Collective Dwelling Record
Census information is important for your community and is vital for planning its public services. By law, all residents living in facilities and establishments must be included in the 2021 Census. The information is collected under the authority of the Statistics Act and is kept strictly confidential. The information you provide may be used by Statistics Canada for other statistical and research purposes or may be combined with other survey or administrative data sources.
Confidential when completed
Section 1: Identification
- Survey Specific Identifier (SSID)
- CLD
- Block Number
- Crew leader name
- Name of collective dwelling
- Address
- Maximum occupancy
- Collective dwelling type code
- Total usual residents (URs)
- Total temporary residents (TRs)
- Total foreign residents (FRs)
- Number of private dwellings attached
- Contact name
- Contact telephone number
- Contact address
- Contact email
- Complete only if final outcome code is '324' (Cancelled)
- Private dwelling
- Business/establishment that does not provide overnight accommodation
- Incorrect address
- Demolished
- Duplicate
- Comments
Section 2: Collective dwelling type code and auxiliary questions
Select one collective dwelling type and answer the corresponding questions.
Hospital (10)
- A1) Is this facility licensed as a hospital?
- Yes
- No
- A2) What services are provided at this facility? (Mark one only)
- Short-term care
- Long-term care
- Both short-term and long-term care
Nursing home and/or residence for senior citizens (20)
- B1) What levels of service are provided to residents at this facility? (Mark one only)
- Extended health care services (professional health care monitoring, nursing care and supervision 24 hours a day). Residents are not independent in most activities of daily living.
- Support services or assisted living services (meals, housekeeping, laundry, supervision of medication, assistance bathing or dressing, etc.), but no extended health care services. Residents are independent in most activities of daily living.
- Extended health care services to some residents, but only support services or assisted living services to other residents. For example, a facility that is a mix of both a nursing home and a residence for senior citizens.
Note: If no care or services are provided to residents, the facility should be enumerated as a private dwelling.
Residential care facility, such as a group home for persons with disabilities or addictions (30)
- C1) Is this facility for (mark all that apply):
- primarily children/minors
- persons with psychological disabilities
- persons with an addiction
- persons with physical challenges and/or disabilities
- persons that are developmentally delayed
- other - specify:
Shelter (40)
- D1) Is this facility primarily for (mark one only):
- homeless persons
- ex-inmates (in halfway houses)
- abused women and their children
- refugees and asylum seekers
- other - specify:
Correctional or custodial facility (50)
- E1) Is this facility primarily a (mark one only):
- federal correctional facility
- young offenders' facility
- provincial/territorial custodial facility
- jail/police lock-up facility
Lodging or rooming house (60)
Religious establishment such as a convent, monastery or seminary (70)
Establishment with temporary accommodation services such as a hotel, campground, YMCA/YWCA, Ronald McDonald House or hostel (90)
- F1) Is this establishment a (mark one only):
- hotel, motel or tourist establishment
- other establishment with temporary accommodation services such as a YMCA/YWCA, Ronald McDonald House or hostel
- campground or park
Other establishment such as a school residence, military base, work camp or vessel (91)
- G1) Is this establishment a (mark one only):
- a school residence or training centre residence
- a military base
- a commercial vessel
- a work camp
- a government vessel
- another establishment
Section 3: Occupancy on May 11
| Room or unit number | Usually lives here (X). Follow up if form not returned. |
Unoccupied (X) | Name of occupant (If name not available, enter " X ") | Number of Urs | Number of TRs | Number of FRs | Remarks | |
|---|---|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 |
| 1 | ||||||||
| 2 | ||||||||
| 3 | ||||||||
| 4 | ||||||||
| 5 | ||||||||
| 6 | ||||||||
| 7 | ||||||||
| 8 | ||||||||
| 9 | ||||||||
| 10 | ||||||||
| 11 | ||||||||
| 12 | ||||||||
| 13 | ||||||||
| 14 | ||||||||
| 15 | ||||||||
| 16 | ||||||||
| 17 | ||||||||
| 18 | ||||||||
| 19 | ||||||||
| 20 | ||||||||
| 21 | ||||||||
| 22 | ||||||||
| 23 | ||||||||
| 24 | ||||||||
| 25 | ||||||||
| Totals for this page | ||||||||
| Cumulative totals | ||||||||
Use additional 1A forms if required.