What is your name?

Answer this question
Your location when the earthquake occurred. This will help us accurately locate this event(Please locate your State and City): What was your situation during the earthquake?: If you were inside please write type of building: Did you feel the earthquake? (If you were asleep, did the earthquake wake you up?) : Yes/No Did others nearby feel the earthquake?: How would you best describe the ground shaking?: Not Felt/Weak/Mild/Moderate/Strong/Violence About how many seconds did the shaking last?: How would you best describe your reaction?: How did you respond?: Was it difficult to stand or walk?: No answer/Did not look/No/Yes, slight swinging/Yes, violent swinging Creaking or other noises?: No answer/Did not pay attention/No/Yes, slight noise/Yes, loud noise/ Did objects rattle, topple over, or fall off shelves?: No answer/No shelves/No/Rattled slightly/Rattled loudly/A few toppled or fell off/Many fell off/Nearly everything fell off Did pictures on walls move or get knocked askew?: No answer/No pictures/No/Yes, but did not fall/Yes, and some fell Did furniture or appliances slide, tip over, or become displaced? No answer/No furniture/No/Yes Was a heavy appliance (refrigerator or range) affected? No answer/No heavy appliance/No/Yes, some contents fell out/Yes, shifted by inches/Yes, shifted by a foot or more/Yes, overturned Were free-standing walls or fences damaged?: No answer/No walls/No/Yes, some were cracked/Yes, some partially fell/Yes, some fell completely If you know the type of building (wood, brick, etc.) and/or your location (which story, basement, penthouse, etc.) please indicate here: If you were inside, was there any damage to the building? Check all that apply. No damage: Yes/No Hairline cracks in walls:Yes/No A few large cracks in walls:Yes/No Many large cracks in walls:Yes/No Ceiling tiles or lighting fixtures fell:Yes/No Cracks in chimney:Yes/No One or several cracked windows:Yes/No Many windows cracked or some broken out:Yes/No Masonry fell from block or brick wall(s):Yes/No Old chimney, major damage or fell down:Yes/No Modern chimney, major damage or fell down:Yes/No Outside wall(s) tilted over or collapsed completely:Yes/No Separation of porch, balcony, or other addition from building:Yes/No Building permanently shifted over foundation:Yes/No
E-mail address?