Canadian Centre for Justice Statistics
Policing Services Program
Confidential when completed
Please provide information as of time of the incident for each chargeable suspect.
See instructions on last page for items indicated with an asterisk ( * ) or refer to the “Scoring Guide for the Homicide Survey”.
This information is collected under the authority of the Statistics Act, Revised Statutes of Canada, 1985, Chapter S-19.
Completion of this questionnaire is a legal requirement under this act.
Objective
This survey collects essential data to produce statistics on the incidence and characteristics of homicide offences in Canada. The information is used by federal and provincial policymakers as well as public and private researchers. The data are also widely disseminated by the media for purposes of general public information. The information may also be used by Statistics Canada for other statistical and research purposes.
Confidentiality
Statistics Canada is prohibited by law from releasing any information it collects which could identify any person, business, or organization, unless consent has been given by the respondent or as permitted by the Statistics Act. Statistics Canada will use the information from this survey for statistical purposes.
Record linkages
To enhance the data from this survey and to minimize the reporting burden for respondents, Statistics Canada may combine the information you provide with other survey or administrative data sources.
Instructions
Please return this questionnaire by December 31st, “Collection Year”. Questionnaires may be returned by mail (see address below) or through the Electronic File Transfer system.
Correspondence
Statistics Canada
ATTN: Central Reception
200 blvd. de la Technologie
Gatineau, QC J8Z 3H6
Phone: Toll free 1-888-659-8229
Fax: 1-888-883-7999
E-mail: statcan.homisurv-enqhomi.statcan@statcan.gc.ca
Fax or e-mail transmission disclosure
Statistics Canada advises you that there could be a risk of disclosure during facsimile or other electronic transmission. However, upon receipt, Statistics Canada will provide the guaranteed level of protection afforded all information collected under the authority of the Statistics Act.
- Incident file number
- Chargeable suspect number
- Name of chargeable suspect
- Surname
- Given name(s)
- Alias
- OR
- 09 Unknown
- Sex of chargeable suspect
- 1 Male
- 2 Female
- a. Date of birth of chargeable suspect
- Year / Month / Day
- Years
- OR
- 000 Less than 1 year of age (includes newborn)
- 999 Unknown
- Marital status of chargeable suspect
- 1 Single (never married)
- 2 Married (legal)
- 3 Common-law / cohabitation
- 4 Divorced
- 5 Separated (legal or informal)
- 6 Widowed
- 9 Unknown
- Aboriginal identity of chargeable suspect
- 00 Not collected / released by police service
- 01 Not an Aboriginal person
- 02 First Nations person (Status or non-Status)
- 03 Métis
- 04 Inuit
- 06 Aboriginal person (group unknown)
- 05 Not provided by the chargeable suspect
- 99 Unknown
- Employment status of chargeable suspect (check one only; if more than one applies, check the response closest to the top of the list)
- 00 Illegal activities (e.g. prostitute, drug dealer, gang member)
- 01 Employed (includes full time, part-time, casual, self-employed)
- 02 Unemployed
- Not in labour force
- 03 Less than 15 years of age - Go to Question 10
- 04 Student - Go to Question 10
- 05 Retired - Go to Question 10
- 06 Homemaker - Go to Question 10
- 07 Other – specify (e.g., social assistance, disability) - Go to Question 10
- 99 Unknown
- Occupation of chargeable suspect (enter most recent occupation or other occupation directly related to the homicide)
- Specify
- OR
- 9 Unknown
- Country of residence of chargeable suspect
- 1 Canada
- 2 United States
- 3 Other country
- 9 Unknown
- Clearance status of chargeable suspect
- 1 Charges laid or recommended
- 2 Cleared by suicide of chargeable suspect - Go to Question 13
- 3 Cleared otherwise – specify - Go to Question 13
- Most serious charge laid or recommended against the chargeable suspect
- 1 Murder 1st-degree
- 2 Murder 2nd-degree
- 3 Manslaughter
- 4 Infanticide
- FPS number of chargeable suspect
- Specify FPS number
- 8 Not applicable
- 9 Unknown
- Chargeable suspect’s previous conviction for criminal activities
- 88 No previous conviction
- Most serious conviction
- 01 Homicide
- 02 Robbery
- 03 Other violent offence
- 04 Property offence
- 05 Drug offence
- 06 Other Criminal Code or Federal / Provincial Statute offence
- 99 Unknown
- Source of information (e.g., CPIC, your own information system, etc.)
- Suspected mental or developmental disorder (e.g., schizophrenia)
- 0 Suspected
- 1 Yes - specify
- 2 No
- 9 Unknown
- Consumption of alcohol, drug or intoxicating substance by chargeable suspect (check one only)
- 8 No alcohol or drug consumed
- 1 Both alcohol and drug consumption
- 2 Alcohol consumption only
- 3 Drug consumption only
- 4 Consumption of intoxicating substance – inhalant, etc.
- 5 Consumption of intoxicant – type unknown
- 9 Unknown
- History of family violence involving this chargeable suspect and any homicide victim(s) in this incident *
- 8 Not a family homicide
- 1 Yes
- 2 No
- 9 Unknown
Instructions
The Investigating Officer is the ideal person to complete this form.
17. History of family violence – refers to violence (e.g. spousal abuse, child or parent battering) between, family members (codes 1-23 and 38-42 on question 25 of the Victim Questionnaire). Even one previously known incidence of violence is sufficient to score “Yes”. The violence must involve this accused person and the victim killed in this incident.
Thank you for your co-operation