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Felt A Quake Elsewhere?

India "Felt A Quake?" Questionnaire
This questionnaire is for an earthquake that you have felt in India, irrespective of your nationality or where the epicentre was located. If you felt an earthquake in another country please select the appropriate location in the drop-down menu next to the "Felt A Quake Elsewhere?" option above. The information you enter in this form, may be used to provide qualitative, quantitative, or graphical descriptions of damage on this website or in collaborative publications. If you would object to this possible usage of your data, please do not fill out this form. Finally, please consider filling out a questionnaire for other historic events that occurred in your region. Try and answer as many questions as possible. All required fields are underlined & in red!

Start Questionnaire

Name:

E-Mail ID:

Where did you feel the earthquake?

Location:		Pin Code:		State/U.T.:
	eg. Pune		eg. 411001

What time did the earthquake occur?

Day	Month	Year	Time

			eg. 21:15 IST

Describe Your Experience

Did you feel it?

Yes, I felt it.

No, I did not.

Tremors lasted

(please append seconds or minutes)

I was

Which storey if indoors

Shaking felt like a

Others nearby

Effects on your surroundings

Hanging objects:

eg. ceiling fans, etc.

Light furniture / small items:

eg. chairs, bottles, etc.

Heavy furniture / large items:

eg. cupboards, refrigerator, etc.

Automobiles:

Large freestanding objects:

eg. lamp posts, trees, billboards, etc.

Water:

Animals:

(only during the earthquake)

Damage to Old Buildings (A)		Damage to new Buildings (B)
	Hairline cracks in a few walls		Fine cracks above frames / along base of walls
	Small cracks in many walls		Fine cracks in infill walls / partitions
	Large, extensive cracks in many walls		Fall of cladding / plaster
	Falls of small pieces of plaster		Large cracks in infill walls / partitions
	Falls of large pieces of plaster		Cracks in columns / beams
	Roof tiles fall		Spalling of concrete / reinforced rods buckle
	Many walls collapse		Collapse of columns / entire upper floor
	Complete collapse of building		Collapse of ground floor / wings

Any Additional Comments?
You may use the next box to clarify answers or to make observations that are not accommodated by above questions. You may also use the following box to give first-person descriptions of how the earthquake affected you. Your information might be reproduced in a macroseismic report(s). You will be identified as "an observer" and your location would be given in general terms. Parts of some first-person accounts may also be reproduced as quotations

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