Canadian Centre for Justice Statistics
Policing Services Program
Confidential when completed
Complete a separate Victim questionnaire for each victim in this incident. Information is reported as of the incident date unless otherwise stated. To ensure records are complete, avoid leaving questions blank or scoring 'unknown' unless necessary. Detailed reporting instructions are found in the Homicide Survey Reporting Guide; available upon request. Verify that homicide information reported to the Homicide Survey matches with homicide information reported by your police service to the Uniform Crime Reporting (UCR) 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
Instructions
Please return this questionnaire by December 31st, 2020. Questionnaires may be returned by mail (see address below) or through the Electronic File Transfer system.
Correspondence
Statistics Canada
ATTN: AADPS
2nd Floor Section B15
Jean Talon Building
150 Tunney's Pasture Driveway
Ottawa, ON K1A 0T6
Phone: Toll free 1-888-659-8229
Fax: 1-800-755-5514
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.
- What is the incident file number assigned to this incident by the investigative police service?
- What is the victim number?
Note: If there is one victim in the incident, the victim number is 1. If there are multiple victims, number the Victim questionnaires sequentially, e.g., 1, 2, 3. - What was the name of the victim?
- Name of victim:
- Surname
- Given name 1
- Given name 2
- Given name 3
- Alias (if applicable)
- Unknown
- What was the sex at birth of the victim?
Note: Refers to the sex assigned at birth of the victim and does not refer to their gender identity or sexual orientation.- Male – Go to question 6
- Female
- Unidentifiable human remains – Go to question 8
- Unknown – Go to question 6
- Was the female victim pregnant at the time of the incident?
- Yes
- No
- Unknown
- What was the victim's gender identity?
Note: Refers to current gender which may be different from sex assigned at birth and may be different from what is indicated on legal documents. Male gender and female gender identities include cisgender and transgender persons. Other gender identity includes persons whose gender is reported as being: other than male or female, unsure of their gender, both male and female, or neither male nor female.- Male
- Female
- Other gender identity – Specify gender identity:
- Unknown
- What was the victim's sexual orientation?
- Heterosexual
- Homosexual, e.g., lesbian or gay
- Bisexual
- Other sexual orientation – Specify sexual orientation
- Unknown
- What was the victim's date of birth?
Note: If the birth date is not known, provide the age of the victim at the time of the incident.- Birth date
- Year / Month / Day
- OR
- Age in years - Specify age:
- Infant less than 1 year of age
- Unknown
- Did the victim live on-reserve or off-reserve?
- Lived on-reserve
- Lived off-reserve, and recently lived on-reserve (within past 5 years)
- Lived off-reserve, and lived on-reserve in the past (more than 5 years)
- Lived off-reserve, and never lived on-reserved
- Lived off-reserve, and unknown if ever lived on-reserve
- Unknown
- What was the victim's address?
- Fixed address
- Street number
- Street name
- Street type
- Street direction
- Apartment/unit
- City, town, village
- Reserve (if applicable)
- County, township, rural municipality (if applicable)
- Province, territory or state
- Postal code or ZIP code
- Country
- No fixed address
- City, town, village
- Reserve (if applicable)
- County, township, rural municipality (if applicable)
- Province, territory or state
- Country
- Unknown
- What was the marital status of the victim?
Note: If the victim was less than 15 years of age at the time of the incident, select Never married (not living common law).- Married
- Living common law, i.e., two people who live together as a couple but who are not legally married to each other
- Never married (not living common law)
- Separated (not living common law)
- Divorced (not living common law)
- Widowed (not living common law)
- Unknown
- What was the Aboriginal identity of the victim?
- Not an Aboriginal person
- First Nations person (status or non-status)
- Métis
- Inuit
- Aboriginal person, but Aboriginal group is unknown
- Unknown
- What was the visible minority identity of the victim?
A visible minority identity is reported for a victim who is non-Caucasian in race or non-white in colour, or who do not identify solely as an Aboriginal person.
Not a visible minority is reported for a victim who is identified as solely an Aboriginal person, or not considered to be a member of a visible minority group, regardless of place of birth.
Select all that apply- Victim was not a visible minority, i.e., identifies solely as Aboriginal or Caucasian in race or white in color
- OR
- South Asian, e.g., East Indian, Pakistani, Sri Lankan
- Chinese
- Black
- Filipino
- Arab
- Latin American
- Southeast Asian, e.g., Vietnamese, Cambodian, Laotian, Thai
- West Asian, e.g., Iranian, Afghan
- Korean
- Japanese
- Other visible minority – Specify visible minority:
- OR
- Visible minority, minority group unknown
- OR
- Visible minority information of victim is not collected or reported by police service
- OR
- Unknown
- Was the victim a Canadian citizen?
- Victim was a Canadian citizen
- Victim was not a Canadian citizen
- Citizenship information of victim is not collected or reported by police service
- Unknown
- What was the victim's immigration status?
Note: An immigrant includes persons who are, or who have ever been, landed mmigrants or permanent residents. Such persons have been granted the right to live in Canada permanently by immigration authorities.- Victim was not an immigrant, e.g., Canadian citizen by birth, tourist
- Victim was an immigrant, i.e., permanent resident
- Victim was a non-permanent resident, e.g., work / study permit, refugee claimant
- Immigration information of victim is not collected or reported by police service
- Unknown
- Was the victim involved in any of the following illegal activities?
Note: Includes where the victim was suspected to be involved in illegal activities. Commodifying sexual activities refers to the victim's involvement in obtaining sexual services, procuring, receiving material benefit or advertising sexual service; does not refer to where the victim was working as a sex worker.
Select all that apply.- Not involved in illegal activities – Go to question 18
- OR
- Illegal drug trade activities
- Commodifying sexual activities, i.e., victim obtained, procured, received material benefit or advertised sexual services
- Organized crime / street-gang activities
- Human trafficking
- Fraud
- Other financial crime
- Other illegal activity – Specify illegal activity:
- OR
- Unknown – Go to question 18
- Was the victim's homicide related to their involvement in the illegal activities reported in question 16?
- Yes
- No
- Unknown
- What was the victim's employment status?
Note: Not in the labour force refers to where the victim was either: less than 15 years old, an institutional resident, unable to work, or unavailable for work.- Employed (in labour force), e.g., full-time, part-time, casual, self-employed – Go to question 20
- Unemployed (in labour force), e.g., seeking employment – Go to question 20
- Not in the labour force, e.g., unable to work
- Unknown – Go to question 20
- What was the primary reason the victim was not in the labour force?
Select only one.- Less than 15 years of age
- Full-time student
- Home or caregiver responsibilities
- Retired
- Disability or illness
- Institutional resident, e.g., of a correctional facility, hospital, nursing home, community group home
- Not eligible to work in Canada, e.g., illegal immigrant, work permit has not been secured
- Other reason victim was not in the labour force – Specify the reason the victim was not in the labour force:
- Unknown
- What was the occupation of the victim?
Note: If the victim was unemployed at the time of the incident, report their last legal occupation. Report if the victim was working as a sex worker in this question.- Occupation of victim – Specify occupation:
- Unknown – Go to question 23
- Was the victim's homicide related to their occupation?
- Yes
- No
- Unknown
- Was the victim working in policing or as a correctional worker, and was their death related to their occupation?
Policing includes: police officers, special constables, recruits or cadets, and auxiliary police officers. It does not include other types of employees within policing such as civilians, public servants, volunteers.
Correctional worker includes: correctional officers, parole officers, Wardens, medical staff, educators, social workers, volunteers, and other occupations within the correctional facility, e.g., caretaker or administrative staff.- Victim worked in policing and death related to occupation
- Victim was a correctional worker and death related to occupation
- Victim worked in policing, or as a correctional worker, but death was not related to occupation
- Victim did not work in policing or as a correctional worker
- Unknown
- Was the victim receiving financial or social assistance?
Note: Applies to both victims in the labour force, i.e., employed or unemployed, and victims not in the labour force.- Yes
- No – Go to question 25
- Unknown – Go to question 25
- What was the source of financial or social assistance?
Select all that apply.- Employment assistance or social assistance program, e.g., Employment Insurance (EI), Workplace Safety and Insurance Board (WSIB), Ontario Works (OW)
- Disability support program, e.g., Ontario Disability Support Program (ODSP)
- Financial support from family or friends
- Financial or social assistance from a band / tribal council
- Other financial or social assistance - Specify source of financial or social assistance:
- Was this victim randomly selected?
Note: Refers to a homicide that does not target a specific individual.- Yes
- No
- Unknown
- Was the victim considered to be a missing person at the time of their death?
Note: Report "Yes" if an active missing person's report for the victim was filed with any police service at the time their death. Does not refer to previous missing person's reports that were not active at the time of their death, i.e., instances where the victim had been reported as missing and subsequently found alive.- Yes
- No
- Unknown
- Does the victim have on record any previous convictions of criminal activities?
Select all that apply.- No previous convictions of criminal activities
- OR
- Crime against the person
- Homicide
- Sexual assault violation, i.e., aggravated sexual assault, sexual assault with a weapon, other sexual assault
- Other sexual violations, e.g., exploitation, invitation to sexual touching, incest, corruption of morals
- Assault, i.e., aggravated assault, assault with a weapon or causing bodily harm, assault level 1, all other types of assault
- Kidnapping, abduction, or forcible confinement
- Trafficking of persons
- Hostage taking
- Robbery
- Commodification of sexual activities, i.e., victim was convicted of obtaining, procuring, receiving material benefit or advertising sexual services
- Harassment, e.g., criminal harassment, harassing communications
- Utter threats to person
- Other crime against the person
- Crime against property
- Arson
- Break and enter
- Theft
- Fraud
- Mischief
- Other crime against property
- Other offences
- Other Criminal Code offence, e.g., gaming / betting, offensive weapons, other Criminal Code not otherwise specified above
- Controlled Drugs and Substances Act (CDSA) or Cannabis Act offence
- Other federal / provincial statute
- OR
- Unknown
- Was the victim in custody, or under community supervision?
i.e., remand, sentenced custody, probation or bail
For adult victims (18 years and older), this includes remand, sentenced custody, i.e., federal or provincial sentence, or intermittent sentence, other temporary detention, probation, conditional sentence, bail, or other community program.
For youth victims (12 to 17 years of age), this includes pre-trial detention, provincial director remand, secure or open custody, community portion of a custody sentence, intensive or deferred custody / supervision, supervised probation, bail, or other community sentence.- Yes
- No
- Unknown
- What was the primary method used to cause death?
Select only one.- Shooting
- Stabbing
- Beating or blows
- Strangulation, suffocation, drowning
- Drug overdose
- Poisoning or lethal injection, i.e., not related to drug overdose
- Smoke inhalation or burns, e.g., fire, liquid, acid
- Exposure or hypothermia
- Abusive head trauma, i.e., previously "shaken baby syndrome"
- Motor vehicle impact or collision
- Neglect or failure to support life
- Other primary method – Specify method used to cause death:
- Unknown
- What was the primary weapon used to cause death?
Select only one.- Firearm
- Rifle or shotgun
- Handgun
- Other firearm-like weapon, e.g., nail gun or pellet gun
- Firearm – type of firearm is unknown
- Knife/object
- Knife
- Other piercing or cutting instrument
- Club or blunt instrument
- Explosive
- Motor vehicle
- Ligature, e.g., rope, belt, cable
- Substance
- Burning liquid or caustic agent
- Poison, drug, gas or fume – Go to question 44
- Fire – Go to question 44
- Water – Go to question 44
- Other
- Physical force, i.e., by hands, feet – Go to question 44
- Other primary weapon, e.g., electricity, dog, pillow, sand – Go to question 44
- No weapon was used – Go to question 44
- Unknown – Go to question 44
- What is the classification of the primary weapon?
Note: Refers to the classification of weapons in Canada according to the Criminal Code and regulations prescribing certain firearms and other weapons (including components and parts of weapons, accessories, cartridge magazines, ammunition and projectiles), as prohibited, restricted or non-restricted.- Prohibited weapon, e.g., some handguns, altered rifles and shotguns, full or converted automatics, some crossbows
- Restricted weapon, e.g., handguns that are not prohibited; semi-automatics, centre-fire rifles, and shotguns with barrel shorter than 470mm
- Non-restricted weapon, e.g., ordinary rifles and shotguns
- Not applicable, i.e., weapon type not required to be classified
- Unknown
- Who owned the primary weapon at the time of the incident?
- Charged / suspect-chargeable (CSC)
- CSC Number
- CSC Surname
- CSC Given name 1
- Victim reported on this questionnaire
- Other, e.g., owned by workplace or other person
- Unknown
- Was the primary weapon initially obtained legally?
- Yes
- No – Go to question 35
- Unknown
- Was the charged / suspect chargeable (CSC) that caused the fatal wound in legal possession of the primary weapon at the time of the incident?
Note: Refers to where the primary weapon used to cause death was a firearm, knife / object, or a substance such as a caustic agent or a drug.- CSC Number
- CSC Surname
- CSC Given name 1
- Yes
- No
- Unknown
- Was the primary weapon legally owned at the time of the incident?
Note: A weapon is legally owned when it has been obtained according to the law, and all legal requirements to own the weapon are in place and up-to-date, e.g., credentials and documentation.- Yes – Go to question 37
- No
- Unknown – Go to question 37
- What was the status of the illegally owned primary weapon at the time of the incident?
- Stolen from the legal Canadian owner
- Lost or missing from the legal Canadian owner
- Illegally purchased from legal Canadian owner
- Illegal weapon, e.g., never legally owned in Canada, smuggled into Canada, purchased on the dark net, homemade
- Unknown
- Was the primary weapon recovered?
- Yes – if the primary weapon is not a firearm, go to question 44.
- No – if the primary weapon is not a firearm, go to question 42.
- – if the primary weapon is not a firearm, go to question 44.
- What was the action type of the firearm used to cause death?
- Single-shot or manual repeating, i.e., bolt, lever, pump, break (or hinge) and revolving action
- Semi-automatic
- Fully automatic
- Unknown
- If the firearm was a rifle or shotgun, was it sawed-off, cut or altered in any other way that resulted in the total length of the firearm being less than 660 mm or it having a barrel that is less than 457 mm long?
- Yes
- No
- Unknown
- Was the firearm registered with the Canadian Firearms Registry, or the province of Quebec's Service d'immatriculation des armes à feu (SIAF)?
Note: Canadian Firearms Registry includes verified firearms that are either restricted or prohibited and were registered by persons possessing a valid Possession and Acquisition Licence (PAL). Does not refer to non-restricted firearms.
Quebec's Service d'immatriculation des armes à feu (SIAF) refers to all non-restricted firearms.- Yes
- No
- Unknown
- Was the firearm sent for tracing?
- Yes
- No
- Unknown
- Where did the firearm originate from?
- Canada, individual
- Canada, business
- United States, individual
- United States, business
- Other foreign country, individual or business
- Unknown
- Did the charged / suspect chargeable (CSC) that discharged the fatal shot possess a valid firearms licence for the classification of firearm used in this incident?
- Yes
- No
- Unknown
- Did the victim have a suspected or known mental illness or a developmental disorder?
Note: This question refers to the investigating officer's assessment of the victim at the time of the incident, and is not a medical diagnoses.- Yes – Specify illness or disorder:
- No
- Unknown
- Did the victim have a suspected or known physical disability or limitation?
Note: This question refers to the investigating officer's assessment of the victim at the time of the incident, and is not a medical diagnoses.- Yes – Specify disability or limitation:
- No
- Unknown
- Had the victim consumed a substance such as alcohol, drugs, or an intoxicating substance, during the period leading up to the incident?
Select all that apply.- Alcohol consumed
- Drugs consumed
- Intoxicating substance consumed, e.g., inhalant
- OR
- The victim did not consume alcohol, drugs or an intoxicating substance
- OR
- Information not available, e.g., medical examiner or Coroner's report results not received
- OR
- Unknown
- Was the victim first to use, or threaten to use, physical force or violence in this incident?
- Yes
- No
- Unknown
- 48. What was the relationship between the closest charged / suspect-chargeable (CSC) and the victim?
Note: The relationship is in the direction of CSC to the victim. If more than one CSC is identified in this incident, select the relationship type of the closest CSC to the victim. For the purposes of the Homicide Survey, the relationship types are organized here within a hierarchy beginning with the closest relationships, e.g., married spouse, to the furthest, e.g., stranger.
Select only one.- Spouse
- Married spouse
- Common-law spouse, i.e., living together as a couple but who are not legally married to each other
- Separated married spouse (not living common law)
- Separated common-law spouse
- Divorced spouse (not living common law)
- Family member (non-spouse)
- Parent
- Step-parent
- Child
- Step-child
- Sibling (including step sibling)
- Extended family member, e.g., in-law, niece/nephew, grandchild, aunt/uncle
- Intimate partner (non-spouse)
- Intimate partner, e.g., boyfriend or girlfriend
- Ex-intimate partner, e.g., ex-boyfriend, ex-girlfriend
- Extra-marital intimate partner
- Other intimate partner
- Acquaintance
- Close friend
- Casual friend
- Family friend
- Roommate, i.e., non-family or intimate partner
- Other household member, i.e., non-family or intimate partner, e.g., boarders
- Temporary house guest, e.g., room rental guest, or other overnight guest
- Intimate partner of a family member (includes ex-partners)
- Neighbour
- Business relationship (legal), e.g., landlord, tenant, colleagues, business co-owners
- Authority figure, e.g., teacher, doctor, babysitter, coach, clergy, nurse
- Reverse authority figure, e.g., student-to-teacher, patient-to-doctor / nurse, child-to-babysitter
- Criminal relationship, e.g., drug trafficker to drug user, customer to sex trade worker, organized crime / street gang affiliation
- Co-substance user, e.g., relationship based solely on co-substance use
- Co-institutional facility member, e.g., co-inmate, co-resident of a long-term care facility
- Other acquaintance
- Other person
- Other relationship type – Specify relationship type:
- Stranger (include where the closest CSC was known to the victim for less than 24 hours before their death)
- Unknown
- Who is the closest charged / suspect-chargeable (CSC) to this victim?
Note: In cases where two CSCs share the same type of closest relationship to the victim, e.g., both CSCs are the victim's parents, select the CSC whom most contributed to the homicide of the victim, according to the investigation, e.g., the CSC who used the primary weapon, or who was most involved in the events leading up to the homicide.- Only 1 CSC identified in this incident
- Closest CSC (if more than one identified in the incident):
- CSC Number
- CSC Surname
- CSC Given name 1
- No CSC identified, i.e., incident is not cleared – Go to end of survey
- Was there a history of family or intimate partner violence involving this victim and the closest charged / suspect-chargeable (CSC) identified in the incident?
Note: Refers to a history of violence between the closest CSC to this victim. Applies to where the relationship was reported in question 48 as: spouse, family (non-spouse), or intimate relationship (non-spouse).- Yes
- No
- Unknown
- Was there an active order preventing contact between the closest charged / suspect-chargeable (CSC) and the victim at the time of the incident?
e.g., peace bond, restraining order, protection order- Yes
- No
- Unknown
Thank you for your cooperation.