Questionnaire Text

Questionnaire form view entire document:  text  image
B. Person Form

15. Do you have any of the following long-lasting conditions?

a) Blindness, deafness or a severe vision or hearing impairment?
[] 1 Yes
[] 2 No
b) A condition that substantially limits one or more basic physical activities such as walking, climbing stairs, reaching, lifting or carrying?
[] 1 Yes
[] 2 No
c) A learning or intellectual disability?
[] 1 Yes
[] 2 No
d) A psychological or emotional condition?
[] 1 Yes
[] 2 No
e) Other, including any chronic illness
[] 1 Yes
[] 2 No
Questionnaire instructions view entire document:  text  image
The results of questions 15 and 16 coupled with other questions will provide important data on the number of people whose activities are reduced because of a disability and the effect of the disability on their lives. These questions were chosen after a number of meetings with experts from the various disability umbrella bodies and government departments.

15 Do you have any of the following long-lasting conditions?

(a) Blindness, deafness or a severe vision or hearing impairment?
[] 1 Yes
[] 2 No
(b) A condition that substantially limits one or more basic physical activities such as walking, climbing stairs, reaching, lifting or carrying?
[] 1 Yes
[] 2 No
(c) A learning or intellectual disability?
[] 1 Yes
[] 2 No
(d) A psychological or emotional condition?
[] 1 Yes
[] 2 No
(e) Other, including any chronic illness
[] 1 Yes
[] 2 No