Earthquake Risk Assessment Questionnaire

Earthquake Risk Assessment Questionnaire
Please complete this questionnaire to help assess the earthquake risk of your property or building.
Property Owner's Full Name
First NameLast Name
Contact Email Address
example@example.com
Property Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Year of Construction
Building Type
Other
Number of Floors
Structural Assessment
Rows Condition Retrofitted for Earthquake
Foundation
Walls
Roof
Distance to Nearest Known Fault Line (km)
Has this property experienced earthquake damage before?
Earthquake Preparedness Measures (select all that apply)
Other
How would you rate your building's overall earthquake safety?
Additional Comments or Concerns
Should be Empty:

Select theme: