Your location at the time of the earthquake
Name*
E-Mail ID*
City/Town/Village*
Locality in
City/Town/Village *
Postcode*
Dzongkhag:
select dzongkhag
Bumthang
Chhukha
Chirang
Dagana
Gasa
Geylegphug
Ha
Luntshi
Mongar
Paro
Pema Gatsel
Punakha
Samchi
Samdrup Jongkhar
Shemgang
Tashigang
Thimphu
Tongsa
Wangdo Phodrang
When did the earthquake occur?
Local Date*
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1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
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Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Local Time*
Please describe your experience of the shaking:
Did you feel it?
Duration of
shaking:
I was:
No Answer
indoors - Asleep, did not awake
indoors - Awake, at rest (sitting etc.)
indoors - Asleep, woken up by shaking
indoors - Walking or other
outdoors - At rest
outdoors - Walking or other
outdoors - Driving
If indoors, which
storey/floor:
Shaking felt like:
No Answer
sensation of dizziness, no vibrations
sensation of dizziness, then mild vibrations
light trembling or swaying motion of self
light trembling or swaying motion of building / furniture
strong shaking or rocking of building / furniture
very strong, slightly difficult to walk
very strong, difficult to walk / drive
severe, thrown to the ground / unable to move
Others near me :
did not feel it
some felt it, but most did not
many felt it, a few did not
everyone felt it
Please describe the effects the earthquake had on your
surroundings
Hanging
objects:
No Answer
Did not move
Did not notice
Slight, gentle swinging
Shook considerably
eg.
ceiling fans, etc.
Light
furniture / small items:
No Answer
Did not move
Did not notice
Shook visibly
Moved / shifted
Overturned / fell
eg. chairs ,
bottles, etc.
Heavy
furniture / large items:
Did not move
No Answer
Did not notice
Shook visibly
Moved / shifted
Overturned / fell
eg. cupboards, refrigerator,
etc.
Automobiles:
No Answer
Did not move
Did not notice
Slight rocking
Shook visibly
Car alarms activated
Large
freestanding objects:
No Answer
Did not move
Did not notice
Slight, gentle swinging
Shook considerably
eg. streetlights , , etc.
Water:
Not disturbed
No Answer
Did not notice
Disturbed slightly in aquariums, containers, etc.
Splashes/large ripples in aquarium, containers, etc.
Disturbed slightly in pools, lakes, etc.
Splashes/large waves in pools, lakes, etc.
Animals:
No reaction
No Answer
Indoors - uneasy
Indoors - frightened
Outdoors - uneasy
Outdoors - frightened
(only during the earthquake )
Was there any
damage to the building you were in ?
Additional comments?
