Delaware Geological Survey

Delaware Geological Survey
Earthquake Questionnaire

Please answer every question to the best of your ability. Either fill in the blanks where called for or check the response that best describes the event. If a question does not apply or if you don't know how to respond to a particular question, simply skip it and go on to the next. Feel free to add additional information in the Additional Comments box at the bottom of the form.

Name (optional):
Telephone (optional):
Home:
Work:

Date and time ( AM PM) you noticed the event.

Your location at time of earthquake (street address, building number, etc)

City, subdivision, development

Nearest road or highway intersection

The event was felt by:
yourself
several people
many people

At the time of the event, you were:
outdoors
indoors

You were:

walking
driving
standing		 sitting
sleeping
just awakening

Did you hear a noise accompanying the event?
yes
no

If a noise was heard, please describe:

If indoors, the building was a:
house
apartment
mobile home
store
office building
other:

If indoors, the building's construction was:
wood frame
brick
stone/masonry
steel; reinforced concrete
other:
don't know

If indoors, you were on the:
basement
ground floor
second floor
other:

If indoors, you felt the building shake or move:
not at all
faintly
moderately
strongly
violently

The shaking motion was:
rapid
slow

How long did the shaking last?
seconds
minutes

The motion came from what direction?

N NE E SE S
SW W NW Not sure

Click in the boxes of all activities which happened:

  • Rattling of windows, doors, dishes, other

  • Hanging objects (doors, lamps, pictures, etc.) began to swing.

      If swinging occurred, the direction of motion was:

      N NE E SE S
      SW W NW Not sure

  • Pendulum clock stopped.

      Pendulum clock faces:

      N NE E SE S
      SW W NW Not sure

  • Small objects, furnishings, other were shifted.

  • Overturned vases, small objects, furnishings, other

  • Cracked plaster, window, mirrors, walls, chimneys, sidewalks, ground,
    other

Have you ever noticed an earthquake in the area before?
yes
no
If so, please give approximate date and time:

Please use this space for any additional comments or questions:


Delaware Geological Survey © 2007
http://www.dgs.udel.edu