By completing this questionnaire, you help the Swiss Seismological Service collect critical information regarding the felt extent of an earthquake, and the effect of the earthquake on the built environment. This information also provides Scientists with a better understanding of the earthquake risk in Switzerland.

We request that you complete the questionnaire even if you did not feel the earthquake - this information is also important. Thank you very much for you cooperation.

Please note the e-mail addresses on this list will not be used for any other purpose, nor re-distributed.

Location and time of the observation


Date of the earthquake*:
(dd.mm.yyyy; e.g.: 03.04.2001)
Local Swiss Time*:
(hh:mm; e.g.: 21:48)

Name:

Location during the earthquake

Street: Nr:
Postal code*:
Town*:
Country:

(* must be filled)

I.  Effects on persons

1a.
Your position during the earthquake:
1b.
If inside a building, which floor were you on?
2.
What were you doing as the earthquake began?
3a.
How strongly did you feel the earthquake?
3b.
What type of motion did you feel?
3c.
Did other people in your immediate environment feel the earthquake?
4.
How did you react to the earthquake?
I did not react
I was surprised
I was woken up
I was frightened
I had problems maintaining my balance
I ran outside
I panicked

II. Effect of the earthquake on objects and surroundings

1.
Hanging objects (Lamps, pictures, etc.):
2.
China, glass:
3.
Windows, doors:
4.
Windows:
shattered
5.
Timber:
creaking, cracking
6.
Small, easily movable objects (single books, vases, etc.):
7.
Small, stable objects (e.g. books in shelfs):

8.
Light furniture:
9.
Heavy Furniture:
10.
Large objects (TV, computer, etc.):
overturned
11.
Liquids in full / nearly full containers:
12.
Liquids in large containers, tanks, pools:
13.
Tombstones:
shifted, rotated, overturned
14.
waves in the ground (if outside):
15.
Monuments, columns:

III. Effects of the earthquake on animals

1.
Animals indoors:
2.
Animals outdoors:

IV.  Effects of the earthquake on buildings

1a.
Type of building:
1b.
Use of building:
2.
Degree of damage (please select highest level of damage):

V.  Remarks

(Please add any additional information you feel is relevant, including other observations such as changes in the level of water wells, cracks in the ground, soil liquefaction / sand boils, landslides, noises and other phenonenom associated with the earthquake (including electromagnetic or light effects).

Do you have any questions about this earthquake in particular, or earthquakes in general? After you submit this form, you will be forwarded to a page with additional information.