U
N
I
T
2
|
Driver's Name - Last PLACE |
First JACOB |
Middle WILLIAM |
Suffix
|
City HUMBOLDT |
State IA - Iowa, US |
Zip 50548 |
Driver's Age 20 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender Male |
State IA - Iowa, US |
Class C - Non-commercial vehicle or commercial Veh w/26000 GVWR or less & either 16 Pass Design or Hazmat |
Endorsements None |
Restrictions
B - Cor Lenses |
Citation Charge Code 2
|
Citation Charge 2
|
Alcohol Test Given? 1 - None |
Drug Test Given? 1 - None |
Citation Charge Code 3
|
Citation Charge 3
|
Citation Charge Code 4
|
Citation Charge 4
|
Seating Position 01 - Front: Left Side / Motorcycle Driver |
Injury Status 5 - Uninjured |
Occupant Protection 2 - Shoulder and lap belt used |
Airbag Deployment 5 - Not deployed |
Airbag Switch Status 1 - Switch in ON position |
Ejection 1 - Not ejected |
Ejection Path
|
Trapped 1 - Not trapped |
Transported to:
|
Transported by:
|
Insurance Co. Name
|
Year 2003 |
Make Chevrolet - CHEV |
Model IMPALA |
Style 4D |
Approximate Cost to Repair or Replace 1000 |
Initial Travel Direction 1 - North |
Vehicle Action 10 - Slowing/stopping |
Speed Limit 45 |
Point of Initial Impact 05 - Rear |
Most Damaged Area 01 - Front |
Extent of Damage 2 - Minor damage |
Underride/Override 1 - None |
Total Occupants 01 |
Traffic Controls 04 - Stop signs |
Vehicle Config. 01 - Passenger car |
Cargo Body Type 01 - Not applicable |
Vehicle Defect 01 - None |
Driver Condition 1 - Apparently normal |
Vision Obscured 01 - Not obscured |
Contributing Circumstances, Driver (up to 2)
|
| SEQUENCE OF EVENTS |
First Event 21 - Vehicle in traffic |
Second Event
|
Third Event
|
Fourth Event
|
Most Harmful Event (by vehicle) 21 - Vehicle in traffic |
Emergency Vehicle Type 1 - Not applicable |
Emergency Status 3 - Not Applicable |
Carrier Name
|
City
|
State
|
Zip
|
Number of Axles
|
Gross Vehicle Weight Rating
|
Placard #
|
Hazardous Materials Released?
|
U
N
I
T
3
|
Driver's Name - Last KNUPP |
First KELSEY |
Middle PATRICIA |
Suffix
|
City FORT DODGE |
State IA - Iowa, US |
Zip 50501 |
Driver's Age 17 |
Citation Charge Code 1
|
Citation Charge 1
|
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 None |
Restrictions
Y - Intermediate License |
Citation Charge Code 2
|
Citation Charge 2
|
Alcohol Test Given? 1 - None |
Drug Test Given? 1 - None |
Citation Charge Code 3
|
Citation Charge 3
|
Citation Charge Code 4
|
Citation Charge 4
|
Seating Position 01 - Front: Left Side / Motorcycle Driver |
Injury Status 5 - Uninjured |
Occupant Protection 2 - Shoulder and lap belt used |
Airbag Deployment 5 - Not deployed |
Airbag Switch Status 1 - Switch in ON position |
Ejection 1 - Not ejected |
Ejection Path
|
Trapped 1 - Not trapped |
Transported to:
|
Transported by:
|
Insurance Co. Name
|
Year 2007 |
Make Dodge - DODG |
Model CALIBER |
Style 4D |
Approximate Cost to Repair or Replace 300 |
Initial Travel Direction 1 - North |
Vehicle Action 10 - Slowing/stopping |
Speed Limit 45 |
Point of Initial Impact 01 - Front |
Most Damaged Area 01 - Front |
Extent of Damage 2 - Minor damage |
Underride/Override 1 - None |
Total Occupants 01 |
Traffic Controls 04 - Stop signs |
Vehicle Config. 01 - Passenger car |
Cargo Body Type 01 - Not applicable |
Vehicle Defect 01 - None |
Driver Condition 1 - Apparently normal |
Vision Obscured 01 - Not obscured |
Contributing Circumstances, Driver (up to 2)
|
| SEQUENCE OF EVENTS |
First Event 21 - Vehicle in traffic |
Second Event
|
Third Event
|
Fourth Event
|
Most Harmful Event (by vehicle) 21 - Vehicle in traffic |
Emergency Vehicle Type 1 - Not applicable |
Emergency Status 3 - Not Applicable |
Carrier Name
|
City
|
State
|
Zip
|
Number of Axles
|
Gross Vehicle Weight Rating
|
Placard #
|
Hazardous Materials Released?
|
| ACCIDENT ENVIRONMENT |
ROADWAY CHARACTERISTICS Major Contributing Circumstances: |
WORKZONE RELATED? |
SEQUENCE OF EVENTS |
Location of First Harmful Event 1 - On Roadway |
Weather Conditions (up to two) 01 - Clear |
Environment 1 - None apparent |
Location 4 - Within or adjacent to work activity |
First Harmful Event of Crash (use codes 11-42 only) 21 - Vehicle in traffic |
Manner of Crash/Collision 3 - Rear-end |
Roadway 05 - Work Zone (construction, maintenance, utility) |
Type 1 - Lane Closure |
Light Conditions 1 - Daylight |
Surface Conditions 1 |
Type of Roadway Junction/Feature 01 - No special feature |
Workers Present? No |
D I A G R A M
0 |
|
| NARRATIVE |
VEHICLE #1, #2 AND #3 WERE SOUTHBOUND ON THE OUTSIDE LANE OF SOUTHBOUND HIGHWAY #169 JUST APPROACHING THE STOP SIGN AT HIGHWAY #7. VEHICLE #3 STRUCK THE REAR OF VEHICLE #2. THIS CAUSED VEHICLE #2 TO STRIKE THE REAR OF VEHICLE #1. DRIVER #3 STATED SHE DID NOT GET SLOWED DOWN IN TIME TO AVOID THE COLLISION. THE INSIDE LANE OF SOUTHBOUND HIGHWAY #169 WAS CLOSED DUE TO CONSTRUCTION IN THE AREA. |
|
Officer
HINDMAN |
Badge No. 204 |
Time Officer Notified of Accident 07:55 |
Time Officer Arrived At Scene 07:55 |
Name of Agency P07 |
Date of Report 9/7/2010 |
Investigation made at scene? Yes |
T.I. #
|
Any questions about this report may be directed to the following address:
Iowa State Patrol District 07 Office
2437 235th St
Ft Dodge,IA 50501-8465
Phone: (515) 972-4213
Fax: (515) 972-4218