Iowa State Patrol: Department of Public Safety

Crash Information

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N 		Date of Accident
4/13/2011		 Time of Accident
12:21 PM 		County
Jackson - 49		 Accident occurred within corporate limits of (city)
 Law Enforcement Case Number:
2011022462
Literal Description
SB/WB US 0061 / US 61 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
692369.7
Y-Coordinate
4657505.
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1 		Driver's Name - Last
BRANDON		 First
SHIRLEY		 Middle
RUTH		 Suffix
City
MAQUOKETA		 State
IA - Iowa, US		 Zip
520600000
Driver's Age
79		 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

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
4 - Possible		 Occupant Protection
2 - Shoulder and lap belt used		 Airbag Deployment
5 - Not deployed		 Airbag Switch Status
1 - Switch in ON position		 Ejection
1 - Not ejected		 Ejection Path
 Trapped
1 - Not trapped
Transported to:
JACKSON CO REGINAL HEALTH CENT		 Transported by:
JACKSON CO REGINAL AMBULANCE
Insurance Co. Name
Year
1999		 Make
Mercedes - MERZ		 Model
VILLAGER		 Style
VAN		 Approximate Cost to Repair or Replace
2000
Initial Travel Direction
3 - South		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
65		 Point of Initial Impact
01 - Front		 Most Damaged Area
01 - Front		 Extent of Damage
2 - Minor damage		 Underride/Override
1 - None
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
8 - Other (explain in narrative)		 Vision Obscured
01 - Not obscured		 Contributing Circumstances, Driver (up to 2)
SEQUENCE OF EVENTS First Event
03 - Ran off road, left		 Second Event
04 - Crossed centerline/median		 Third Event
 Fourth Event
42 - Other fixed object (explain in narrative)		 Most Harmful Event (by vehicle)
33 - Ditch/embankment
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?
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Y

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If Property other than vehicles damaged explain Object Damaged
FENCE		 Estimate of Damage
500
Owner's Name - Last
IOWA DEPT. OF TRANSP		 First
 Middle
 Suffix
Owner Company Name
City
AMES		 State
IA - Iowa, US		 Zip
ACCIDENT ENVIRONMENT ROADWAY CHARACTERISTICS
Major Contributing Circumstances:		 WORKZONE RELATED? SEQUENCE OF EVENTS
Location of First Harmful Event
3 - Median		 Weather Conditions (up to two)
01 - Clear		 Environment
1 - None apparent		 Location
 First Harmful Event of Crash (use codes 11-42 only)
33 - Ditch/embankment
Manner of Crash/Collision
1 - Non-collision		 Roadway
01 - None apparent		 Type
Light Conditions
1 - Daylight		 Surface Conditions
1		 Type of Roadway Junction/Feature
01 - No special feature		 Workers Present?
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0
NARRATIVE

VEHICLE #1 WAS TRAVELING SOUTHBOUND ON HIGHWAY 61, SHE REMEMBERED TRAVELING AROUND A CURVE AND THEN WENT OFF THE ROAD INTO THE MEDIAN. THE VEHICLE TRAVELED THROUGH THE MEDIAN CROSSED THE NORTHBOUND LANES AND INTO THE DITCH COMING TO REST IN A FIELD.
Officer
NELSON 		Badge No.
363		 Time Officer Notified of Accident
12:21		 Time Officer Arrived At Scene
12:25
Name of Agency
P12		 Date of Report
4/13/2011		 Investigation made at scene?
Yes		 T.I. #


Any questions about this report may be directed to the following address:
Iowa State Patrol District 12 Office
22365 20th Ave
Stockton,IA 52769-9612
Phone: (563) 284-9501
Fax: (563) 284-9504