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Driver's Name - Last WALDROP |
First TYLER |
Middle MATTHEW |
Suffix
|
City FORT DODGE |
State IA - Iowa, US |
Zip 50501 |
Driver's Age 18 |
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
S - SR Required |
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 1 - Fatal |
Occupant Protection 6 - Helmet used |
Airbag Deployment 6 - Not applicable |
Airbag Switch Status 3 - No ON/OFF switch present |
Ejection 3 - Totally ejected |
Ejection Path
|
Trapped 2 - Freed by non-mechanical means |
Transported to: TRINITY REGIONAL |
Transported by: TRINITY REGIONAL |
Insurance Co. Name
|
Year
|
Make
|
Model 250 QUAD RUNNER |
Style 4 WHEELER |
Approximate Cost to Repair or Replace 500 |
Initial Travel Direction 1 - North |
Vehicle Action 88 - Other (explain in narrative) |
Speed Limit
|
Point of Initial Impact 09 - Top |
Most Damaged Area 09 - Top |
Extent of Damage 2 - Minor damage |
Underride/Override 1 - None |
Total Occupants 1 |
Traffic Controls 01 - No controls present |
Vehicle Config. 88 - Other (explain in narrative) |
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 11 - Overturn/rollover |
Second Event
|
Third Event
|
Fourth Event
|
Most Harmful Event (by vehicle) 11 - Overturn/rollover |
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?
|