Canadian Centre for Justice Statistics
Exempt from Access Under any Legislation
Please provide information as of time of the incident.
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.
- Name of police service/ detachment where homicide occurred
- Respondent code
- Incident file number
- Number of homicide victims
- Number of chargeable homicide suspects
- Date of incident (i.e. date of attack – if exact date is unknown, estimate the date)
- Year /Month /Day
- Time of incident (if exact time is unknown, estimate the time)
- From 00:01 to 04:00
- From 04:01 to 08:00
- From 08:01 to 12:00
- From 12:01 to 16:00
- From 16:01 to 20:00
- From 20:01 to 24:00
- Unknown
- Specific type of location of incident* (Check one only)
- Single home, house, townhouse
- Other residential dwelling unit (e.g.,rooming house, dormitory, seniors' residence)
- Apartment building
- Hotel, motel, bed & breakfast
- Convenience store (Go to Question 10)
- Gas bar (Go to Question 10)
- Bank, trust company (Go to Question 10)
- Bar, restaurant, after-hours club (Go to Question 10)
- Other commercial / corporate place (Go to Question 10)
- Parking lot (Go to Question 10)
- School (Primary / Secondary)* (Go to Question 10)
- University / College (Go to Question 10)
- Correctional institution (Go to Question 10)
- Community group home /halfway house (Go to Question 10)
- Public institution (Go to Question 10)
- Privately owned vehicle (Go to Question 10)
- Taxi, limousine (Go to Question 10)
- Public transportation and / or connected facility (Go to Question 10)
- Street, road, highway (Go to Question 10)
- Open area* (Go to Question 10)
- Other – specify (Go to Question 10)
- Unknown (Go to Question 10)
- Occupancy of the residence where the incident occurred
- Joint occupancy by one or more victims and one or more of the chargeable suspects
- Occupied by one or more victims
- Occupied by one or more of the chargeable suspects
- Neither any of the victims nor any of the chargeable suspects were occupants
- Unknown
- Location of incident (if rural, give section, township and range or distance to the nearest town)
- City, town, village
- County, Township, Rural Municipality
- Postal Code
- Most serious violation (indicate even if homicide is unsolved)
- Murder – first degree
- Murder – second degree
- Manslaughter
- Infanticide
- Cleared status*
- Cleared by charge (laid or recommended)
- Cleared by suicide
- Cleared otherwise - specify
- Not cleared (Go to Question 14)
- Clearance date
- Year /Month /Day
- Associated or related offences committed by the chargeable suspect(s) that lead to this homicide* (e.g., robbery that ends in the death of the victim(s)). (Check the most serious offence)
- No related offence
- Sexual assault
- Other assault
- Kidnapping, abduction, etc.
- Robbery - personal
- Robbery - bank, other commercial institution
- Criminal harassment (Stalking)
- Other violent crime
- Arson
- Break and enter
- Theft
- Other property crime
- Prostitution-related offence
- Other Criminal Code
- Controlled Drugs and Substances Act (CDSA)
- Other Federal / Provincial Statute
- Unknown
- Indicate type of drug involved if the homicide was related to the illegal drug trade* (i.e., drug trafficking or settling of drug accounts) (Check the drug involved in the most serious CDSA offence )
- Not drug related
- Cannabis
- Cocaine (includes crack)
- Heroin
- Other controlled drugs and Substances
- Evidence of drugs – type unknown
- Unknown
- Evidence that this incident was gang-related (involving organised crime or street gangs)
- Suspected
- Yes
- No
- Unknown
- Apparent motive related to the incident* (Check one only)
- Settling of accounts (e.g., drug /gang-related)
- Revenge
- Jealousy
- Concealment (e.g., killing newborn)
- Argument or quarrel
- Frustration, anger or despair
- Financial gain, protection of assets
- Personal protection (e.g., battered spouse)
- Hate crime*
- Fear of apprehension
- Terrorism, political cause
- Sexual violence
- Mercy killing / assisted suicide
- No apparent motive
- Other, specify
- Unknown
- Narrative* (Provide a summary of special or specific circumstances leading up to and surrounding the homicide incident)
Autorization
This authorizes the Chief Statistician to disseminate aggregated information reported on these questionnaires, excluding personal identifiers (e.g., name, date of birth, FPS number) to the public.
Name of Official (Please print)
Name of Police Service / Detachment:
Signature:
Date:
Telephone Number:
(Area code before number)
Instructions
The Investigating Officer is the ideal person to complete this form.
*8. School (primary / secondary) - Includes outside parking lots and playgrounds during and after regular school hours when used for education (e.g. adult night school), school sanctioned extra-curricular activities (e.g. sporting events, school dances, etc.) and other events (e.g. scout meetings, gymnasium rental, etc.) Homicides occurring on school grounds after the school is closed should be scored as "20 - Open area".
Open area - Includes areas to which the public has access such as bodies of water, parks and playgrounds, bush areas, and pleasure boats not being used as temporary residences.
12. Clearance status - When incidents are cleared by charge, suicide or otherwise, submit charged/suspect chargeable forms to Statistics Canada.
14. Associated or related offence - If the intent of the accused was to commit another offence which then led to the homicide, then an associated offence should be scored. If police can determine that the intent of the perpetrator was to commit homicide from the outset, then no associated or related offence can occur.
15. Illegal drug trade - Includes all homicides that occur as a result of either the accused or the victim being involved in the illegal drug business (e.g. drug dealing, settling of drug-related accounts or debts and drug trafficking disputes) including importing, trafficking and possessing drugs. This question does not refer to whether the accused and/or victim were under the influence of drugs at the time of the incident.
17. Hate crime - Includes all homicides where the accused person's primary motive was hate, prejudice or bias based on race, national or ethnic origin, language, colour, religion, sex, age, mental or physical disability, sexual orientation or any other similar factor.
18. Narrative - In your own words, provide greater detail of the motives and the events leading up to the homicide. Omitting important details about the homicide and/or scoring "unknown" without sufficient explanation will result in CCJS contacting the investigating officer to obtain clarification.
Information for respondents
Authority:
Statistics Act, Revised Statutes of Canada, 1985, Chapter S19.
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.
Confidentiality :
Statistics Canada is prohibited by law from publishing any statistics which would divulge information obtained from this survey that relates to any identifiable respondent / individual without the previous written consent of that respondent / individual. The information reported on this questionnaire will be treated in confidence, used for statistical purposes and published in aggregate form only. The confidentiality provisions of the Statistics Act are not affected by either the Access to Information Act or any other legislation.
Correspondence:
If you require further clarification to complete this questionnaire please contact:
Central Reception, SC 0505
Operations & Integration Division, Statistics Canada
150 Tunney's Pasture Driveway
Ottawa, Ontario, K1A 0T6
Phone: Toll free 1-888-659-8229
Fax: 1-888-883-7999
E-mail: homi-surv@statcan.gc.ca
Thank you for your cooperation