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Aardbevingen
Enquêteformulier aardbeving...
Questionnaire earthquakes in the Netherlands
Date of the earthquake
Time of earthquake
City
Street
House number
Island
Your e-mail address
The following questions are optional but help us to establish the intensity of the earthquake
Did you feel it?
No
Yes
What was your situation during the earthquake?
Please select
Not specified
Inside a building
Outside a building
In a stopped vehicle
In a moving vehicle
If you were inside, in what kind of building?
Please select
No building
Store/school/factory
Appartment
House
Other
What is the building made of?
Please select
Not specified
Masonary with foundation
Masonary no foundation
Wood no foundation
Wood with foundation
Which floor where you?
Please select
Ground floor
First floor
Second floor
Third floor
Cellar
Other
Were you asleep?
No
Yes
Did others nearby feel it?
Please select
Not specified
No others felt it
Some felt it, most did not
Most felt it
Everyone/almost everyone felt it
How would you describe the shaking?
Please select
Not specified
Not felt
Weak
Mild
Moderate
Strong
Violent
How many seconds did it last?
How would you describe your reaction?
Please select
Not specified
No reaction/not felt
Very little reaction
Excitement
Somewhat frightened
Very frightened
Extremely frightened
How did you respond?
Please select
Not specified
Took no action
Moved to doorway
Dropped and covered
Ran outside
Was it difficult to stand and/or walk?
Please select
Not specified
No
Yes
Did you notice any swinging of doors or other free-hanging objects?
Please select
Not specified
No
Yes, slight swinging
Yes, violent swinging
Did you hear creaking or other noises?
Please select
Not specified
No
Yes, slight noise
Yes, loud noise
Did objects rattle, topple over, or fall off shelves?
Please select
Not specified
No
Rattled slightly
Rattled loudly
A few toppled or fell off
Many fell off
Nearly everything fell off
Did pictures on walls move or get knocked askew?
Please select
Not specified
No
Yes, but did not fall
Yes, and some fell
Did any furniture or appliances slide, topple over, or become displaced?
Please select
Not specified
No
Yes
Was a heavy appliance (refrigerator or range) affected?
Please select
Not specified
No
Yes, some contents fell out
Yes, shifted by inches
Yes, shifted by a foot or more
Yes, overturned
Were free-standing walls or fences damaged?
Please select
No
Not specified
Yes, some partially fell
Yes, some were cracked
Yes, some fell completely
Was there any damage to the building?
No damage
Hairline cracks in walls
A few large cracks in walls
Many large cracks in walls
Ceiling tiles or lighting fixtures fell
Cracks in chimney
One or several cracked windows
Many windows cracked or some broken out
Masonry fell from block or brick wall(s)
Old chimney, major damage or fell down
Modern chimney, major damage or fell down
Outside wall(s) tilted over or collapsed completely
Separation of porch, balcony, or other addition from building
Building permanently shifted over foundation
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