By filling out this questionnaire you are agreeing to participate in this study.
Your location when the earthquake occurred:
Street Address (or milepost):
City, State:
Zip code:
1. What was your situation during the earthquake?
- No answer
- Inside
- Outside
- In stopped vehicle
- In moving vehicle
- Other
2. If you were inside please select the type of building or structure:
- No building
- Single Family Home or Duplex
- Apartment Building
- Office Building/School
- Mobile Home with Permanent Foundation
- Trailer or Recr. Vehicle with No Foundation
- Other (please describe)
3. Were you asleep during the earthquake?
- No
- Slept through it
- Woke up
4. Did you feel the earthquake? (If you were asleep, did the earthquake wake you up?)
- No
- Yes
5. Did others nearby feel the earthquake?
- No answer/Don't know/Nobody else nearby
- No others felt it
- Some felt it, but most did not
- Most others felt it, but some did not
- Everyone or almost everyone felt it
6. How would you best describe the ground shaking?
- No description
- Not felt
- Weak
- Mild
- Moderate
- Strong
- Violent
7. About how many seconds did the shaking last?
___________
8. How would you best describe your reaction?
- No answer/Don't remember
- No reaction/Not felt
- Very little reaction
- Excitement
- Somewhat frightened
- Very frightened
- Extremely frightened
9. How did you respond?
- No answer/Don't remember
- Took no action
- Moved to doorway
- Ducked and covered
- Ran outside
- Other (please describe)
10. Was it difficult to stand or walk?
- No
- Yes
11. Did you notice the swinging/ swaying of doors or hanging objects?
- No answer/Did not look
- No
- Yes, slight swinging
- Yes, violent swinging
12. Did you notice creaking or other noises?
- No answer/Did not pay attention
- No
- Yes, slight noise
- Yes, loud noise
13. Did objects rattle, topple over, or fall off shelves?
- No answer/No shelves
- No
- Rattled slightly
- Rattled loudly
- A few toppled or fell off
- Many fell off
- Nearly everything fell off
14. Did pictures on walls move or get knocked askew?
- No answer/No pictures
- No
- Yes, but did not fall
- Yes, and some fell
15. Did any furniture or appliances slide, tip over, or become displaced?
- No answer/No furniture
- No
- Yes
16. Was a heavy appliance (refrigerator or range) affected?
- No answer/No heavy appliance
- No
- Yes, some contents fell out
- Yes, shifted by inches
- Yes, shifted by a foot or more
- Yes, overturned
17. Were free-standing walls or fences damaged?
- No answer/No walls
- No
- Yes, some were cracked
- Yes, some partially fell
- Yes, some fell completely