Cuestionario macrosísmico

Please fill in this questionnaire.
Even if you did not feel the earthquake, your report is very useful. Thank you for you contribution.
(*) Required field
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Your location during the earthquake

(*) Country:  
(*) Province/Distrito/Région:  
(*) Municipality/Concelho/Département:  
(*) Neighborhood/district/Freguesia/Commune:  
(*) Province/ Country:  
(*) Postal code:  
Outdoors Indoors. On the      st/ nd/ rd/ th floor of a - storey building   In a vehicle Other
Moving Stopped Asleep

How did you feel the earthquake?

(*) Did you feel the earthquake?    No   Yes Did you hear any sound?    No   Yes
(*) Date of earthquake   At what time?   If you felt more than one tremor, please specify:  

How would you best describe the shaking during the earthquake?

No shaking Mild Strong
Weak Moderate Violent
Describe it if you want:

How did you react during the earthquake?

No reaction Alarmed Very frightened
Very little Frightened Extremely frightened

Did you find it difficult to stand during the earthquake?

I wasn't standing No Yes

Did others near you feel the earthquake?

I don't know No one Some did; most didn't Most did; some didn't Everyone No one was sleeping
Indoors
Outdoors
Did people run outdoors frightened?
How many woke up?

Effects on objects

I don't know Nothing Slight swinging Considerable swinging
Hanging lamps
Liquids
I don't know Nothing Rattled slightly Rattled loudly A few toppled over or fell off Many fell off Nearly everything fell off
Objects on shelves
Specify the objects if you like:
I don't know Nothing Rattled slightly Moved Some fell off
Pictures on walls
I don't know Nothing Rattled slightly Open windows/doors shook Opened or closed
Doors and windows
I don't know Nothing Rattled slightly Shifted Overturned
Furniture or appliances

Damage

Were any buildings damaged in your area? I don't know No Yes
Hairline cracks in walls Many windows cracked Ceiling tiles or lighting fixtures fell
A few large cracks in walls Cracks in chimneys Masonry fell from block or brick walls
Many large cracks in walls Major damage to old chimneys Outside walls tilted over or collapsed
Small pieces of plaster fell Major damage to modern chimneys Separation of porch, balcony, or other addition from building
Fairly large pieces of plaster fell Old chimneys fell down Building moved over foundation
Some windows cracked Modern chimneys fell down

¿Los daños fueron en el edificio en el que se encontraba o en otros de esa localidad/barrio?:

Would you like to add any comment or clarification?

If there were any damages, effects on natural surroundings or want to make any other comment or observation, please include it here: