U
N
I
T
1
|
Driver's Name - Last
HARBACH |
First
SCOTT |
Middle
ALAN |
Suffix
|
City
DELHI |
State
IA - Iowa, US |
Zip
52223 |
Driver's Age
52 |
Citation Charge Code 1
UNDER INVESTIGATION |
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
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
1 - None 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:
DELAWARE CO HOSP / MANCHESTER |
Transported by:
DEL CO AMBULANCE |
Insurance Co. Name
|
Year
2002 |
Make
Ford - FORD |
Model
TAU |
Style
4D |
Approximate Cost to Repair or Replace
2000 |
Initial Travel Direction
4 - West |
Vehicle Action
01 - Movement essentially straight |
Speed Limit
55 |
Point of Initial Impact
03 - Right Side |
Most Damaged Area
03 - Right Side |
Extent of Damage
5 - Severe, vehicle totaled |
Underride/Override
1 - None |
Total Occupants
02 |
Traffic Controls
04 - Stop signs |
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
03 - Ran off road, left |
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
OTT |
First
PHILIP |
Middle
BRUCE |
Suffix
|
City
MANCHESTER |
State
IA - Iowa, US |
Zip
520570000 |
Driver's Age
40 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender
Male |
State
IA - Iowa, 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?
4 - Breath |
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
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:
REFUSED TREATMENT |
Transported by:
|
Insurance Co. Name
INTERSTATE POWER & LIGHT |
Year
2001 |
Make
Ford - FORD |
Model
|
Style
CB |
Approximate Cost to Repair or Replace
2500 |
Initial Travel Direction
3 - South |
Vehicle Action
01 - Movement essentially straight |
Speed Limit
55 |
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
01 - No controls present |
Vehicle Config.
05 - Single-unit truck (2-axle, 6-tires) |
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
03 - Ran off road, left |
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
INTERSTATE POWER & LIGHT |
City
DUBUQUE |
State
IA - Iowa, US |
Zip
520029670 |
Number of Axles
2 |
Gross Vehicle Weight Rating
17500 |
Placard #
|
Hazardous Materials Released?
3 - Not applicable |
| 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)
02 - Partly cloudy |
Environment
1 - None apparent |
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?
|
P
E
R
S
O
N
|
I
N
J
U
R
E
D
|
Name- Last
HARBACH |
First
MARISSA |
Middle
|
Suffix
|
City
|
State
|
Zip Code
|
Age
13 |
Sex
Female |
Unit No.
01 |
Seating Position
03 - Front: Right Side |
Injury Status
1 - Fatal |
Occupant Protection
1 - None used |
Airbag Deployment
5 - Not deployed |
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:
DELAWARE CO HODP / MANCHESTER |
Transported by:
DELAWARE CO AMBULANCE |
| NON-MOTORIST |
Type
|
Location
|
Action
|
Condition
|
Safety Equipment
|
Contributing Circumstances
|
Unit No. of Vehicle Striking
|
D
I
A
G
R
A
M
0 |
 |
| NARRATIVE |
VEHICLE 1 WAS WEST BOUND WHEN IT PULLED IN FRONT OF VEHICLE 2 WHICH WAS SOUTH BOUND. VEHICLE 2 STRUCK VEHICLE 1 IN THE PASSENGER SIDE CAUSING VEHICLE 2 TO SPIN COMING TO REST FACING SOUTH IN THE SOUTH WEST DITCH. VEHICLE 1ALSO ENTERED THE SOUTH WEST DITCH AND CAME TO REST FACING SOUTH. |
|
Officer
DRISCOLL |
Badge No.
127 |
Time Officer Notified of Accident
16:38 |
Time Officer Arrived At Scene
16:44 |
Name of Agency
P10 |
Date of Report
5/7/2011 |
Investigation made at scene?
Yes |
T.I. #
|
Any questions about this report may be directed to the following address:
Iowa State Patrol District 10 Office
15239 35th St
Oelwein,IA 50662-9446
Phone: (319) 283-5521
Fax: (319) 283-2046