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Driver's Name - Last SMITH |
First VANCE |
Middle MARTIN |
Suffix
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City ST CHARLES |
State IA - Iowa, US |
Zip 50240 |
Driver's Age 46 |
Citation Charge Code 1 321J.21 |
Citation Charge 1 DRIVING WHILE REVOKED |
Gender Male |
State IA - Iowa, US |
Class B - Veh w/26001 GVWR or more Towed unit is less than 10001 GVWR |
Endorsements N - Tank |
Restrictions
None |
Citation Charge Code 2 321.288 |
Citation Charge 2 FAILURE TO MAINTAIN CONTROL OF VEHICLE |
Alcohol Test Given? 1 - None |
Drug Test Given? 1 - None |
Citation Charge Code 3
|
Citation Charge 3
|
Citation Charge Code 4
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Citation Charge 4
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Seating Position 01 - Front: Left Side / Motorcycle Driver |
Injury Status 5 - Uninjured |
Occupant Protection 2 - Shoulder and lap belt used |
Airbag Deployment 6 - Not applicable |
Airbag Switch Status 3 - No ON/OFF switch present |
Ejection 1 - Not ejected |
Ejection Path
|
Trapped 1 - Not trapped |
Transported to: NO TREATMENT |
Transported by:
|
Insurance Co. Name
|
Year 1999 |
Make International - INTL |
Model 4000 SERIES |
Style TRUCK |
Approximate Cost to Repair or Replace 12000 |
Initial Travel Direction 3 - South |
Vehicle Action 01 - Movement essentially straight |
Speed Limit 55 |
Point of Initial Impact 01 - Front |
Most Damaged Area 05 - Rear |
Extent of Damage 4 - Disabling damage |
Underride/Override 1 - None |
Total Occupants 1 |
Traffic Controls 01 - No controls present |
Vehicle Config. 06 - Single-unit truck (>=3 axles) |
Cargo Body Type 04 - Cargo tank |
Vehicle Defect 01 - None |
Driver Condition 2 - Physical impairment |
Vision Obscured 01 - Not obscured |
Contributing Circumstances, Driver (up to 2)
|
SEQUENCE OF EVENTS |
First Event 01 - Ran off road, right |
Second Event 42 - Other fixed object (explain in narrative) |
Third Event
|
Fourth Event
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Most Harmful Event (by vehicle) 42 - Other fixed object (explain in narrative) |
Emergency Vehicle Type 1 - Not applicable |
Emergency Status 3 - Not Applicable |
Carrier Name
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City
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State
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Zip
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Number of Axles
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Gross Vehicle Weight Rating
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Placard #
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Hazardous Materials Released?
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