Iowa State Patrol: Department of Public Safety

Crash Information

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N 		Date of Accident
5/2/2011		 Time of Accident
05:46 PM 		County
Webster - 94		 Accident occurred within corporate limits of (city)
Fort Dodge - 2690		 Law Enforcement Case Number:
2011026027
Literal Description
1ST AVE S and S 15TH ST 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
403240.3
Y-Coordinate
4706531.
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1 		Driver's Name - Last
JELSMA		 First
RANDY		 Middle
JOSEPH		 Suffix
City
FORT DODGE		 State
IA - Iowa, US		 Zip
505010000
Driver's Age
53		 Citation Charge Code 1
 Citation Charge 1
Gender
Male		 State
IA - Iowa, US		 Class
C - Non-commercial vehicle or commercial Veh w/26000 GVWR or less & either 16 Pass Design or Hazmat		 Endorsements
 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
1 - Deployed front of person		 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
2004		 Make
Chevrolet - CHEV		 Model
AVA		 Style
SW		 Approximate Cost to Repair or Replace
10000
Initial Travel Direction
3 - South		 Vehicle Action
02 - Turning left		 Speed Limit
25		 Point of Initial Impact
01 - Front		 Most Damaged Area
01 - Front		 Extent of Damage
4 - Disabling damage		 Underride/Override
1 - None
Total Occupants
01		 Traffic Controls
02 - Traffic signals		 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?
U
N
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2 		Driver's Name - Last
SORENSON		 First
DEA		 Middle
MARIE		 Suffix
City
FORT DODGE		 State
IA - Iowa, US		 Zip
50501
Driver's Age
33		 Citation Charge Code 1
321.297		 Citation Charge 1
DRIVING ON WRONG SIDE OF TWO WAY ROADWAY
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
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
 Trapped
1 - Not trapped
Transported to:
TRINITY		 Transported by:
TRINITY
Insurance Co. Name
Year
2009		 Make
Toyota - TOYT		 Model
COROLLA		 Style
4D		 Approximate Cost to Repair or Replace
9000
Initial Travel Direction
4 - West		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
25		 Point of Initial Impact
01 - Front		 Most Damaged Area
01 - Front		 Extent of Damage
4 - Disabling damage		 Underride/Override
1 - None
Total Occupants
02		 Traffic Controls
02 - Traffic signals		 Vehicle Config.
01 - Passenger car		 Cargo Body Type
01 - Not applicable		 Vehicle Defect
01 - None		 Driver Condition
6 - Under the influence of alcohol/drugs/medications		 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)
01 - Clear		 Environment
1 - None apparent		 Location
 First Harmful Event of Crash (use codes 11-42 only)
21 - Vehicle in traffic
Manner of Crash/Collision
2 - Head-on		 Roadway
01 - None apparent		 Type
Light Conditions
1 - Daylight		 Surface Conditions
1		 Type of Roadway Junction/Feature
11 - Four-way intersection		 Workers Present?
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D 		Name- Last
SORENSON		 First
HOUSTON		 Middle
 Suffix
City
 State
 Zip Code
Age
16		 Sex
Female		 Unit No.
2		 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:
TRINITY		 Transported by:
TRINITY
NON-MOTORIST Type
 Location
 Action
 Condition
 Safety Equipment
 Contributing Circumstances
 Unit No. of Vehicle Striking
D
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0
NARRATIVE

UNIT ONE WAS GOING SOUTH ON SOUTH 15TH ATTEMPTING TO TURN EAST ONTO 1ST AVE SOUTH. UNIT TWO WAS GOING WEST IN THE EASTBOUND INSIDE LANE ON 1ST AVE SOUTH. THE TWO UNITS COLLIDED MOSTLY HEAD ON.
Officer
NILES 		Badge No.
158		 Time Officer Notified of Accident
17:50		 Time Officer Arrived At Scene
18:05
Name of Agency
P07		 Date of Report
5/2/2011		 Investigation made at scene?
Yes		 T.I. #


Any questions about this report may be directed to the following address:
Iowa State Patrol District 07 Office
2437 235th St
Ft Dodge,IA 50501-8465
Phone: (515) 972-4213
Fax: (515) 972-4218