Iowa State Patrol: Department of Public Safety

Crash Information

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N 		Date of Accident
10/10/2010		 Time of Accident
10:42 PM 		County
Scott - 82		 Accident occurred within corporate limits of (city)
Walcott - 8052		 Law Enforcement Case Number:
2010058562
Literal Description
Y40 N. OF F58 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
684741.7
Y-Coordinate
4607858.
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1 		Driver's Name - Last
MATHIS		 First
AMY		 Middle
LYNN		 Suffix
City
DURANT		 State
IA - Iowa, US		 Zip
52747
Driver's Age
26		 Citation Charge Code 1
321J.2		 Citation Charge 1
OWI 1ST
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
321.288		 Citation Charge 2
FAIL TO MAINTAIN CONTROL
Alcohol Test Given?
2 - Blood		 Drug Test Given?
1 - None		 Citation Charge Code 3
321.445		 Citation Charge 3
NO SEATBELT
Citation Charge Code 4
 Citation Charge 4
Seating Position
01 - Front: Left Side / Motorcycle Driver		 Injury Status
3 - Non-incapacitating		 Occupant Protection
4 - Shoulder belt only used		 Airbag Deployment
1 - Deployed front of person		 Airbag Switch Status
1 - Switch in ON position		 Ejection
1 - Not ejected		 Ejection Path
 Trapped
2 - Freed by non-mechanical means
Transported to:
GENESIS EAST DAVENPORT		 Transported by:
WALCOTT EMS
Insurance Co. Name
Year
1994		 Make
Ford - FORD		 Model
ESC		 Style
SW		 Approximate Cost to Repair or Replace
7000
Initial Travel Direction
3 - South		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
55		 Point of Initial Impact
05 - Rear		 Most Damaged Area
01 - Front		 Extent of Damage
5 - Severe, vehicle totaled		 Underride/Override
9 - Unknown
Total Occupants
1		 Traffic Controls
01 - No controls present		 Vehicle Config.
01 - Passenger car		 Cargo Body Type
01 - Not applicable		 Vehicle Defect
01 - None		 Driver Condition
6 - Under the influence of alcohol/drugs/medications		 Vision Obscured
01 - Not obscured		 Contributing Circumstances, Driver (up to 2)
SEQUENCE OF EVENTS First Event
21 - Vehicle in traffic		 Second Event
06 - Evasive action (swerve, panic braking, etc.)		 Third Event
 Fourth Event
38 - Poles (utility, light, etc.)		 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?
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Y

D
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If Property other than vehicles damaged explain Object Damaged
FENCE		 Estimate of Damage
500
Owner's Name - Last
DIETZ		 First
RODNEY		 Middle
 Suffix
Owner Company Name
563-284-6079
City
WALCOTT		 State
IA - Iowa, US		 Zip
P
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P
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Y

D
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G
E
If Property other than vehicles damaged explain Object Damaged
TELEPHONE POLE Y40 WEST DITCH		 Estimate of Damage
2000
Owner's Name - Last
 First
 Middle
 Suffix
Owner Company Name
ALLIANT ENERGY- 1-877-740-5050
City
DEWITT		 State
IA - Iowa, US		 Zip
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
1 - Non-collision		 Roadway
01 - None apparent		 Type
Light Conditions
5 - Dark, roadway not lighted		 Surface Conditions
1		 Type of Roadway Junction/Feature
01 - No special feature		 Workers Present?
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NARRATIVE

UNIT ONE WAS TRAVELING SOUTH ON Y40. UNIT ONE WENT OFF ROAD AND ENTERED THE WEST DITCH. UNIT ONE STRUCK A TELEPHONE POLE AND A FENCE. UNIT ONE CAME TO REST FACING NORTH IN A FARM FIELD. CHARGES PENDING BLOOD RESULTS.
Officer
ERWIN 		Badge No.
334		 Time Officer Notified of Accident
22:42		 Time Officer Arrived At Scene
22:52
Name of Agency
P12		 Date of Report
10/10/2010		 Investigation made at scene?
Yes		 T.I. #


Any questions about this report may be directed to the following address:
Iowa State Patrol District 12 Office
22365 20th Ave
Stockton,IA 52769-9612
Phone: (563) 284-9501
Fax: (563) 284-9504