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Driver's Name - Last DILLARD |
First TERESA |
Middle ANN |
Suffix
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City PACIFIC JUNCTION |
State IA - Iowa, US |
Zip 51561 |
Driver's Age 57 |
Citation Charge Code 1 321.288 |
Citation Charge 1 FAIL TO MAINTAIN CONTROL |
Gender Female |
State IA - Iowa, US |
Class C - Non-commercial vehicle or commercial Veh w/26000 GVWR or less & either 16 Pass Design or Hazmat |
Endorsements N - Tank |
Restrictions
None |
Citation Charge Code 2 321J.2(2)(A) |
Citation Charge 2 OWI IST |
Alcohol Test Given? 1 - None |
Drug Test Given? 3 - Urine |
Citation Charge Code 3
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Citation Charge 3
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Citation Charge Code 4
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Citation Charge 4
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Seating Position 01 - Front: Left Side / Motorcycle Driver |
Injury Status 4 - Possible |
Occupant Protection 2 - Shoulder and lap belt used |
Airbag Deployment 1 - Deployed front of person |
Airbag Switch Status 1 - Switch in ON position |
Ejection 1 - Not ejected |
Ejection Path
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Trapped 2 - Freed by non-mechanical means |
Transported to: N/A |
Transported by: N/A |
Insurance Co. Name
|
Year 1996 |
Make Ford - FORD |
Model CROWN VICTORIA |
Style 4 DOOR |
Approximate Cost to Repair or Replace 5000 |
Initial Travel Direction 3 - South |
Vehicle Action 01 - Movement essentially straight |
Speed Limit 55 |
Point of Initial Impact 01 - Front |
Most Damaged Area 01 - Front |
Extent of Damage 3 - Functional damage |
Underride/Override 1 - None |
Total Occupants 01 |
Traffic Controls 11 - Workzone signs |
Vehicle Config. 01 - Passenger car |
Cargo Body Type 01 - Not applicable |
Vehicle Defect 01 - None |
Driver Condition 5 - Asleep, fainted, fatigued, etc |
Vision Obscured 01 - Not obscured |
Contributing Circumstances, Driver (up to 2)
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SEQUENCE OF EVENTS |
First Event 01 - Ran off road, right |
Second Event 26 - Other non-fixed object (explain in narrative) |
Third Event
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Fourth Event
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Most Harmful Event (by vehicle) 01 - Ran off road, right |
Emergency Vehicle Type 1 - Not applicable |
Emergency Status 3 - Not Applicable |
Carrier Name
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City
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State
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Zip
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Number of Axles
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Gross Vehicle Weight Rating
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Placard #
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Hazardous Materials Released?
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