U
N
I
T
1
|
Driver's Name - Last
HAZEN |
First
LORI |
Middle
LYNN |
Suffix
|
City
WHAT CHEER |
State
IA - Iowa, US |
Zip
50268 |
Driver's Age
45 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender
Female |
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?
2 - Blood |
Drug Test Given?
3 - Urine |
Citation Charge Code 3
|
Citation Charge 3
|
Citation Charge Code 4
|
Citation Charge 4
|
Seating Position
01 - Front: Left Side / Motorcycle Driver |
Injury Status
1 - Fatal |
Occupant Protection
1 - None 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:
MAHASKA COUNTY HOSPTIAL |
Transported by:
AMBULANCE |
Insurance Co. Name
|
Year
1996 |
Make
Pontiac - PONT |
Model
GRAND AM SE |
Style
2-DOOR |
Approximate Cost to Repair or Replace
3200 |
Initial Travel Direction
2 - East |
Vehicle Action
88 - Other (explain in narrative) |
Speed Limit
55 |
Point of Initial Impact
01 - Front |
Most Damaged Area
01 - Front |
Extent of Damage
4 - Disabling damage |
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
6 - Under the influence of alcohol/drugs/medications |
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?
|
U
N
I
T
2
|
Driver's Name - Last
GRAHEK |
First
JESSICA |
Middle
LYNN |
Suffix
|
City
OSKALOOSA |
State
IA - Iowa, US |
Zip
52577 |
Driver's Age
19 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender
Female |
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
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:
MERCY HOSPITAL DES MOINES |
Transported by:
AIRCAR |
Insurance Co. Name
|
Year
2000 |
Make
Hyundai - HYUN |
Model
SONATA GLS |
Style
4-DOOR |
Approximate Cost to Repair or Replace
4000 |
Initial Travel Direction
4 - West |
Vehicle Action
01 - Movement essentially straight |
Speed Limit
55 |
Point of Initial Impact
01 - Front |
Most Damaged Area
01 - Front |
Extent of Damage
5 - Severe, vehicle totaled |
Underride/Override
1 - None |
Total Occupants
2 |
Traffic Controls
01 - No controls present |
Vehicle Config.
01 - Passenger car |
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)
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
2 - Head-on |
Roadway
01 - None apparent |
Type
|
Light Conditions
1 - Daylight |
Surface Conditions
1 |
Type of Roadway Junction/Feature
01 - No special feature |
Workers Present?
|
P
E
R
S
O
N
|
I
N
J
U
R
E
D
|
Name- Last
PARASHOS |
First
GEORGIA |
Middle
|
Suffix
|
City
|
State
|
Zip Code
|
Age
19 |
Sex
Female |
Unit No.
2 |
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:
MAHASKA HOSPITAL |
Transported by:
AMBULANCE |
| NON-MOTORIST |
Type
|
Location
|
Action
|
Condition
|
Safety Equipment
|
Contributing Circumstances
|
Unit No. of Vehicle Striking
|
D
I
A
G
R
A
M
0 |
 |
| NARRATIVE |
VEHICLE #1 WAS TRAVELING EAST OH HIGHWAY 92. WITNESSES ADVISED THAT VEHICLE #1 WAS ALL OVER THE ROADWAY. VEHICLE #2 WAS HEADING WEST ON HIGHWAY 92. VEHICLE #1 ENTERED WESTBOUND LANE OF TRAVEL HITTING VEHICLE #2 HEAD ON. FEB 21, 2012 THIS REPORT WAS UPDATED. BLOOD ALCOHOL AND DRUG TESTS. |
|
Officer
STEIGLEDER |
Badge No.
433 |
Time Officer Notified of Accident
15:30 |
Time Officer Arrived At Scene
16:10 |
Name of Agency
P13 |
Date of Report
1/8/2012 |
Investigation made at scene?
Yes |
T.I. #
|
Any questions about this report may be directed to the following address:
Iowa State Patrol District 13 Office
1300 S Grand Ave
Mt Pleasant,IA 52641-1862
Phone: (319) 385-8715
Fax: (319) 385-2743