Iowa State Patrol: Department of Public Safety

Crash Information

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N 		Date of Accident
3/7/2011		 Time of Accident
08:10 AM 		County
Carroll - 14		 Accident occurred within corporate limits of (city)
 Law Enforcement Case Number:
2011015399
Literal Description
N041 / TIMBER AVE 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
357434.5
Y-Coordinate
4671927.
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1 		Driver's Name - Last
JACOB		 First
JESSE		 Middle
ALLEN		 Suffix
City
LAKE CITY		 State
IA - Iowa, US		 Zip
51449
Driver's Age
 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:
STEWART MEMORIAL		 Transported by:
PVT VEH
Insurance Co. Name
Year
2002		 Make
Dodge - DODG		 Model
CVN		 Style
VN		 Approximate Cost to Repair or Replace
3000
Initial Travel Direction
1 - North		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
55		 Point of Initial Impact
03 - Right Side		 Most Damaged Area
07 - Left Side		 Extent of Damage
4 - Disabling damage		 Underride/Override
1 - None
Total Occupants
01		 Traffic Controls
10 - Traffic director		 Vehicle Config.
03 - Van or mini-van		 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
01 - Ran off road, right		 Second Event
33 - Ditch/embankment		 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
4 - Roadside		 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
4		 Type of Roadway Junction/Feature
01 - No special feature		 Workers Present?
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NARRATIVE

VEHICLE NORTHBOUND N-41 ROUNDING CURVE. DRIVER LOST CONTROL ON SNOW COVERED ROAD. VEHICLE, ENTERED INTO EAST DITCH ROLLED ONE REVOLUTION AND CAME TO REST ON WHEEL BASE
Officer
MORENZ 		Badge No.
230		 Time Officer Notified of Accident
08:16		 Time Officer Arrived At Scene
08:30
Name of Agency
P07		 Date of Report
2/17/2011		 Investigation made at scene?
Yes		 T.I. #


Any questions about this report may be directed to the following address:
Iowa State Patrol District 07 Office
2437 235th St
Ft Dodge,IA 50501-8465
Phone: (515) 972-4213
Fax: (515) 972-4218