U
N
I
T
1
|
Driver's Name - Last COOK |
First DANIELLE |
Middle NICOLE |
Suffix
|
City TIPTON |
State IA - Iowa, US |
Zip 527720000 |
Driver's Age 20 |
Citation Charge Code 1 321.288 |
Citation Charge 1 FAILURE TO MAINTAIN CONTROL |
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 5 - Uninjured |
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 1 - Not trapped |
Transported to:
|
Transported by:
|
Insurance Co. Name
|
Year 1999 |
Make Pontiac - PONT |
Model GRM |
Style 4D |
Approximate Cost to Repair or Replace 3000 |
Initial Travel Direction 1 - North |
Vehicle Action 01 - Movement essentially straight |
Speed Limit 55 |
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. 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 06 - Evasive action (swerve, panic braking, etc.) |
Second Event 21 - Vehicle in traffic |
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
|
City
|
State
|
Zip
|
Number of Axles
|
Gross Vehicle Weight Rating
|
Placard #
|
Hazardous Materials Released?
|
U
N
I
T
2
|
Driver's Name - Last WERREMEYER |
First ROBERT |
Middle THOMAS |
Suffix
|
City MOSCOW |
State IA - Iowa, US |
Zip 527600000 |
Driver's Age 43 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender Male |
State IA - Iowa, US |
Class D - Chauffeur |
Endorsements 1 - Trk - Trctr Semi-Trailer Comb |
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:
|
Transported by:
|
Insurance Co. Name
|
Year 1989 |
Make Ford - FORD |
Model RNG |
Style PK |
Approximate Cost to Repair or Replace 1500 |
Initial Travel Direction 1 - North |
Vehicle Action 02 - Turning left |
Speed Limit 55 |
Point of Initial Impact 05 - Rear |
Most Damaged Area 05 - Rear |
Extent of Damage 5 - Severe, vehicle totaled |
Underride/Override 1 - None |
Total Occupants 02 |
Traffic Controls 01 - No controls present |
Vehicle Config. 02 - Four-tire light truck (pick-up, panel) |
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
|
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
|
City
|
State
|
Zip
|
Number of Axles
|
Gross Vehicle Weight Rating
|
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) 02 - Partly cloudy |
Environment 1 - None apparent |
Location
|
First Harmful Event of Crash (use codes 11-42 only) 21 - Vehicle in traffic |
Manner of Crash/Collision 3 - Rear-end |
Roadway 01 - None apparent |
Type
|
Light Conditions 1 - Daylight |
Surface Conditions 1 |
Type of Roadway Junction/Feature 11 - Four-way intersection |
Workers Present?
|
P
E
R
S
O
N
|
I
N
J
U
R
E
D
|
Name- Last WERREMEYER |
First KEVIN |
Middle
|
Suffix
|
City
|
State
|
Zip Code
|
Age
|
Sex Male |
Unit No. 02 |
Seating Position 03 - Front: Right Side |
Injury Status 4 - Possible |
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 1 - Not ejected/not applicable |
Trapped 1 - Not trapped |
Transported to: TIPTON AMBULANCE |
Transported by: U OF I |
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 AND #2 WERE NORTHBOUND ON HIGHWAY 38. VEHICLE #2 SLOWED AND WAS PREPARING TO MAKE A LEFT TURN. VEHICLE #1 COLLIDED INTO THE REAR OF VEHICLE #2. BOTH VEHICLES CAME TO REST ON THE TRAVELED PORTION. |
|
Officer
REMLEY |
Badge No. 424 |
Time Officer Notified of Accident 13:31 |
Time Officer Arrived At Scene 13:31 |
Name of Agency P12 |
Date of Report 10/31/2010 |
Investigation made at scene? Yes |
T.I. #
|
Any questions about this report may be directed to the following address:
Iowa State Patrol District 12 Office
22365 20th Ave
Stockton,IA 52769-9612
Phone: (563) 284-9501
Fax: (563) 284-9504