U
N
I
T
1
|
Driver's Name - Last JONES |
First TRACY |
Middle LEE |
Suffix
|
City TREMONT |
State IL - Illinois, US |
Zip 61568 |
Driver's Age 39 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender Male |
State IL - Illinois, 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 5 - Uninjured |
Occupant Protection 2 - Shoulder and lap belt used |
Airbag Deployment 5 - Not deployed |
Airbag Switch Status 9 - Unknown |
Ejection 1 - Not ejected |
Ejection Path
|
Trapped 1 - Not trapped |
Transported to:
|
Transported by:
|
Insurance Co. Name FUTURE ENVIRONMENTAL INC |
Year 2007 |
Make
|
Model PB 340 |
Style TANK TRUCK |
Approximate Cost to Repair or Replace 5000 |
Initial Travel Direction 4 - West |
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 4 - Disabling damage |
Underride/Override 1 - None |
Total Occupants 01 |
Traffic Controls 01 - No controls present |
Vehicle Config. 06 - Single-unit truck (>=3 axles) |
Cargo Body Type 04 - Cargo tank |
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 FUTURE ENVIRONMENTAL INC |
City MOKENA |
State IL - Illinois, US |
Zip 60448 |
Number of Axles 4 |
Gross Vehicle Weight Rating 64000 |
Placard #
|
Hazardous Materials Released? 2 - No |
U
N
I
T
2
|
Driver's Name - Last SCHAFFER |
First SHAWNA |
Middle RENEE |
Suffix
|
City FORT MADISON |
State IA - Iowa, US |
Zip 526270000 |
Driver's Age 33 |
Citation Charge Code 1 321.322 (PARA 2) |
Citation Charge 1 FAILURE TO OBEY STOP OR YIELD SIGN |
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
B - Cor Lenses |
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 5 - Uninjured |
Occupant Protection 2 - Shoulder and lap belt used |
Airbag Deployment 5 - Not deployed |
Airbag Switch Status 9 - Unknown |
Ejection 1 - Not ejected |
Ejection Path
|
Trapped 1 - Not trapped |
Transported to:
|
Transported by:
|
Insurance Co. Name
|
Year 2000 |
Make Chevrolet - CHEV |
Model S10 |
Style PK |
Approximate Cost to Repair or Replace 5000 |
Initial Travel Direction 3 - South |
Vehicle Action 01 - Movement essentially straight |
Speed Limit 55 |
Point of Initial Impact 06 - Left Rear |
Most Damaged Area 05 - Rear |
Extent of Damage 4 - Disabling damage |
Underride/Override 1 - None |
Total Occupants 01 |
Traffic Controls 04 - Stop signs |
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 10 - Blinded by sun or headlights |
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?
|
| 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 5 - Glare |
Location
|
First Harmful Event of Crash (use codes 11-42 only) 21 - Vehicle in traffic |
Manner of Crash/Collision 5 - Broadside |
Roadway 01 - None apparent |
Type
|
Light Conditions 1 - Daylight |
Surface Conditions 1 |
Type of Roadway Junction/Feature 11 - Four-way intersection |
Workers Present?
|
D I A G R A M
0 |
|
| NARRATIVE |
VEHICLE NUMBER ONE WAS WEST BOUND ON HIGHWAY 16. VEHICLE NUMBER TWO WAS TRAVELING SOUTH BOUND ON 280TH AVE. VEHICLE NUMBER TWO WAS ATTEMPTING TO CROSS HIGHWAY 16. VEHICLE NUMBER TWO FAILS TO YIELD THE RIGHT AWAY FROM THE STOP SIGN AND IS STRUCK BY VEHICLE NUMBER ONE. |
|
Officer
WYATT |
Badge No. 318 |
Time Officer Notified of Accident 07:42 |
Time Officer Arrived At Scene 08:01 |
Name of Agency P13 |
Date of Report 4/12/2011 |
Investigation made at scene? Yes |
T.I. #
|
Any questions about this report may be directed to the following address:
Iowa State Patrol District 13 Office
1300 S Grand Ave
Mt Pleasant,IA 52641-1862
Phone: (319) 385-8715
Fax: (319) 385-2743