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Questionnaire for an earthquake you felt in Nepal

Please use this questionnaire to report an earthquake you have felt in Nepal. If you felt an earthquake in another country, please start over by returning to the previous page. Fields marked by a red asterisk (*) are mandatory.


Your location at the time of the earthquake

Name*:
E-Mail ID*:
City/Town/Village*:
e.g. Kathmandu
Locality*:
e.g. Durbar Square
Postcode*:
Zone:

When did the earthquake occur?

Local Date*:
Local Time*:

Please describe your experience of the shaking:

Did you feel it?
Yes. I felt it No, I did not feel it.
Duration of shaking: (please indicate if in seconds or in minutes)
I was:
If indoors, which storey/floor:
Shaking felt like:
Others near me :

Please describe the effects the earthquake had 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. streetlights, trees, etc.

Water:

 
Animals:
  (only during the earthquake)

Was there any damage to the building you were in?

Additional comments?

No apparent damage

Hairline cracks in a few walls

Small cracks in many walls

Large, extensive cracks in many walls

Falls of small pieces of plaster

Falls of large pieces of plaster

Roof tiles fall

Walls collapse

Roofs collapse

Complete collapse of building

 

 

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