REQUEST FOR EARTHQUAKE INFORMATION

Effects of Ground Shaking

We are requesting your assistance in gathering information on the pattern of ground shaking from significant earthquakes. This information will help us to better understand both the effects of specific earthquakes and how your area will respond to future earthquakes.

You can help by filling out the questionnaire below. Even if you did not feel the earthquake, but were in the general region of the epicenter, please respond!

One of the most useful pieces of information for this earthquake will be the percentage of persons who felt it in different communities. Please be as specific as you can about where you were during the earthquake. In order for your answers to be useful we need to be able to locate on a map where you were at the time of the earthquake. Therefore, it is important to supply the address of your location at the time you felt (or didn't feel) the earthquake. The Zip Code is very important.

Again, we need replies from people who didn't feel the earthquake as well as those who did.

All of the information is confidential and will only be used to determine the pattern of ground shaking.

Name (optional):
Phone (optional)

Date and Approximate Time when earthquake was felt

(Example: 2000 JAN 2 at 9:23 AM)
Year: Month: Day:
Hour: Minute: am/pm: Local Time

Your location when the earthquake occurred:

Street Address:
Nearest Cross Streets:
County:

City: State: Zip Code:

Your Reaction to the Earthquake

How strong was the shaking?
  • Not Felt
  • Weak
  • Mild
  • Moderate
  • Strong
  • Violent
  • If the earthquake was felt, how many seconds did the shaking last?

    • Where were you during the earthquake?

  • Inside building or structure
  • Outside building or structure
  • Driving
  • Other
  • If Other, describe:

    • Were you asleep when the earthquake occurred?

  • Yes
  • No

    • If yes, did the earthquake awake you?

  • Yes
  • No
    • What was your reaction to the earthquake?
  • Panic
  • Very frightened
  • Somewhat frightened
  • Excitement
  • Very little reaction
  • Not felt
    • How did you respond to the earthquake?
  • Ran outside
  • Ducked and covered
  • Moved to doorway
  • Took no action

    • Was it difficult to stand or walk?

  • Yes
  • No
  • Did not try to stand

    • Effects on a Building or Structure you were in during the Earthquake

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

  • Yes
  • No
    • Did you notice any noise such as creaking of walls or doors?
  • Yes
  • No

    • Did objects topple over or fall off of shelves?

  • None
  • Just a few
  • Many
  • Everything

    • Did pictures on walls move or get knocked askew?

  • Yes
  • No
  • Did not notice

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

  • No
  • Yes, but slid less than 1 foot
  • Yes, lots of motion

    • Damage to the Structure of the Building where you were Located

    Was there damage to the building where you were located?

  • Yes
  • No
  • Not sure
    • If there was damage, check all of the following that occurred:

    Select the type of building or structure:

  • Single Family Home or Duplex
  • Apartment Building
  • Office Building
  • Mobile Home with Permanent Foundation
  • Trailer or Recreational Vehicle with No Foundation
  • Other
  • If other, describe:

    • In a few Words Describe the type of Building Construction (for example, wood frame, brick, reinforced concrete):

    Describe any other effects of shaking not covered above:

    If you do not like your answers, click here to clear the entire form and start over:

    To submit your completed form and record your answers, press this button once:

    Report any problems via e-mail to seis_info@ess.washington.edu