Crash Information

L O C A T I O N	Date of Accident 6/5/2011	Time of Accident 09:43 AM	County Scott - 82	Accident occurred within corporate limits of (city) Walcott - 8052	Law Enforcement Case Number: 2011032606
	Literal Description SB/WB Interstate 0080				Legal Intervention? No	Private Property? No
					X-Coordinate: 684987.7
					Y-Coordinate 4609507.

U N I T 1	Driver's Name - Last SMITH			First DEBRA			Middle MARIE		Suffix
	City LEES SUMMIT			State MO - Missouri, US				Zip 64081
	Driver's Age 51					Citation Charge Code 1 321.288		Citation Charge 1 FAIL TO MAINTAIN CONTROL
	Gender Female	State MO - Missouri, US	Class	Endorsements None	Restrictions C - Mechanical Aid	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 4 - Possible	Occupant Protection 2 - Shoulder and lap belt used		Airbag Deployment 1 - Deployed front of person	Airbag Switch Status 1 - Switch in ON position		Ejection 1 - Not ejected	Ejection Path	Trapped 1 - Not trapped
	Transported to: GENESIS EAST					Transported by: DURANT AMBULANCE
	Insurance Co. Name
	Year 1995		Make Toyota - TOYT		Model CAMRY		Style 4DR		Approximate Cost to Repair or Replace 3000
	Initial Travel Direction 4 - West	Vehicle Action 01 - Movement essentially straight	Speed Limit 70	Point of Initial Impact 01 - Front	Most Damaged Area 01 - Front	Extent of Damage 5 - Severe, vehicle totaled	Underride/Override 1 - None
	Total Occupants 02	Traffic Controls 01 - No controls present	Vehicle Config. 01 - Passenger car	Cargo Body Type 01 - Not applicable	Vehicle Defect 01 - None	Driver Condition 5 - Asleep, fainted, fatigued, etc	Vision Obscured 01 - Not obscured	Contributing Circumstances, Driver (up to 2)
	SEQUENCE OF EVENTS			First Event 01 - Ran off road, right	Second Event 13 - Other non-collision	Third Event	Fourth Event	Most Harmful Event (by vehicle) 13 - Other non-collision
	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?

P R O P E R T Y D A M A G E	If Property other than vehicles damaged explain	Object Damaged CHAIN LINK FENCE		Estimate of Damage 1000
	Owner's Name - Last	First	Middle	Suffix
	Owner Company Name I-80 TRUCK STOP
	City WALCOTT	State IA - Iowa, US		Zip

ACCIDENT ENVIRONMENT		ROADWAY CHARACTERISTICS Major Contributing Circumstances:	WORKZONE RELATED?	SEQUENCE OF EVENTS
Location of First Harmful Event 2 - Shoulder	Weather Conditions (up to two) 01 - Clear	Environment 1 - None apparent	Location	First Harmful Event of Crash (use codes 11-42 only) 13 - Other non-collision
Manner of Crash/Collision 1 - Non-collision	Weather Conditions (up to two) 01 - Clear	Roadway 01 - None apparent	Type
Light Conditions 1 - Daylight	Surface Conditions 1	Type of Roadway Junction/Feature 16 - Intersection with ramp	Workers Present?

P
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Name- Last
SMITH

First
MONIQUE

Middle
MARIE

Suffix

City

State

Zip Code

Age
25

Sex
Female

Unit No.
01

Seating Position
03 - Front: Right Side

Injury Status
4 - Possible

Occupant Protection
2 - Shoulder and lap belt used

Airbag Deployment
1 - Deployed front of person

Airbag Switch Status
1 - Switch in ON position

Ejection
1 - Not ejected

Ejection Path
1 - Not ejected/not applicable

Trapped
1 - Not trapped

Transported to:
GENESIS EAST

Transported by:
DURANT AMBULANCE

NON-MOTORIST

Type

Location

Action

Condition

Safety Equipment

Contributing Circumstances

Unit No. of Vehicle Striking

D
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A
G
R
A
M

0

NARRATIVE

VEHICLE 1 WAS TRAVELING WEST ON I-80 AT THE 284.5 MILE MARKER. THE DRIVER OF VEHICLE 1 RAN OFF THE ROADWAY IN A NORTHERLY DIRECTION, STRUCK A FENCE AND ENTERED A PARKING LOT. AFTER ENTERING THE PARKING LOT, VEHICLE 1 WENT BACK THROUGH THE FENCE AND CAME TO FINAL REST IN THE NORTH DITCH FACING A SOUTHERLY DIRECTION.

Officer HUFFMAN	Badge No. 131	Time Officer Notified of Accident 09:47	Time Officer Arrived At Scene 09:53
Name of Agency P12	Date of Report 6/5/2011	Investigation made at scene? Yes	T.I. #

Any questions about this report may be directed to the following address:
Iowa State Patrol District 12 Office
22365 20th Ave
Stockton,IA 52769-9612
Phone: (563) 284-9501
Fax: (563) 284-9504