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You can help us to define the extent of shaking and damage for earthquakes in Belgium, and you may provide specific details about how your area may respond to future earthquakes.

ROB scientists may use the information you enter in this form to provide qualitative, quantitative, or graphical descriptions of damage in their publications, but your personnal data will not be used. Should you object to this possible usage of your data, please do not fill out this form.

Your zip code is required to locate the intensity in your area. All other identifiers (name, e-mail, phone, and location) are optional, but may be critical for a more local evaluation.

If you have information about more than one site, please complete as many form as needed.

QUESTIONNAIRE FOR A NEW EVENT

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Name Max. 40 characters

E-mail

Phone

Date and time of the earthquake (approximate)

Date

Time

Your location when the earthquake occurred

CountryPlease choose a country Belgium France United Kingdom Nederland Duitsland Grand Duché du Luxembourg Your country is not in the list, please contact your local seismological center.

Zip code

City Max. 100 characters

Street, Address Max. 60 characters

Your situation when the earthquake occurred

What was your situation during the earthquake?

No answer Inside Outside In stopped vehicle In moving vehicle Other

If you were inside, please select the type of building or structure

No Building Family Home Apartment Building Office Building/School Mobile Home with Permanent Foundation Trailer or Recr. Vehicle with No Foundation Other

If you know the floor, please specify it

-10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100

If other, please describe

Max. 120 characters

Perception of the earthquake

Were you asleep during the earthquake?

No Yes, and I slept through it Yes, but I woke up

Did you feel the earthquake?

No

Yes

Did you hear a noise?

No Yes, Light and brief noise Yes, Light and prolonged noise Yes, Strong and brief noise Yes, Strong and prolonged noise

Did other persons nearby feel the earthquake?

No answer - Don't know - Nobody else nearby No other person felt it Some felt it, but most did not Most others felt it, but some did not Everyone or almost everyone felt it

Your experience of the earthquake

How would you best describe the ground shaking?

No description Not felt Weak Mild Moderate Strong Violent

About how many seconds did the shaking last?

No answer 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60

How would you best describe your reaction?

No answer - Don't remember No reaction - Not felt Very little reaction Excitement Somewhat frightened Very frightened Extremely frightened

How did you respond? (Select one.)

No answer - Don't remember Took no action Moved to doorway Ducked and covered Ran outside Other

Was it difficult to stand or walk?

No answer - Did not try No Yes, difficult to stand Yes, I was fallen Yes, I was forcibly thrown to the ground

Earthquake effects on the furniture and the buildings

Did you notice the swinging or swaying of doors or hanging objects?

No answer - Did not look No Yes, slight swinging Yes, violent swinging

Did you notice creaking or other noises?

No answer - Did not pay attention No Yes, slight noise Yes, loud noise

Did objects rattle, topple over, or fall off shelves?

No answer - No shelves 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?

No answer - No picture No Yes, but did not fall Yes, and some fell

Did any furniture or appliances slide, tip over, or become displaced?

No answer - No furniture No Yes

Was a heavy appliance (refrigerator or range) affected?

No answer - No heavy appliance No Yes, some contents fell out Yes, shifted by inches/cm Yes, shifted by a foot or more (>30cm) Yes, overturned

Were free-standing walls or fences damaged?

No answer - No walls No Yes, some were cracked Yes, some partially fell Yes, some fell completely

If you were inside, was there any damage to the building? Was there any damage to the buildings nearby you? 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 shifted over foundation

If you know the type (wood, brick, etc.) and/or the height (in floors) of building please indicate here. Max. 80 characters

Additional comments

If you have some complementary observations, use the next box.

(Do not ask questions here. Use the email)

Max. 5000 characters

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