Earthquake Felt Report

Name (optional)
Phone (optional)
E-mail address (optional)

Date you felt the earthquake:

Month January February March April May June July August September October November December   Day:

Time you felt the earthquake:

Hour:   Minute:    AM/PM AM PM

Was this event felt at the above location?

1. Yes
2. No
3. No Answer

Please indicate your location when the earthquake occurred:

Street Address:
Nearest Cross Streets:
County:
City:
State:
Zip Code:

If felt, how strong was the shaking?

1. Weak
2. Mild
3. Moderate
4. Strong
5. Violent
6. No Answer

How many seconds did the shaking last?

Where were you when you felt the earthquake?

1. Inside
2. Outside
3. Driving
4. Other, describe:
5. No Answer

If inside, select the type of building:

1. Single Family Home or Duplex
2. Apartment Building
3. Office Building
4. Mobile Home with Permanent Foundation
5. Trailer or Recreational Vehicle with No Foundation
6. Other, describe:
7. No Answer

Were you asleep when the earthquake occurred?

1. Yes
2. No
3. No Answer

If yes, did the earthquake awake you?

1. Yes
2. No
3. No Answer

What was your reaction to the earthquake?

1. Panic
2. Very frightened
3. Somewhat frightened
4. Excitement
5. Very little reaction
6. Not felt
7. No Answer

Do you have any additional comments on how you reacted:

How did you respond to the earthquake?

1. Ran outside
2. Ducked and covered
3. Moved to doorway
4. Took no action
5. No Answer

Do you have any additional comments on how you or those around you responded:

Was it difficult to stand or walk?

1. Yes
2. No
3. Did not try
4. No Answer

Did you notice swinging of doors or swaying of hanging objects?

1. Yes
2. No
3. No Answer

Did you notice any noise such as creaking of walls or doors?

1. Yes
2. No
3. No Answer

Did objects topple over or fall off of shelves?

1. Yes
2. No
3. No Answer

If yes, which of the following best describes how many objects fell?

1. Just a few
2. Many
3. Everything
4. No Answer

Did pictures on walls move or get knocked askew?

1. Yes
2. No
3. Did not notice
4. No Answer

Did any furniture or heavy appliances slide, tip over, or become displaced?

1. Yes
2. No
3. Did not notice
4. No Answer

If yes, did any of these items slide more than 1 foot?

1. Yes
2. No
3. No Answer

If you were inside, was there any damage to the building?

1. Yes
2. No
3. Not sure
4. No Answer

If yes, check all of the following that occurred:

• Just a few very minor cracks
• Numerous cracks in walls or ceilings
• Numerous cracks in floors or foundation
• Chimney cracks
• Major chimney damage
• Building moved off foundation
• Major damage to foundation
• Broken windows
• Toppled block or brick wall
• Broken pipes
• Collapse of wall or ceiling
• Separation of porch, addition or balcony from building

Describe the type of building construction (for example, wood or brick):

Describe any other effects of shaking not covered above:

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