Iowa State Patrol: Department of Public Safety

Crash Information

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N 		Date of Accident
1/10/2011		 Time of Accident
12:57 PM 		County
Cerro Gordo - 17		 Accident occurred within corporate limits of (city)
 Law Enforcement Case Number:
2011001790
Literal Description
NB I-35 .95 MILES NORTH OF THE 196MM 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
471072.5
Y-Coordinate
4781615.
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1 		Driver's Name - Last
GORDON		 First
KENNETH		 Middle
ROY		 Suffix
City
NEVADA		 State
IA - Iowa, US		 Zip
50201
Driver's Age
50		 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
1 - Fatal		 Occupant Protection
1 - None used		 Airbag Deployment
5 - Not deployed		 Airbag Switch Status
1 - Switch in ON position		 Ejection
2 - Partially ejected		 Ejection Path
 Trapped
3 - Extricated by mechanical means
Transported to:
MERCY HOSPITAL		 Transported by:
MASON CITY AMBULANCE
Insurance Co. Name
Year
2002		 Make
Ford - FORD		 Model
F150		 Style
PK		 Approximate Cost to Repair or Replace
6000
Initial Travel Direction
1 - North		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
70		 Point of Initial Impact
07 - Left Side		 Most Damaged Area
07 - Left Side		 Extent of Damage
4 - Disabling damage		 Underride/Override
1 - None
Total Occupants
1		 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
9 - Unknown		 Vision Obscured
01 - Not obscured		 Contributing Circumstances, Driver (up to 2)
SEQUENCE OF EVENTS First Event
03 - Ran off road, left		 Second Event
11 - Overturn/rollover		 Third Event
 Fourth Event
 Most Harmful Event (by vehicle)
11 - Overturn/rollover
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
3 - Median		 Weather Conditions (up to two)
08 - Snow		 Environment
2 - Weather condition		 Location
 First Harmful Event of Crash (use codes 11-42 only)
11 - Overturn/rollover
Manner of Crash/Collision
1 - Non-collision		 Roadway
02 - Road surface condition		 Type
Light Conditions
1 - Daylight		 Surface Conditions
3		 Type of Roadway Junction/Feature
01 - No special feature		 Workers Present?
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NARRATIVE

UNIT WAS NORTHBOUND NEAR MILE MARKER 196.90 WHEN IT STARTED INTO THE DITCH, IT ROLLED ONE COMPLETE TIME AND THEN ANOTHER PARTIAL. THE DRIVER WAS NOT WEARING HIS SEAT BELT AND BECAUSE OF THAT WAS PARTIALLY EJECTED FROM THE VEHICLE.
Officer
HAUGEN 		Badge No.
114		 Time Officer Notified of Accident
12:57		 Time Officer Arrived At Scene
13:01
Name of Agency
P08		 Date of Report
1/10/2011		 Investigation made at scene?
Yes		 T.I. #


Any questions about this report may be directed to the following address:
Iowa State Patrol District 08 Office
4425 Washington Avenue
Mason City,IA 50401-7002
Phone: (641) 424-3625
Fax: (641) 423-8381