Were you asleep during the earthquake?
No
Yes, and I slept through it
Yes, and it woke me up
Did others nearby feel it?
I don't know/No one else was nearby
Nobody else felt it
Some felt it, most did not
Most felt it
Everyone felt it
Your experience during the earthquake:
How would you best describe the shaking?
I didn't feel it
Weak
Light
Moderate
Strong
Violent
Approximately, how many seconds did the shaking last?
How would you best describe your reaction?
No reaction/Didn't feel it
Small reaction
On guard/Excited
Somewhat frightened
Very frightened
Extremely frightened
How did you respond?
I took no action
I moved to a doorway
I dropped and covered
I ran outside
Other
Was it difficult to stand and/or walk?
No
Yes
Effects of the Earthquake:
Did you notice any swinging/swaying of doors or other free-hanging objects?
No
Yes, a slight swing
Yes, a violent swing
Did you hear creaking or other noises?
No
Yes, I could hear slight noise
Yes, the building made noticeable noise
Yes, the building made strong noise
Did objects rattle, topple over or fall off shelves?
It wasn't noticable
Rattled slightly
Rattled strongly
Some objects were toppled over/fell off shelves
Many objects toppled over/fell off shelves
Nearly everything fell off.
Did pictures on walls move or get knocked askew?
No
Yes, but they did not fall off
Yes, and some fell off
Did any furniture or appliances slide, topple over or otherwise become displaced?
No
Yes
Was a heavy appliance (refrigerator or range) affected?
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
Yes, some were cracked
Yes, some partially fell
Yes, some fell completely
Additional Comments:
If you know the type of terrain on which the structure was built on, please indicate it here: