Iowa State Patrol: Department of Public Safety

Crash Information

L
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A
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N 		Date of Accident
12/28/2010		 Time of Accident
04:00 PM 		County
Clinton - 23		 Accident occurred within corporate limits of (city)
 Law Enforcement Case Number:
2010073757
Literal Description
360 AVE and 292 ST and 360TH AVE 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
716694.6
Y-Coordinate
4625566.
U
N
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1 		Driver's Name - Last
BURNETT		 First
STEVEN		 Middle
J		 Suffix
City
REEDSBURG		 State
WI - Wisconsin, US		 Zip
539590000
Driver's Age
46		 Citation Charge Code 1
 Citation Charge 1
Gender
Male		 State
WI - Wisconsin, 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?
4 - Breath		 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
9 - Unknown		 Ejection
1 - Not ejected		 Ejection Path
 Trapped
1 - Not trapped
Transported to:
 Transported by:
Insurance Co. Name
Year
1992		 Make
Buick - BUIC		 Model
LASABRE		 Style
4DR		 Approximate Cost to Repair or Replace
1500
Initial Travel Direction
4 - West		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
55		 Point of Initial Impact
01 - Front		 Most Damaged Area
01 - Front		 Extent of Damage
4 - Disabling damage		 Underride/Override
1 - None
Total Occupants
1		 Traffic Controls
06 - No Passing Zone (marked)		 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
01 - Ran off road, right		 Second Event
 Third Event
 Fourth Event
 Most Harmful Event (by vehicle)
01 - Ran off road, right
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)
13 - Other non-collision
Manner of Crash/Collision
1 - Non-collision		 Roadway
01 - None apparent		 Type
Light Conditions
1 - Daylight		 Surface Conditions
1		 Type of Roadway Junction/Feature
12 - T - intersection		 Workers Present?
D
I
A
G
R
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M

0
NARRATIVE

UNIT 1 WAS TRAVELING EASTBOUND ON 292ND ST. UNIT 1 LOST CONTROL AND EXITED THE ROADWAY TO THE RIGHT. UNIT 1 CAME TO REST FACING NORTH IN THE NORTH DITCH.
Officer
OLIVER 		Badge No.
460		 Time Officer Notified of Accident
16:00		 Time Officer Arrived At Scene
16:15
Name of Agency
P12		 Date of Report
12/28/2010		 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