U
N
I
T
2
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Driver's Name - Last PSAROS |
First ANDREW |
Middle JOHN |
Suffix
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City MONTICELLO |
State IA - Iowa, US |
Zip 52310 |
Driver's Age 30 |
Citation Charge Code 1 321.20B |
Citation Charge 1 FAILURE TO SHOW SECURITY AGAINST LIABILITY (ACCIDENT) |
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 2 321.285 |
Citation Charge 2 FAIL TO STOP WITHIN THE ASSURED AND CLEAR DISTANCE |
Alcohol Test Given? 1 - None |
Drug Test Given? 1 - None |
Citation Charge Code 3 321.285 |
Citation Charge 3 SPEED |
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 2 - Incapacitating |
Occupant Protection 2 - Shoulder and lap belt used |
Airbag Deployment 3 - Deployed both front/side |
Airbag Switch Status 3 - No ON/OFF switch present |
Ejection 1 - Not ejected |
Ejection Path
|
Trapped 1 - Not trapped |
Transported to: FINLEY HOSPITAL |
Transported by: CASCADE AMBULANCE |
Insurance Co. Name
|
Year 2000 |
Make Ford - FORD |
Model WINDSTAR |
Style VAN |
Approximate Cost to Repair or Replace 6000 |
Initial Travel Direction 3 - South |
Vehicle Action 01 - Movement essentially straight |
Speed Limit 65 |
Point of Initial Impact 01 - Front |
Most Damaged Area 01 - Front |
Extent of Damage 5 - Severe, vehicle totaled |
Underride/Override 1 - None |
Total Occupants 01 |
Traffic Controls 01 - No controls present |
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 06 - Evasive action (swerve, panic braking, etc.) |
Second Event 21 - Vehicle in traffic |
Third Event
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Fourth Event
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Most Harmful Event (by vehicle) 06 - Evasive action (swerve, panic braking, etc.) |
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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