Crash Information
L
O
C
A
T
I
O
N
Date of Accident
6/3/2011
Time of Accident
12:44 AM
County
Dallas - 25
Accident occurred within corporate limits of (city)
Law Enforcement Case Number:
2011032163
Literal Description
US 0169 / N AVE (Milepost 93)
Legal Intervention?
No
Private Property?
No
X-Coordinate:
414845.3
Y-Coordinate
4614896.
U
N
I
T
1
Driver's Name - Last
ROLL
First
MAX
Middle
CHARLES
Suffix
City
ADEL
State
IA - Iowa, US
Zip
500030000
Driver's Age
32
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
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
Injury Status
Occupant Protection
Airbag Deployment
Airbag Switch Status
Ejection
Ejection Path
Trapped
Transported to:
Transported by:
Insurance Co. Name
Year
2009
Make
Dodge - DODG
Model
CHA
Style
4D
Approximate Cost to Repair or Replace
5000
Initial Travel Direction
Vehicle Action
Speed Limit
Point of Initial Impact
Most Damaged Area
Extent of Damage
Underride/Override
Total Occupants
Traffic Controls
Vehicle Config.
Cargo Body Type
Vehicle Defect
Driver Condition
Vision Obscured
Contributing Circumstances, Driver (up to 2)
SEQUENCE OF EVENTS
First Event
Second Event
Third Event
Fourth Event
Most Harmful Event (by vehicle)
Emergency Vehicle Type
Emergency Status
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
Weather Conditions (up to two)
Environment
Location
First Harmful Event of Crash (use codes 11-42 only)
25 - Animal
Manner of Crash/Collision
Roadway
Type
Light Conditions
Surface Conditions
Type of Roadway Junction/Feature
Workers Present?
D
I
A
G
R
A
M
0
NARRATIVE
VEH #1 WAS SOUTHBOUND ON HWY 169. VEH #1 STRUCK A DEER. VEH #1 CAME TO REST ON THE SOUTHBOUND SHOULDER OF HWY 169.
Officer
ELLIOTT
Badge No.
125
Time Officer Notified of Accident
00:50
Time Officer Arrived At Scene
00:56
Name of Agency
P01
Date of Report
6/3/2011
Investigation made at scene?
Yes
T.I. #
Any questions about this report may be directed to the following address:
Iowa State Patrol District 01 Office
260 NW 48th Place
Des Moines,IA 50313-2299
Phone: (515) 725-0010
Fax: (515) 725-0011