Iowa State Patrol: Department of Public Safety

Crash Information

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A
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N 		Date of Accident
6/3/2011		 Time of Accident
11:49 AM 		County
Pottawattamie - 78		 Accident occurred within corporate limits of (city)
 Law Enforcement Case Number:
2011032270
Literal Description
47MM WB I-80 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
315795.3
Y-Coordinate
4596306.
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1 		Driver's Name - Last
MOORE		 First
DONALD		 Middle
RAY		 Suffix
City
KNOXVILLE		 State
IA - Iowa, US		 Zip
501380000
Driver's Age
60		 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
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
 Injury Status
 Occupant Protection
 Airbag Deployment
 Airbag Switch Status
 Ejection
 Ejection Path
 Trapped
Transported to:
 Transported by:
Insurance Co. Name
Year
2010		 Make
Dodge - DODG		 Model
CHARGER		 Style
4DR		 Approximate Cost to Repair or Replace
3000
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

Vehicle #1 was traveling west on I-80 near the 47mm. While traveling west in the right lane, driver of vehicle #1 stated he struck a deer that entered the roadway from the north ditch. Driver of vehicle #1 exited the interstate to make a report. The report was taken at the BP gas station in Walnut.
Officer
BROSAM 		Badge No.
078		 Time Officer Notified of Accident
11:51		 Time Officer Arrived At Scene
12:06
Name of Agency
P03		 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 03 Office
2025 Hunt Ave
Council Bluffs,IA 51503-4254
Phone: (712) 328-8001
Fax: (712) 328-1504