U
N
I
T
1
|
Driver's Name - Last YAGOUB-ADAM |
First MAHDI |
Middle SIDDIG |
Suffix
|
City DES MOINES |
State IA - Iowa, US |
Zip 50314 |
Driver's Age 41 |
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 4 - Possible |
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: SKIFF MEDICAL CENTER (NEWTON) |
Transported by: NEWTON RESCUE |
Insurance Co. Name
|
Year 2002 |
Make
|
Model PATHFINDER |
Style SUV |
Approximate Cost to Repair or Replace 15000 |
Initial Travel Direction 4 - West |
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 5 - Severe, vehicle totaled |
Underride/Override 1 - None |
Total Occupants 7 |
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 04 - Crossed centerline/median |
Third Event
|
Fourth Event
|
Most Harmful Event (by vehicle) 04 - Crossed centerline/median |
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
|
First
|
Middle
|
Suffix
|
City
|
State
|
Zip
|
Driver's Age
|
Citation Charge Code 1
|
Citation Charge 1
|
Gender
|
State
|
Class
|
Endorsements None |
Restrictions
None |
Citation Charge Code 2
|
Citation Charge 2
|
Alcohol Test Given?
|
Drug Test Given?
|
Citation Charge Code 3
|
Citation Charge 3
|
Citation Charge Code 4
|
Citation Charge 4
|
Seating Position
|
Injury Status
|
Occupant Protection
|
Airbag Deployment
|
Airbag Switch Status
|
Ejection
|
Ejection Path
|
Trapped
|
Transported to:
|
Transported by:
|
Insurance Co. Name MAX FREIGHT INC |
Year 2006 |
Make
|
Model TR |
Style TR |
Approximate Cost to Repair or Replace 9000 |
Initial Travel Direction 9 - Unknown |
Vehicle Action 13 - Illegally Parked/unattended |
Speed Limit 70 |
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 01 - No controls present |
Vehicle Config. 09 - Tractor/semi-trailer |
Cargo Body Type 02 - Van/enclosed box |
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 23 - Parked motor vehicle |
Second Event
|
Third Event
|
Fourth Event
|
Most Harmful Event (by vehicle) 23 - Parked motor vehicle |
Emergency Vehicle Type 1 - Not applicable |
Emergency Status 3 - Not Applicable |
Carrier Name MAX FREIGHT INC |
City NORTHBROOK |
State IL - Illinois, US |
Zip 60062 |
Number of Axles 5 |
Gross Vehicle Weight Rating 80 |
Placard #
|
Hazardous Materials Released? 2 - No |
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 2 - Weather condition |
Location
|
First Harmful Event of Crash (use codes 11-42 only) 21 - Vehicle in traffic |
Manner of Crash/Collision 1 - Non-collision |
Roadway 02 - Road surface condition |
Type
|
Light Conditions 5 - Dark, roadway not lighted |
Surface Conditions 4 |
Type of Roadway Junction/Feature 01 - No special feature |
Workers Present?
|
P
E
R
S
O
N
|
I
N
J
U
R
E
D
|
Name- Last ALI |
First YASMIN |
Middle AWAD ELSEED |
Suffix
|
City
|
State
|
Zip Code
|
Age 29 |
Sex Female |
Unit No. 1 |
Seating Position 08 - Rear: Center |
Injury Status 3 - Non-incapacitating |
Occupant Protection 1 - None used |
Airbag Deployment 6 - Not applicable |
Airbag Switch Status 3 - No ON/OFF switch present |
Ejection 1 - Not ejected |
Ejection Path 1 - Not ejected/not applicable |
Trapped 1 - Not trapped |
Transported to: SKIFF MEDICAL CENTER (NEWTON) |
Transported by: NEWTON RESCUE |
NON-MOTORIST |
Type
|
Location
|
Action
|
Condition
|
Safety Equipment
|
Contributing Circumstances
|
Unit No. of Vehicle Striking
|
P
E
R
S
O
N
|
I
N
J
U
R
E
D
|
Name- Last ADAM |
First SUAD |
Middle
|
Suffix
|
City
|
State
|
Zip Code
|
Age 56 |
Sex Female |
Unit No. 1 |
Seating Position 07 - Rear: Left Side |
Injury Status 1 - Fatal |
Occupant Protection 1 - None used |
Airbag Deployment 6 - Not applicable |
Airbag Switch Status 3 - No ON/OFF switch present |
Ejection 1 - Not ejected |
Ejection Path 1 - Not ejected/not applicable |
Trapped 1 - Not trapped |
Transported to: STATE MEDICAL EXAMINERS |
Transported by: WALLACE FUNERAL HOME |
NON-MOTORIST |
Type
|
Location
|
Action
|
Condition
|
Safety Equipment
|
Contributing Circumstances
|
Unit No. of Vehicle Striking
|
D I A G R A M
0 |
|
NARRATIVE |
UNIT #1 WAS TRAVELING WEST BOUND ON INTERSTATE 80 AT APPROXIMATELY THE 175.9 MILE MARKER AND LOST CONTROL. UNIT #1 WENT INTO THE MEDIAN AND COLLIDED WITH A PARKED SEMI THAT WAS ALREADY THERE. THERE WAS ONE FATALITY, ONE SERIOUS INJURY AND THE REST WERE NO INJURED. BOTH VEHICLE WERE TOWED BY BARNEY'S TOWING. OPERATOR OF UNIT #2: ID NO 0011361102 MCCALL,EDWARD DEONDRE 342 N CHURCH ST FLORENCE SC 295066132 FLOR CNTY SEX M HGT 5 11 WGT 310 BIRTH 07/11/1984 SSN 248-65-9197 RACE BLACK STATUS-DL:NO SUSPENSION CDL:NO DISQUALIFICATION **** COMMERCIAL DRIVER LICENSE **** COMMERCIAL DL CLASS A ISSUED 10/17/2008 **** IDENTIFICATION ONLY **** ISSUED 12/08/1999 |
|
Officer
STARRETT |
Badge No. 248 |
Time Officer Notified of Accident 06:50 |
Time Officer Arrived At Scene 06:59 |
Name of Agency P01 |
Date of Report 1/11/2011 |
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