U
N
I
T
1
|
Driver's Name - Last HAFELE |
First KELLY |
Middle ARLENE |
Suffix
|
City OTTUMWA |
State IA - Iowa, US |
Zip 525010000 |
Driver's Age 32 |
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 3 - Non-incapacitating |
Occupant Protection 2 - Shoulder and lap belt used |
Airbag Deployment 5 - Not deployed |
Airbag Switch Status 9 - Unknown |
Ejection 1 - Not ejected |
Ejection Path
|
Trapped 1 - Not trapped |
Transported to: MAHASKA COUNTY HOSPITAL |
Transported by: AMBULANCE |
Insurance Co. Name
|
Year 1999 |
Make Ford - FORD |
Model XPL |
Style SW |
Approximate Cost to Repair or Replace 8000 |
Initial Travel Direction 1 - North |
Vehicle Action 01 - Movement essentially straight |
Speed Limit 65 |
Point of Initial Impact 02 - Right Front |
Most Damaged Area 09 - Top |
Extent of Damage 5 - Severe, vehicle totaled |
Underride/Override 1 - None |
Total Occupants 03 |
Traffic Controls 01 - No controls present |
Vehicle Config. 04 - Sport utility vehicle |
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 06 - Evasive action (swerve, panic braking, etc.) |
Third Event
|
Fourth Event 11 - Overturn/rollover |
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?
|
U
N
I
T
2
|
Driver's Name - Last DAUGHERTY |
First NICHOLAS |
Middle PATRICK |
Suffix
|
City LE MARS |
State IA - Iowa, US |
Zip 51031 |
Driver's Age 34 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender Male |
State IA - Iowa, US |
Class A - Veh w/26001 GVWR or more Towed unit is 10001 GVWR or more |
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 6 - Not applicable |
Airbag Switch Status 3 - No ON/OFF switch present |
Ejection 1 - Not ejected |
Ejection Path
|
Trapped 1 - Not trapped |
Transported to: NA |
Transported by: NA |
Insurance Co. Name DIRKSEN TRUCKING |
Year 2001 |
Make
|
Model TR |
Style SEMI |
Approximate Cost to Repair or Replace 0 |
Initial Travel Direction 1 - North |
Vehicle Action 06 - Changing lanes |
Speed Limit 65 |
Point of Initial Impact 99 - Unknown |
Most Damaged Area
|
Extent of Damage 1 - None |
Underride/Override 1 - None |
Total Occupants 01 |
Traffic Controls 01 - No controls present |
Vehicle Config. 09 - Tractor/semi-trailer |
Cargo Body Type 11 - Large utility (2+ axles) |
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 06 - Evasive action (swerve, panic braking, etc.) |
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 DIRKSEN TRUCKING |
City LE MARS |
State IA - Iowa, US |
Zip 51031 |
Number of Axles 5 |
Gross Vehicle Weight Rating 80000 |
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) 01 - Clear |
Environment 1 - None apparent |
Location
|
First Harmful Event of Crash (use codes 11-42 only) 21 - Vehicle in traffic |
Manner of Crash/Collision 1 - Non-collision |
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 CASTILLO |
First ROSALINDA |
Middle L |
Suffix
|
City
|
State
|
Zip Code
|
Age 19 |
Sex Female |
Unit No. 1 |
Seating Position 09 - Rear: Right Side |
Injury Status 2 - Incapacitating |
Occupant Protection 1 - None used |
Airbag Deployment 6 - Not applicable |
Airbag Switch Status 3 - No ON/OFF switch present |
Ejection 3 - Totally ejected |
Ejection Path 3 - Through side window/door |
Trapped 1 - Not trapped |
Transported to: METHODIST HOSPITAL |
Transported by: AMBULANCE |
NON-MOTORIST |
Type
|
Location
|
Action
|
Condition
|
Safety Equipment
|
Contributing Circumstances
|
Unit No. of Vehicle Striking
|
P
E
R
S
O
N
|
I
N
J
U
R
E
D
|
Name- Last VANCE |
First CARMEN |
Middle L |
Suffix
|
City
|
State
|
Zip Code
|
Age 36 |
Sex Female |
Unit No. 1 |
Seating Position 03 - Front: Right Side |
Injury Status 3 - Non-incapacitating |
Occupant Protection 2 - Shoulder and lap belt used |
Airbag Deployment 5 - Not deployed |
Airbag Switch Status 9 - Unknown |
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 NORTH ON HWY 63 IN THE INSIDE LANE AND WAS JUST STARTING TO PASS VEHICLE 2 WHICH WAS IN THE OUTSIDE LANE. VEHICLE 2 DID NOT SEE VEHICLE 1 AND STARTED TO MERGE INTO THE INSIDE LANE CAUSING THE DRIVER OF VEHICLE 1 TO HIT THE BRAKES AND SWERVE TO THE LEFT. THE DRIVER OF VEHICLE 2 THEN SAW VEHICLE 1 AND STOPPED MERGING INTO THE INSIDE LANE. THE DRIVER OF VEHICLE 1 THEN LOST CONTROL OF THE CAR. VEHICLE 1 ENTERED THE MEDIAN CAUSING THE VEHICLE TO ROLL OVER. VEHICLE 1 CAME TO REST ON THE DRIVERS SIDE OF THE CAR. |
|
Officer
VANDERWIEL |
Badge No. 112 |
Time Officer Notified of Accident 17:53 |
Time Officer Arrived At Scene 17:57 |
Name of Agency P13 |
Date of Report 8/25/2010 |
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