You can help provide information about the extent of shaking and damage for
earthquakes in the United States, and you may provide specific details
about how your area may respond to future earthquakes.
USGS scientists may use the information you enter in this form to provide
qualitative, quantitative, or graphical descriptions of damage in USGS
publications. If you would object to this possible usage of your data,
please do not fill out this form.
Your ZIP code is REQUIRED! (If you are NOT in the US, please use the non-US earthquake reporting form.)
All other identifiers (name, e-mail, phone, and location) are optional, but we need your ZIP code to locate the
intensity in your area. The other data may be critical for further resampling, if needed.
Identifying information (optional):
Name:
E-mail:
Phone:
Since you are submitting this form for a new or unknown earthquake, please fill out the following information completely. This will help us accurately locate this event.
Your location when the earthquake occurred:
Street Address:
Nearest Cross Street:
City:
County:
State/Possession:
Country: United States
Zip Code: REQUIRED!
(Don't know your zip code at the time of the earthquake? Look it up!
Not in the US? Use this form.)
Date of earthquake
Month:
Day:
Year:
Time of earthquake
Hour:
Minute:
While answering all these questions is optional, we encourage you to fill out as many as possible so we can provide a more accurate intensity
estimate.
What was your situation during the earthquake? If you were inside please select the type of building or structure:
If other, please describe:
Were you asleep during the earthquake? Did you feel the earthquake? (If you were asleep, did the earthquake wake you up?)
No
Yes
Did others nearby feel the earthquake?
Your experience of the earthquake:
How would you best describe the ground shaking? About how many seconds did the shaking last? How would you best describe your reaction? How did you respond? (Select one.)
If other, please describe: Was it difficult to stand or walk?
Earthquake effects:
Did you notice the swinging/swaying of doors or hanging objects? Did you notice creaking or other noises? Did objects rattle, topple over, or fall off shelves? Did pictures on walls move or get knocked askew? Did any furniture or appliances slide, tip over, or become displaced? Was a heavy appliance (refrigerator or range) affected? Were free-standing walls or fences damaged?
If you were inside, was there any damage to the building? Check all that apply.
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
If you know the type of building (wood, brick, etc.) and/or your location (which story, basement, penthouse, etc.) please indicate here:
Additional Comments:
You may use the next box to clarify answers or to make observations that are not accommodated
by other questions. You may also use the following box to give first-person descriptions of how the
earthquake affected you. USGS scientists may use some of the information that you enter in qualitative
descriptions of shaking or damage in USGS publications. You would be identified as "an observer" and your
location would be given in general terms. Parts of some first-person accounts may be reproduced as quotations
in USGS publications.
To submit your completed form, press this button:
Click here to clear the entire form and start over:
Thank you for completing this form. Please report any problems or corrections
via the comment form.
Information on this page last reviewed Feb. 11, 2003. General Disclaimer.
Paperwork Reduction Act Statement
This information is being collected to supplement instrumental data, and
to promote public safety through a better understanding of earthquakes.
Response to this request is voluntary. No action may be taken
against you for refusing to supply the information requested. A
Federal agency may not conduct or sponsor a collection of
information unless it displays a valid OMB control number.
Public reporting burden for this form is estimated to average 6 minutes
per response, including the time for reviewing instructions, gathering
and maintaining data, and completing and reviewing the form.
Comments regarding this collection of information should be directed
to: Bureau Clearance Officer, U.S. Geological Survery,
807 National Center, Reston, VA, 20192
