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date of earthquake:
approximate time:
location of the observer:
observer’s contact details (optional):

felt inside houses by:	I don’t know no one very few people (less than 10%) few people (from 10 to 25%) many people (from 25 to 50%) most people (more than 50%)
felt outside by:	I don’t know not felt outside very few people (less than 10%) few people (from 10 to 25%) many people (from 25 to 50%) most people (more than 50%)
Did it wake those who were asleep?:	I don’t know no one very few people (less than 10%) few people (from 10 to 25%) many people (from 25 to 50%) most people (more than 50%)
Did they go out onto the street?:	I don’t know no one went out very few people (less than 10%) few people (from 10 to 25%) many people (from 25 to 50%) most people (more than 50%)
Did some people lose their balance?:	I don’t know no one very few (less than 10%) few people (from 10 to 25%) many people (from 25 to 50%) most people (more than 50%)
Movement of hanging objects (wall lamps, pictures):	I don’t know no slight rocking rocking good degree of rocking
Crockery and glasses:	I don’t know nothing happened to them rattled crashed into each other broke
Movement or falling of supported objects (picture frames, pottery):	I don’t know or no movement occurred one or two moved or fell many fell
Furniture:	I don’t know or nothing happened to them visibly vibrated they moved slightly they moved or overturned furniture, televisions, computers fell over
Doors and windows:	I don’t know or nothing happened to them rattled opened and closed by themselves windows broke
Liquids:	I don’t know or nothing happened to them spilled over from full containers general splashing
Reaction of animals:	I don’t know, or they did nothing strange they were frightened
Type of building you were in:	I don’t know I was outside in a building made of stone a building with a concrete structure a building with a steel structure
the floor you were on:	I don’t know I was outside lower than the fourth floor on the fourth floor on the fifth floor above the fifth floor
Other observations: