U
N
I
T
1
|
Driver's Name - Last
SOKOLOWSKI |
First
LORI |
Middle
JO |
Suffix
|
City
HOLSTEIN |
State
IA - Iowa, US |
Zip
51025 |
Driver's Age
55 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender
Female |
State
IA - Iowa, US |
Class
D - Chauffeur |
Endorsements
3 - Pass Veh less than 16 Pass Design |
Restrictions
B - Cor Lenses |
Citation Charge Code 2
|
Citation Charge 2
|
Alcohol Test Given?
2 - Blood |
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
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:
JENSEN FUNERAL HOME |
Transported by:
JENSEN FUNERAL |
Insurance Co. Name
|
Year
2005 |
Make
Pontiac - PONT |
Model
BONNEVILLE |
Style
4DR |
Approximate Cost to Repair or Replace
10000 |
Initial Travel Direction
4 - West |
Vehicle Action
01 - Movement essentially straight |
Speed Limit
55 |
Point of Initial Impact
03 - Right Side |
Most Damaged Area
03 - Right Side |
Extent of Damage
5 - Severe, vehicle totaled |
Underride/Override
1 - None |
Total Occupants
2 |
Traffic Controls
01 - No controls present |
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
06 - Evasive action (swerve, panic braking, etc.) |
Second Event
21 - Vehicle in traffic |
Third Event
|
Fourth Event
|
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?
|
U
N
I
T
2
|
Driver's Name - Last
SCHMIDT |
First
DERON |
Middle
EDWARD |
Suffix
|
City
BATTLE CREEK |
State
IA - Iowa, US |
Zip
51006 |
Driver's Age
48 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender
Male |
State
IA - Iowa, US |
Class
A - Veh w/26001 GVWR or more Towed unit is 10001 GVWR or more |
Endorsements
None |
Restrictions
3 - Commercial Inst Perm |
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
3 - Non-incapacitating |
Occupant Protection
2 - Shoulder and lap belt used |
Airbag Deployment
1 - Deployed front of person |
Airbag Switch Status
3 - No ON/OFF switch present |
Ejection
1 - Not ejected |
Ejection Path
|
Trapped
1 - Not trapped |
Transported to:
HORN MEMORIAL HOSP |
Transported by:
HOLSTEIN AMBULANCE |
Insurance Co. Name
KIRKS METER AND INSPECTION |
Year
2004 |
Make
General Motors - GMC |
Model
C4500 |
Style
TRK |
Approximate Cost to Repair or Replace
8000 |
Initial Travel Direction
3 - South |
Vehicle Action
01 - Movement essentially straight |
Speed Limit
55 |
Point of Initial Impact
08 - Left Front |
Most Damaged Area
08 - Left Front |
Extent of Damage
5 - Severe, vehicle totaled |
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
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
1 - Not applicable |
Emergency Status
3 - Not Applicable |
Carrier Name
KIRKS METER AND INSPECTION |
City
BATTLE CREEK |
State
IA - Iowa, US |
Zip
51006 |
Number of Axles
2 |
Gross Vehicle Weight Rating
16000 |
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)
08 - Snow |
Environment
2 - Weather condition |
Location
|
First Harmful Event of Crash (use codes 11-42 only)
21 - Vehicle in traffic |
Manner of Crash/Collision
5 - Broadside |
Roadway
02 - Road surface condition |
Type
|
Light Conditions
1 - Daylight |
Surface Conditions
5 |
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
PENCOOK |
First
MARIA |
Middle
MARGARET |
Suffix
|
City
|
State
|
Zip Code
|
Age
28 |
Sex
Female |
Unit No.
1 |
Seating Position
03 - Front: Right Side |
Injury Status
1 - Fatal |
Occupant Protection
9 - Unknown |
Airbag Deployment
5 - Not deployed |
Airbag Switch Status
3 - No ON/OFF switch present |
Ejection
1 - Not ejected |
Ejection Path
1 - Not ejected/not applicable |
Trapped
3 - Extricated by mechanical means |
Transported to:
JENSEN FUNERAL HOME |
Transported by:
JENSEN FUNERAL |
| NON-MOTORIST |
Type
|
Location
|
Action
|
Condition
|
Safety Equipment
|
Contributing Circumstances
|
Unit No. of Vehicle Striking
|
D
I
A
G
R
A
M
0 |
 |
| NARRATIVE |
VEH 1 WAS WB ON HWY 20. VEH 2 WAS EB ON HWY 20. VEH 1 LOST CONTROL AND BEGAN TO SPIN IN A COUNTERCLOCKWISE DIRECTION INTO THE PATH OF VEH 2. VEH 2 HIT VEH 1 BROADSIDE KILLING BOTH INDIVIDUALS IN VEH 1. INVESTIGATION IN ONGOING BY AN ISP TI. |
|
Officer
ERDMANN |
Badge No.
041 |
Time Officer Notified of Accident
08:05 |
Time Officer Arrived At Scene
08:25 |
Name of Agency
P06 |
Date of Report
3/7/2011 |
Investigation made at scene?
Yes |
T.I. #
|
Any questions about this report may be directed to the following address:
Iowa State Patrol District 06 Office
503 W 44th St
Spencer,IA 51301-2089
Phone: (712) 262-1424
Fax: (712) 262-3222