Iowa State Patrol: Department of Public Safety

Crash Information

L
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N 		Date of Accident
9/16/2010		 Time of Accident
08:15 AM 		County
Jasper - 50		 Accident occurred within corporate limits of (city)
 Law Enforcement Case Number:
2010054190
Literal Description
US 0065 / W US 65 N and NB/EB US 0065 / US 65 N and Iowa 0117 / IOWA 117 N and NB/EB Iowa 0330 / IOWA 330 N 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
474374.7
Y-Coordinate
4628717.
U
N
I
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1 		Driver's Name - Last
VEREN		 First
CLINTON		 Middle
ANTHONY		 Suffix
City
NEVADA		 State
IA - Iowa, US		 Zip
502010000
Driver's Age
30		 Citation Charge Code 1
 Citation Charge 1
Gender
Male		 State
IA - Iowa, US		 Class
D - Chauffeur		 Endorsements
1 - Trk - Trctr Semi-Trailer Comb		 Restrictions

None		 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
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
 Trapped
1 - Not trapped
Transported to:
N/A		 Transported by:
N/A
Insurance Co. Name
Year
2007		 Make
Chevrolet - CHEV		 Model
1500		 Style
TRUCK		 Approximate Cost to Repair or Replace
25000
Initial Travel Direction
2 - East		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
55		 Point of Initial Impact
01 - Front		 Most Damaged Area
01 - Front		 Extent of Damage
5 - Severe, vehicle totaled		 Underride/Override
1 - None
Total Occupants
01		 Traffic Controls
05 - Yield signs		 Vehicle Config.
02 - Four-tire light truck (pick-up, panel)		 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

2 		Driver's Name - Last
JACKSON		 First
CHRIS		 Middle
LEVERN		 Suffix
City
OSKALOOSA		 State
IA - Iowa, US		 Zip
52577
Driver's Age
35		 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

None		 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
3 - Non-incapacitating		 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
 Trapped
3 - Extricated by mechanical means
Transported to:
METHODIST HOSPITAL		 Transported by:
BAXTER GROUND UNIT
Insurance Co. Name
Year
2001		 Make
Ford - FORD		 Model
F15		 Style
PK		 Approximate Cost to Repair or Replace
25000
Initial Travel Direction
1 - North		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
65		 Point of Initial Impact
01 - Front		 Most Damaged Area
01 - Front		 Extent of Damage
5 - Severe, vehicle totaled		 Underride/Override
1 - None
Total Occupants
02		 Traffic Controls
01 - No controls present		 Vehicle Config.
02 - Four-tire light truck (pick-up, panel)		 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)
03 - Cloudy		 Environment
1 - None apparent		 Location
 First Harmful Event of Crash (use codes 11-42 only)
21 - Vehicle in traffic
Manner of Crash/Collision
5 - Broadside		 Roadway
01 - None apparent		 Type
Light Conditions
1 - Daylight		 Surface Conditions
1		 Type of Roadway Junction/Feature
11 - Four-way intersection		 Workers Present?
P
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D 		Name- Last
ANDERSON		 First
TERRY		 Middle
JOE		 Suffix
City
 State
 Zip Code
Age
53		 Sex
Male		 Unit No.
2		 Seating Position
03 - Front: Right Side		 Injury Status
3 - Non-incapacitating		 Occupant Protection
1 - None used		 Airbag Deployment
2 - Deployed side of person		 Airbag Switch Status
1 - Switch in ON position		 Ejection
1 - Not ejected		 Ejection Path
1 - Not ejected/not applicable		 Trapped
1 - Not trapped
Transported to:
METHODIST HOSPITAL		 Transported by:
GROUND UNIT
NON-MOTORIST Type
 Location
 Action
 Condition
 Safety Equipment
 Contributing Circumstances
 Unit No. of Vehicle Striking
D
I
A
G
R
A
M

0
D
I
A
G
R
A
M

1
D
I
A
G
R
A
M

2
NARRATIVE

VEHICLE #1 WAS TRAVELING SOUTH BOUND ON HWY 65 APPROACHING JCT HWY 330 / 117. VEHICLE #2 WAS TRAVELING NORTH BOUND ON HWY 65 IN THE INSIDE LANE APPROACHING JCT HWY 330 / 117. VEHICLE #1 FAILED TO YIELD TO VEHICLE #2 WHEN CROSSING TO HWY 117. VEHICLE #2 ATTEPTED TO MANUVER OUT OF THE WAY. VEHICLE #1 STRUCK THE FRONT OF VEHICLE #2.
Officer
AARHUS 		Badge No.
058		 Time Officer Notified of Accident
08:17		 Time Officer Arrived At Scene
08:30
Name of Agency
P01		 Date of Report
9/16/2010		 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