U
N
I
T
1
|
Driver's Name - Last
HERNANDEZ |
First
STACEY |
Middle
MARIE |
Suffix
|
City
AREDALE |
State
IA - Iowa, US |
Zip
506058407 |
Driver's Age
18 |
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
1 - Fatal |
Occupant Protection
2 - Shoulder and lap belt used |
Airbag Deployment
1 - Deployed front of person |
Airbag Switch Status
3 - No ON/OFF switch present |
Ejection
1 - Not ejected |
Ejection Path
|
Trapped
3 - Extricated by mechanical means |
Transported to:
MERCY HOSPITAL |
Transported by:
MASON CITY AMBULANCE |
Insurance Co. Name
|
Year
2004 |
Make
Ford - FORD |
Model
FOC |
Style
4D |
Approximate Cost to Repair or Replace
8000 |
Initial Travel Direction
3 - South |
Vehicle Action
01 - Movement essentially straight |
Speed Limit
55 |
Point of Initial Impact
99 - Unknown |
Most Damaged Area
01 - Front |
Extent of Damage
5 - Severe, vehicle totaled |
Underride/Override
1 - None |
Total Occupants
02 |
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
01 - Ran off road, right |
Second Event
04 - Crossed centerline/median |
Third Event
|
Fourth Event
|
Most Harmful Event (by vehicle)
22 - Vehicle in/from other roadway |
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
WAGNER |
First
DUANE |
Middle
EUGENE |
Suffix
|
City
OSAGE |
State
IA - Iowa, US |
Zip
504610000 |
Driver's Age
53 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender
Male |
State
IA - Iowa, US |
Class
B - Veh w/26001 GVWR or more Towed unit is less than 10001 GVWR |
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
3 - Non-incapacitating |
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:
MERCY HOSPITAL |
Transported by:
MASON CITY AMBULANCE |
Insurance Co. Name
OSAGE COOPERATIVE ELEVATOR |
Year
2010 |
Make
|
Model
CON |
Style
TL |
Approximate Cost to Repair or Replace
10000 |
Initial Travel Direction
1 - North |
Vehicle Action
01 - Movement essentially straight |
Speed Limit
55 |
Point of Initial Impact
08 - Left Front |
Most Damaged Area
08 - Left Front |
Extent of Damage
4 - Disabling damage |
Underride/Override
1 - None |
Total Occupants
01 |
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
1 - Apparently normal |
Vision Obscured
01 - Not obscured |
Contributing Circumstances, Driver (up to 2)
|
| SEQUENCE OF EVENTS |
First Event
22 - Vehicle in/from other roadway |
Second Event
|
Third Event
|
Fourth Event
|
Most Harmful Event (by vehicle)
22 - Vehicle in/from other roadway |
Emergency Vehicle Type
1 - Not applicable |
Emergency Status
3 - Not Applicable |
Carrier Name
OSAGE COOPERATIVE ELEVATOR |
City
OSAGE |
State
IA - Iowa, US |
Zip
504610358 |
Number of Axles
3 |
Gross Vehicle Weight Rating
71020 |
Placard #
|
Hazardous Materials Released?
2 - No |
| 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)
03 - Cloudy |
Environment
1 - None apparent |
Location
|
First Harmful Event of Crash (use codes 11-42 only)
22 - Vehicle in/from other roadway |
Manner of Crash/Collision
5 - Broadside |
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
BARTUSEK |
First
ANTHONY |
Middle
JAMES |
Suffix
|
City
|
State
|
Zip Code
|
Age
24 |
Sex
Male |
Unit No.
01 |
Seating Position
03 - Front: Right Side |
Injury Status
2 - Incapacitating |
Occupant Protection
2 - Shoulder and lap belt used |
Airbag Deployment
1 - Deployed front of person |
Airbag Switch Status
3 - No ON/OFF switch present |
Ejection
1 - Not ejected |
Ejection Path
1 - Not ejected/not applicable |
Trapped
1 - Not trapped |
Transported to:
MERCY HOSPITAL |
Transported by:
MASON CITY 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 |
UNIT #1 WAS SOUTHBOUND ON HIGHWAY 65. UNIT #2 WAS NORTHBOUND ON HIGHWAY 65. DRIVER OF UNIT #1 LOST CONTROL AND CROSSED MEDIAN. UNIT #1 STRUCK THE FRONT OF UNIT #2. |
|
Officer
McNALLY |
Badge No.
477 |
Time Officer Notified of Accident
10:04 |
Time Officer Arrived At Scene
10:05 |
Name of Agency
P08 |
Date of Report
9/16/2010 |
Investigation made at scene?
Yes |
T.I. #
|
Any questions about this report may be directed to the following address:
Iowa State Patrol District 08 Office
4425 Washington Avenue
Mason City,IA 50401-7002
Phone: (641) 424-3625
Fax: (641) 423-8381