U
N
I
T
1
|
Driver's Name - Last
DAVROS |
First
AMANDA ANN |
Middle
|
Suffix
|
City
NEWTON |
State
IA - Iowa, US |
Zip
502080000 |
Driver's Age
32 |
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
3 - Non-incapacitating |
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:
REFUSED |
Transported by:
REFUSED IN WRITING UFD |
Insurance Co. Name
|
Year
2006 |
Make
Pontiac - PONT |
Model
GRA |
Style
4D |
Approximate Cost to Repair or Replace
15000 |
Initial Travel Direction
4 - West |
Vehicle Action
01 - Movement essentially straight |
Speed Limit
70 |
Point of Initial Impact
02 - Right Front |
Most Damaged Area
02 - Right Front |
Extent of Damage
4 - Disabling damage |
Underride/Override
1 - None |
Total Occupants
01 |
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
21 - Vehicle in traffic |
Second Event
01 - Ran off road, right |
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
MATHEWS |
First
ROCKY |
Middle
A |
Suffix
|
City
PLATTSMOUTH |
State
NE - Nebraska, US |
Zip
68048 |
Driver's Age
56 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender
Male |
State
NE - Nebraska, US |
Class
|
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
5 - Uninjured |
Occupant Protection
2 - Shoulder and lap belt used |
Airbag Deployment
3 - Deployed both front/side |
Airbag Switch Status
3 - No ON/OFF switch present |
Ejection
1 - Not ejected |
Ejection Path
|
Trapped
1 - Not trapped |
Transported to:
|
Transported by:
|
Insurance Co. Name
|
Year
2008 |
Make
Chevrolet - CHEV |
Model
SILVERADO |
Style
1500 |
Approximate Cost to Repair or Replace
7000 |
Initial Travel Direction
4 - West |
Vehicle Action
01 - Movement essentially straight |
Speed Limit
70 |
Point of Initial Impact
02 - Right Front |
Most Damaged Area
01 - Front |
Extent of Damage
3 - Functional damage |
Underride/Override
1 - None |
Total Occupants
03 |
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
|
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)
03 - Cloudy |
Environment
1 - None apparent |
Location
|
First Harmful Event of Crash (use codes 11-42 only)
21 - Vehicle in traffic |
Manner of Crash/Collision
6 - Sideswipe, same direction |
Roadway
01 - None apparent |
Type
|
Light Conditions
1 - Daylight |
Surface Conditions
1 |
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
CASTRO |
First
JOSE |
Middle
RIGOBERTO |
Suffix
|
City
|
State
|
Zip Code
|
Age
58 |
Sex
Male |
Unit No.
02 |
Seating Position
03 - Front: Right Side |
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
1 - Not ejected/not applicable |
Trapped
1 - Not trapped |
Transported to:
MERCY HOSPITAL |
Transported by:
UNKNOWN CITIZEN |
| NON-MOTORIST |
Type
|
Location
|
Action
|
Condition
|
Safety Equipment
|
Contributing Circumstances
|
Unit No. of Vehicle Striking
|
D
I
A
G
R
A
M
0 |
 |
| NARRATIVE |
UNIT 1 STATES WAS TRAVELING IN RIGHT LANE WHEN NON CONTACT VEHICLE SWERVED TOWARDS HER LANE. UNIT 1 SWERVED TO AVOID. EVIDENCE AT SCENE SHOWS UNIT 1 LEAVING SKID MARKS ON RIGHT SHOULDER THEN LEFT LANE WHERE IMPACT OCCURRED WITH UNIT 2. UNIT 1 AND 2 THEN ENDED UP ON SHOULDER AND DITCH ON WEST SIDE OF INTERSTATE. UNIT 2 STATES HE WAS BEHIND UNIT 1 WHEN SHE LOST CONTROL AND HE MOVED TO FAST LANE TO TRY AND AVOID ACCIDENT. UNIT 1 AND 2 COLLIDED IN LEFT LANE AND CAME TO REST AS LISTED ABOVE. |
|
Officer
HITCHCOCK |
Badge No.
423 |
Time Officer Notified of Accident
17:50 |
Time Officer Arrived At Scene
18:03 |
Name of Agency
P03 |
Date of Report
4/14/2011 |
Investigation made at scene?
Yes |
T.I. #
|
Any questions about this report may be directed to the following address:
Iowa State Patrol District 03 Office
2025 Hunt Ave
Council Bluffs,IA 51503-4254
Phone: (712) 328-8001
Fax: (712) 328-1504