U
N
I
T
1
|
Driver's Name - Last PARRY |
First PAUL |
Middle M |
Suffix
|
City DEKALAB |
State WI - Wisconsin, US |
Zip 60115 |
Driver's Age 48 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender Male |
State IL - Illinois, 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 5 - Uninjured |
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: NOT TRANSPORTED |
Transported by:
|
Insurance Co. Name
|
Year 2008 |
Make Chevrolet - CHEV |
Model MAL |
Style 4D |
Approximate Cost to Repair or Replace 2000 |
Initial Travel Direction 1 - North |
Vehicle Action 05 - Overtaking/passing |
Speed Limit 70 |
Point of Initial Impact 04 - Right Rear |
Most Damaged Area 04 - Right Rear |
Extent of Damage 2 - Minor damage |
Underride/Override 1 - None |
Total Occupants 1 |
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
|
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 BARCLAY |
First TIMOTHY |
Middle ALLEN |
Suffix
|
City ROCHESTER |
State MN - Minnesota, US |
Zip 55901 |
Driver's Age 45 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender Male |
State MN - Minnesota, US |
Class A - Veh w/26001 GVWR or more Towed unit is 10001 GVWR or more |
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 6 - Not applicable |
Airbag Switch Status 3 - No ON/OFF switch present |
Ejection 1 - Not ejected |
Ejection Path
|
Trapped 1 - Not trapped |
Transported to: NOT TRANSPORTED |
Transported by:
|
Insurance Co. Name
|
Year 2006 |
Make
|
Model TR |
Style SEMO |
Approximate Cost to Repair or Replace 500 |
Initial Travel Direction 1 - North |
Vehicle Action 01 - Movement essentially straight |
Speed Limit 70 |
Point of Initial Impact 08 - Left Front |
Most Damaged Area 08 - Left Front |
Extent of Damage 2 - Minor damage |
Underride/Override 1 - None |
Total Occupants 1 |
Traffic Controls 01 - No controls present |
Vehicle Config. 10 - Tractor/doubles |
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) 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 6 - Sideswipe, same direction |
Roadway 02 - Road surface condition |
Type
|
Light Conditions 3 - Dawn |
Surface Conditions 5 |
Type of Roadway Junction/Feature 01 - No special feature |
Workers Present?
|
D I A G R A M
0 |
|
| NARRATIVE |
UNIT 1 WAS NORHTBOUND OVERTAKING UNIT 2 WHEN HE SAID HE LOST CONTROL DUE TO SLUSH SLIDDING INTO UNIT 2'S LANE. UNIT 2 THEN STRUCK UNIT 1 IN THE REAR PASSENGER SIDE DOOR. |
|
Officer
HAUGEN |
Badge No. 114 |
Time Officer Notified of Accident 07:07 |
Time Officer Arrived At Scene 07:15 |
Name of Agency P08 |
Date of Report 4/19/2011 |
Investigation made at scene? Yes |
T.I. #
|
Any questions about this report may be directed to the following address:
Iowa State Patrol District 08 Office
4425 Washington Avenue
Mason City,IA 50401-7002
Phone: (641) 424-3625
Fax: (641) 423-8381