Iowa State Patrol: Department of Public Safety

Crash Information

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N 		Date of Accident
6/6/2011		 Time of Accident
05:43 PM 		County
Story - 85		 Accident occurred within corporate limits of (city)
 Law Enforcement Case Number:
2011032915
Literal Description
MM 119.3 S. OF STORY CITY N.B. 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
454308.9
Y-Coordinate
4663281.
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1 		Driver's Name - Last
OLSTHOORN		 First
DONALD		 Middle
CLAY		 Suffix
City
FORT DODGE		 State
IA - Iowa, US		 Zip
505010000
Driver's Age
19		 Citation Charge Code 1
321.306		 Citation Charge 1
IMPROPER USE OF LANES
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
321.20B		 Citation Charge 2
NO INSURANCE
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
5 - Not deployed		 Airbag Switch Status
9 - Unknown		 Ejection
1 - Not ejected		 Ejection Path
 Trapped
1 - Not trapped
Transported to:
 Transported by:
Insurance Co. Name
Year
2001		 Make
Pontiac - PONT		 Model
GRA		 Style
4D		 Approximate Cost to Repair or Replace
1500
Initial Travel Direction
1 - North		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
70		 Point of Initial Impact
03 - Right Side		 Most Damaged Area
03 - Right Side		 Extent of Damage
1 - None		 Underride/Override
1 - None
Total Occupants
1		 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
04 - Crossed centerline/median		 Second Event
21 - Vehicle in traffic		 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?
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2 		Driver's Name - Last
COBURN		 First
BRYCE		 Middle
PHILLIP		 Suffix
City
RADCLIFFE		 State
IA - Iowa, US		 Zip
502300000
Driver's Age
33		 Citation Charge Code 1
321.20B		 Citation Charge 1
NO INSURANCE
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
5 - Uninjured		 Occupant Protection
2 - Shoulder and lap belt used		 Airbag Deployment
5 - Not deployed		 Airbag Switch Status
9 - Unknown		 Ejection
1 - Not ejected		 Ejection Path
 Trapped
1 - Not trapped
Transported to:
 Transported by:
Insurance Co. Name
Year
2008		 Make
Ford - FORD		 Model
F25		 Style
PK		 Approximate Cost to Repair or Replace
1500
Initial Travel Direction
1 - North		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
70		 Point of Initial Impact
06 - Left Rear		 Most Damaged Area
06 - Left Rear		 Extent of Damage
1 - None		 Underride/Override
1 - None
Total Occupants
1		 Traffic Controls
01 - No controls present		 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?
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
6 - Sideswipe, same direction		 Roadway
01 - None apparent		 Type
Light Conditions
1 - Daylight		 Surface Conditions
1		 Type of Roadway Junction/Feature
01 - No special feature		 Workers Present?
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NARRATIVE

VEHICLE #1 WAS GOING NORTH IN THE INSIDE LANE OF INTERSTATE 35 WHEN IT MADE A LANE CHANGE INTO THE SIDE OF VEHICLE #2 WHICH WAS ALSO GOING NORTH. DRIVER #1 STATED THAT HE WAS ASLEEP WHEN THE LANE CHANGE OCCURRED.
Officer
TJEPKES 		Badge No.
074		 Time Officer Notified of Accident
17:43		 Time Officer Arrived At Scene
17:59
Name of Agency
P01		 Date of Report
6/6/2011		 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