Felt Earthquake Report

You can help by completing the following questionnaire.  Although you may not have felt the quake, but you were in the general area of the epicenter, please answer (We want to know the areas where the quake was felt and also where the quake was not felt). Your answers will be used to map the distribution of seismic intensity.

It requires approximately LOCAL DATE & TIME when the quake was felt, your city and ZIP CODE !All other data (name, email and phone) are optional,but we need your Zip Code to determine the seismic intensity in your area.The other data will be useful to restrict further the different intensities in the places where the quake was felt.


*Date of earthquake

Month: Day: Year:
*Time of earthquake

Hour: Minute:


Name:
E-mail:
Telephone:
*Town/City: *Zip Code:


Your answer to the following questions is optional. However, your response to the maximum number of questions would help us to estimate more precisely the intensity of the earthquake.


Where you were during the earthquake?
If you were inside, select the type of building or structure:
Did you felt the earthquake?
No Sí

Were you asleep?

Did others feel it?

Your experience during the quake:

How would you best describe the shaking?
About how many seconds did the shaking last?



How whould you best describe your reaction?

How did you respond during the shaking?

Was it difficult to stand and/or walk?
No Sí

Earthquake Effects:

Did you notice any swinging/swaying of doors or other free-hanging objects?

Did you hear creaking or other noises?

Did objects rattle, topple over, or fall of shelves?

Did pictures on walls move or get knocked askew?

Did any furniture or appliances slide, topple over, or otherwise become displaced?
No Yes

Was a heavy appliance (refrigerator or range) affected?

Were free-standing walls or fences damaged?

If you were inside, Was there any damage to the building? Check all that apply.















Additional Comments:


Make sure you fill the form for proper earthquake!