Your location at the time of the earthquake
Name*
E-Mail ID*
City/Town/Village*
Locality*
Province/State:
select province
Ayeyarwady
Bago
Chin
Kachin
Kayah
Karen
Magway
Mandalay
Mon
Rakhine
Sagaing
Shan
Tanintharyi
Yangon
When did the earthquake occur?
Local Date*
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3
4
5
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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?
