U
N
I
T
1
|
Driver's Name - Last SWANSON |
First LARRY |
Middle D |
Suffix
|
City LOVES PARK |
State IL - Illinois, US |
Zip 61111 |
Driver's Age 60 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender Male |
State IL - Illinois, US |
Class D - Chauffeur |
Endorsements None |
Restrictions
B - Cor Lenses |
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 3 - No ON/OFF switch present |
Ejection 1 - Not ejected |
Ejection Path
|
Trapped 1 - Not trapped |
Transported to:
|
Transported by:
|
Insurance Co. Name
|
Year 2000 |
Make Honda - HOND |
Model ODYSSEY |
Style VAN |
Approximate Cost to Repair or Replace 10000 |
Initial Travel Direction 2 - East |
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 2 - Minor damage |
Underride/Override 1 - None |
Total Occupants 1 |
Traffic Controls 11 - Workzone signs |
Vehicle Config. 03 - Van or mini-van |
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?
|
U
N
I
T
2
|
Driver's Name - Last
|
First
|
Middle
|
Suffix
|
City
|
State
|
Zip
|
Driver's Age
|
Citation Charge Code 1
|
Citation Charge 1
|
Gender
|
State
|
Class
|
Endorsements None |
Restrictions
None |
Citation Charge Code 2
|
Citation Charge 2
|
Alcohol Test Given?
|
Drug Test Given?
|
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
|
Make
|
Model
|
Style
|
Approximate Cost to Repair or Replace
|
Initial Travel Direction
|
Vehicle Action
|
Speed Limit
|
Point of Initial Impact 07 - Left Side |
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 21 - Vehicle in traffic |
Second Event 52 - Hit and run |
Third Event
|
Fourth Event
|
Most Harmful Event (by vehicle) 52 - Hit and run |
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 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 6 - Sideswipe, same direction |
Roadway 05 - Work Zone (construction, maintenance, utility) |
Type
|
Light Conditions 5 - Dark, roadway not lighted |
Surface Conditions 1 |
Type of Roadway Junction/Feature 01 - No special feature |
Workers Present?
|
D I A G R A M
0 |
|
| NARRATIVE |
UNIT 1 WAS EASTBOUND ON INTERSTATE 80 IN A WORK ZONE WHERE THE LEFT LANE WAS CLOSED. UNIT 1 WAS TRAVELING NEXT TO A TRACTOR SEMI-TRAILER AS BOTH VEHICLES APPROACHED THE LANE CLOSURE. UNIT 1 AND THE TRACTOR SEMI-TRAILER COLLIDED IN A SIDESWIPE-STYLE COLLISION AS BOTH VEHICLES ENTERED THE LANE CLOSURE. THE TRACTOR SEMI-TRAILER CONTINUED EASTBOUND ON INTERSTATE 80 WITHOUT STOPPING. |
|
Officer
PEDERSEN |
Badge No. 173 |
Time Officer Notified of Accident 23:06 |
Time Officer Arrived At Scene 23:30 |
Name of Agency P12 |
Date of Report 8/23/2011 |
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