U
N
I
T
1
|
Driver's Name - Last
VANBEEK |
First
PAUL |
Middle
DONNELL |
Suffix
|
City
BAXTER |
State
IA - Iowa, US |
Zip
500280000 |
Driver's Age
25 |
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
3 - No ON/OFF switch present |
Ejection
1 - Not ejected |
Ejection Path
|
Trapped
1 - Not trapped |
Transported to:
|
Transported by:
|
Insurance Co. Name
|
Year
2003 |
Make
Mitsubishi - MITS |
Model
DIA |
Style
4D |
Approximate Cost to Repair or Replace
5000 |
Initial Travel Direction
3 - South |
Vehicle Action
01 - Movement essentially straight |
Speed Limit
65 |
Point of Initial Impact
02 - Right Front |
Most Damaged Area
02 - Right Front |
Extent of Damage
4 - Disabling damage |
Underride/Override
1 - None |
Total Occupants
02 |
Traffic Controls
01 - No controls present |
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
06 - Evasive action (swerve, panic braking, etc.) |
Second Event
21 - Vehicle in traffic |
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
2
|
Driver's Name - Last
AGNEW |
First
SANDRA KAY |
Middle
|
Suffix
|
City
BURLINGTON |
State
IA - Iowa, US |
Zip
526010000 |
Driver's Age
66 |
Citation Charge Code 1
321321.306 |
Citation Charge 1
USE OF LANES |
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
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
3 - No ON/OFF switch present |
Ejection
1 - Not ejected |
Ejection Path
|
Trapped
1 - Not trapped |
Transported to:
|
Transported by:
|
Insurance Co. Name
|
Year
2007 |
Make
Ford - FORD |
Model
ECP |
Style
SW |
Approximate Cost to Repair or Replace
5000 |
Initial Travel Direction
3 - South |
Vehicle Action
06 - Changing lanes |
Speed Limit
65 |
Point of Initial Impact
08 - Left Front |
Most Damaged Area
08 - Left Front |
Extent of Damage
4 - Disabling damage |
Underride/Override
1 - None |
Total Occupants
04 |
Traffic Controls
01 - No controls present |
Vehicle Config.
04 - Sport utility vehicle |
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
|
First Harmful Event of Crash (use codes 11-42 only)
21 - Vehicle in traffic |
Manner of Crash/Collision
6 - Sideswipe, same direction |
Roadway
01 - None apparent |
Type
|
Light Conditions
1 - Daylight |
Surface Conditions
1 |
Type of Roadway Junction/Feature
11 - Four-way intersection |
Workers Present?
|
D
I
A
G
R
A
M
0 |
 |
| NARRATIVE |
VEHICLE #1 IS SOUTHBOUND ON HWY 330 AT THE INTERSECTION OF HWY 330/HWY 65 AND HWY 117 DRIVING IN THE INSIDE OF TWO LANES OF TRAVEL. VEHICLE #2 IS IN THE SAME DIRECTION OF TRAVEL BUT DRIVING IN THE OUTSIDE LANE OF TRAVEL ON HWY 330. HWY 330 IS TWO LANES IN EACH DIRECTION OF TRAVEL AND RUNS NORTHEAST TO SOUTHWEST. HWY 117 RUNS SOUTHBOUND AND IS A TWO LANE ROADWAY. HWY 65 RUNS TWO LANES IN A NORTHBOUND DIRECTION OF TRAVEL. VEHICLE #1 IS IN THE PROCESS OF PASSING VEHICLE #2 WHEN VEHICLE #1 SIGNALS A LANE CHANGE TO THE LEFT AND VEERS INTO THE INSIDE LANE OF TRAVEL OCCUPIED BY VEHICLE #1. THIS LANE CHANGE BY VEHICLE #2 IS AN ATTEMPT TO GET IN A POSITION TO TURN SOUTH ON HWY 117. VEHICLE #1 TRIES TO AVOID VEHICLE #2 BY SWERVING TO THE RIGHT BUT IS UNABLE TO AVOID VEHICLE #2. IMPACT OCCURS IN THE INSIDE LANE OF TRAVEL ON HWY 330 . THIS IMPACT OCCURS TO THE RIGHT FRONT OF VEHICLE #1 TO THE LEFT FRONT OF VEHICLE #2. AFTER IMPACT VEHICLE #1 COMES TO REST FACING SOUTHWEST IN THE MEDIAN. AFTER IMPACT VEHICLE #2 COMES TO REST FACING WEST IN THE MIDDLE OF THE INTERSECTION ON HWY 330 |
|
Officer
BATTLES |
Badge No.
392 |
Time Officer Notified of Accident
09:33 |
Time Officer Arrived At Scene
09:45 |
Name of Agency
P01 |
Date of Report
9/4/2010 |
Investigation made at scene?
Yes |
T.I. #
|
Any questions about this report may be directed to the following address:
Iowa State Patrol District 01 Office
260 NW 48th Place
Des Moines,IA 50313-2299
Phone: (515) 725-0010
Fax: (515) 725-0011