
[Space to fill out answers from questions on page 24 for household members 3 through 6.]
[p. 26]
Remember, these questions are only for persons aged 15 and over.
[] Car, truck or van - as driver
[] Car, truck or van - as passenger
[] Public transit (e.g., bus, streetcar, subway, light-rail transit, commuter train, ferry)
[] Walked to work
[] Bicycle
[] Motorcycle
[] Taxicab
[] Other method
[] French
[] Other, specify ____
[] Yes, English
[] Yes, French
[] Yes, other - specify ____
[] None - go to Question 51
Or
[] Number of weeks ____
Mark "x" one circle only.
[] Full time (30 hours or more per week)
[] Part time (less than 30 hours per week)
[p. 27]
[Space to fill out answers from questions on page 26 for household members 3 through 6.]
[p. 28]
51. During the year ending December 31, 2000, did this person receive any income from the sources listed below?
If "yes," also enter the amount; in case of a loss, also mark "loss."
Do not include child tax benefits.
Paid employment:
Dollars ____ Cents _ _
[] No
Dollars ____ Cents _ _
[] Loss
[] No
Dollars ____ Cents _ _
[] Loss
[] No
Dollars ____ Cents _ _
[] No
Dollars ____ Cents _ _
[] No
Dollars ____ Cents _ _
[] No
Dollars ____ Cents _ _
[] No
Dollars ____ Cents _ _
[] Loss
[] No
Dollars ____ Cents _ _
[] No
Dollars ____ Cents _ _
[] No
Dollars ____ Cents _ _
[] Loss
[] No
[p. 29]
[Space to fill out answers from questions on page 28 for household members 3 through 6.]
[p. 30]
STEP F: Answer Questions H1 to H8 about this dwelling.
A dwelling is a separate set of living quarters with a private entrance from the outside or from a common hallway or stairway inside the building. This entrance should not be through someone else's living quarters.
H1. Who pays the rent or mortgage, taxes, electricity, etc., for this dwelling?
[] Person 1
[] Person 2
[] Person 3
[] Person 4
[] Person 5
[] Person 6
[] A person who is listed on another questionnaire for this dwelling
[] A person who does not live here
[] Owned by you or a member of this household (even if it is still being paid for)?
[] Rented (even if no cash rent is paid)?
Do not count bathrooms, halls, vestibules and rooms used solely for business purposes.
Number of rooms ____
H3(b). How many of these rooms are bedrooms?
H4. When was this dwelling originally built?
[] 1920 or before
[] 1921-1945
[] 1946-1960
[] 1961-1970
[] 1971-1980
[] 1981-1985
[] 1986-1990
[] 1991-1995
[] 1996-2001
[] No, only regular maintenance is needed (painting, furnace cleaning, etc.)
[] Yes, minor repairs are needed (missing or loose floor tiles, bricks or shingles, defective steps, railing or siding, etc.)
[] Yes, major repairs are needed (defective plumbing or electrical wiring, structural repairs to walls, floors or ceilings, etc.)
[p. 31]
Answer Questions H6 to H8 for only the dwelling that you now occupy, even if you own or rent more than one dwelling. If the exact amount is not known, please give best estimate.
Note: If you are a farm operator living on the farm you operate, mark "x" here [] and go to Step G on next page.
[] Included in rent or other payments
Or
[] Dollars ____ Cents __ per year
[] Included in rent or other payments
Or
[] Dollars ____ Cents __ per year
[] Included in rent or other payments
Or
[] Dollars ____ Cents __ per year
Or
[] Dollars ____ Cents _ _
Or
[] Dollars ____ Cents _ _ per month
[] No
Or
[] Dollars ____ Cents _ _ per month
[] No, go to Step G on next page
Or
[] Dollars ____ Cents _ _ Cents per month
[p. 32]
STEP G: You have now completed your questionnaire. Please mail it today. Thank you for your cooperation.
The law protects what you tell us
cannot be given to anyone outside Statistics Canada -- not the police, not another government department, not another person. This is your right.
Your census questionnaire will be retained in accordance with legislative requirements
and will be stored securely. You can ask to see the information you gave about yourself on your 2001 Census questionnaire after November 2001. To do this, write to the Privacy Coordinator, Statistics Canada, 25th Floor, R.H. Coats Building, Ottawa, Ontario K1A 0T6.