U
N
I
T
1
|
Driver's Name - Last LINDNER |
First ANTHONY |
Middle LEO |
Suffix
|
City ODEBOLT |
State IA - Iowa, US |
Zip 514580000 |
Driver's Age 45 |
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 T - Dbl/Trpl Trlr |
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 3 - Non-incapacitating |
Occupant Protection 2 - Shoulder and lap belt used |
Airbag Deployment 6 - Not applicable |
Airbag Switch Status 3 - No ON/OFF switch present |
Ejection 1 - Not ejected |
Ejection Path
|
Trapped 1 - Not trapped |
Transported to: ST ANTHONYS HOSPITAL |
Transported by: PRIVATE PARTY |
Insurance Co. Name FARNER BOCKEN CO |
Year 2008 |
Make Mack - MACK |
Model SEMI TRACTOR |
Style SEMI |
Approximate Cost to Repair or Replace 20000 |
Initial Travel Direction 1 - North |
Vehicle Action 01 - Movement essentially straight |
Speed Limit 55 |
Point of Initial Impact 01 - Front |
Most Damaged Area 01 - Front |
Extent of Damage 4 - Disabling damage |
Underride/Override 1 - None |
Total Occupants 2 |
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 21 - Vehicle in traffic |
Second Event 06 - Evasive action (swerve, panic braking, etc.) |
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 FARNER BOCKEN CO |
City CARROLL |
State IA - Iowa, US |
Zip 514010368 |
Number of Axles 3 |
Gross Vehicle Weight Rating 60000 |
Placard #
|
Hazardous Materials Released? 2 - No |
U
N
I
T
2
|
Driver's Name - Last RAMBANG |
First RECHOL |
Middle NYANTHAM |
Suffix
|
City STORM LAKE |
State IA - Iowa, US |
Zip 50588 |
Driver's Age 41 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender Female |
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 1 - Fatal |
Occupant Protection 2 - Shoulder and lap belt used |
Airbag Deployment 1 - Deployed front of person |
Airbag Switch Status 1 - Switch in ON position |
Ejection 1 - Not ejected |
Ejection Path
|
Trapped 3 - Extricated by mechanical means |
Transported to: FARBER & OTTMEN FUNERAL |
Transported by: SAME |
Insurance Co. Name
|
Year 2000 |
Make Chrysler - CHRY |
Model VOYAGER |
Style VAN |
Approximate Cost to Repair or Replace 10000 |
Initial Travel Direction 3 - South |
Vehicle Action 01 - Movement essentially straight |
Speed Limit 55 |
Point of Initial Impact 01 - Front |
Most Damaged Area 01 - Front |
Extent of Damage 5 - Severe, vehicle totaled |
Underride/Override 2 - Underride, compartment intrusion |
Total Occupants 1 |
Traffic Controls 01 - No controls present |
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 04 - Crossed centerline/median |
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?
|
P
R
O
P
E
R
T
Y
D
A
M
A
G
E
|
If Property other than vehicles damaged explain |
Object Damaged NONE |
Estimate of Damage
|
Owner's Name - Last
|
First
|
Middle
|
Suffix
|
Owner Company Name
|
City
|
State
|
Zip
|
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 2 - Head-on |
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 CAMPBELL |
First TERRY |
Middle
|
Suffix
|
City
|
State
|
Zip Code
|
Age 56 |
Sex Male |
Unit No. 1 |
Seating Position 03 - Front: Right Side |
Injury Status 2 - Incapacitating |
Occupant Protection 2 - Shoulder and lap belt 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: ST ANTHONYS IN CARROLL |
Transported by: SAC CO AMBULANCE |
NON-MOTORIST |
Type
|
Location
|
Action
|
Condition
|
Safety Equipment
|
Contributing Circumstances
|
Unit No. of Vehicle Striking
|
D I A G R A M
0 |
|
NARRATIVE |
VEHICLE #1 WAS NORTHBOUND ON HIGHWAY 71. VEHICLE #2 WAS SOUTHBOUND ON HIGHWAY 71. VEHICLE #2 LOST CONTROL ON THE SLICK SNOW COVERED ROAD, CROSSED THE CENTERLINE AND SLID INTO THE PATH OF VEHICLE #1. BOTH VEHICLES THEN LEFT THE ROADWAY AND INTO THE WEST DITCH. |
|
Officer
WISSLER |
Badge No. 294 |
Time Officer Notified of Accident 05:18 |
Time Officer Arrived At Scene 06:15 |
Name of Agency P04 |
Date of Report 3/25/2011 |
Investigation made at scene? Yes |
T.I. #
|
Any questions about this report may be directed to the following address:
Iowa State Patrol District 04 Office
3710 Highway 30 E
Denison,IA 51442-7560
Phone: (712) 263-4621
Fax: (712) 263-2325