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I
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1
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Driver's Name - Last BROWN |
First HAROLD |
Middle WAYNE |
Suffix
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City BURLINGTON JCT |
State MO - Missouri, US |
Zip 64428 |
Driver's Age 67 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender Male |
State MO - Missouri, US |
Class
|
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
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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 4 - Possible |
Occupant Protection 2 - Shoulder and lap belt used |
Airbag Deployment 5 - Not deployed |
Airbag Switch Status 3 - No ON/OFF switch present |
Ejection 1 - Not ejected |
Ejection Path
|
Trapped 1 - Not trapped |
Transported to: HAMILTON COUNTY HOSP |
Transported by: ELLSWORTH EMS |
Insurance Co. Name
|
Year 2008 |
Make General Motors - GMC |
Model SERRIA |
Style TK |
Approximate Cost to Repair or Replace 10000 |
Initial Travel Direction 3 - South |
Vehicle Action 01 - Movement essentially straight |
Speed Limit 70 |
Point of Initial Impact 03 - Right Side |
Most Damaged Area 03 - Right Side |
Extent of Damage 3 - Functional damage |
Underride/Override 1 - None |
Total Occupants 2 |
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 03 - Ran off road, left |
Second Event 35 - Guardrail |
Third Event
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Fourth Event 10 - Separation of units |
Most Harmful Event (by vehicle) 11 - Overturn/rollover |
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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