U
N
I
T
1
|
Driver's Name - Last UNKNOWN |
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? 1 - None |
Drug Test Given?
|
Citation Charge Code 3
|
Citation Charge 3
|
Citation Charge Code 4
|
Citation Charge 4
|
Seating Position 99 - Unknown |
Injury Status 9 - Unknown |
Occupant Protection 9 - Unknown |
Airbag Deployment 9 - Unknown |
Airbag Switch Status 9 - Unknown |
Ejection 1 - Not ejected |
Ejection Path
|
Trapped 1 - Not trapped |
Transported to:
|
Transported by:
|
Insurance Co. Name
|
Year
|
Make
|
Model
|
Style SEMI |
Approximate Cost to Repair or Replace
|
Initial Travel Direction 2 - East |
Vehicle Action 01 - Movement essentially straight |
Speed Limit 70 |
Point of Initial Impact 02 - Right Front |
Most Damaged Area 02 - Right Front |
Extent of Damage 9 - Unknown |
Underride/Override 1 - None |
Total Occupants 1 |
Traffic Controls 88 - Other control (explain in narrative) |
Vehicle Config. 09 - Tractor/semi-trailer |
Cargo Body Type 02 - Van/enclosed box |
Vehicle Defect 99 - Unknown |
Driver Condition 9 - Unknown |
Vision Obscured 01 - Not obscured |
Contributing Circumstances, Driver (up to 2)
|
| SEQUENCE OF EVENTS |
First Event 23 - Parked motor vehicle |
Second Event 52 - Hit and run |
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
|
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
|
Year 2008 |
Make Ford - FORD |
Model CROWN VICTORIA |
Style 4 DOOR |
Approximate Cost to Repair or Replace 2000 |
Initial Travel Direction 2 - East |
Vehicle Action 12 - Legally Parked |
Speed Limit 70 |
Point of Initial Impact 06 - Left Rear |
Most Damaged Area 06 - Left Rear |
Extent of Damage 2 - Minor damage |
Underride/Override 1 - None |
Total Occupants 01 |
Traffic Controls 88 - Other control (explain in narrative) |
Vehicle Config. 01 - Passenger car |
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 2 - Police |
Emergency Status 1 - Yes, in emergency |
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 8 - Other (explain in narrative) |
Location
|
First Harmful Event of Crash (use codes 11-42 only) 21 - Vehicle in traffic |
Manner of Crash/Collision 6 - Sideswipe, same direction |
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?
|
D I A G R A M
0 |
|
| NARRATIVE |
VEHICLE #2 WAS LEGALLY PARKED IN THE TRAVEL PORTION OF THE ROADWAY, WITH ALL EMERGENCY LIGHTS FLASHING, AND PROVIDING TRAFFIC CONTROL FOR ANOTHER VEHICLE AT THE 34.90 MILE MARKER OF I-80 EB. VEHICLE #1 WAS TRAVELING EB AT THE 34.90 MILE MARKER OF I-80 AND FAILED TO YIELD TO THE EMERGENCY LIGHTS OF VEHICLE #2. VEHICLE #1 COLLIDED INTO THE REAR LEFT OF VEHICLE #2 AND CONTINUED EB WITHOUT STOPPING. |
|
Officer
BEENEN |
Badge No. 066 |
Time Officer Notified of Accident 23:40 |
Time Officer Arrived At Scene 23:58 |
Name of Agency P03 |
Date of Report 2/14/2011 |
Investigation made at scene? Yes |
T.I. #
|
Any questions about this report may be directed to the following address:
Iowa State Patrol District 03 Office
2025 Hunt Ave
Council Bluffs,IA 51503-4254
Phone: (712) 328-8001
Fax: (712) 328-1504