Crash Information

L O C A T I O N	Date of Accident 10/30/2010	Time of Accident 12:01 PM	County Des Moines - 29	Accident occurred within corporate limits of (city) Burlington - 0977	Law Enforcement Case Number: 2010062126
	Literal Description GNAHN ST measuring 0.12 Miles North from SUNNYSIDE AVE and GNAHN ST				Legal Intervention? No	Private Property? No
					X-Coordinate: 659010.8
					Y-Coordinate 4521545.

U N I T 1	Driver's Name - Last SMITH			First PAUL			Middle DAVID		Suffix
	City BURLINGTON			State IA - Iowa, US				Zip 52601
	Driver's Age 61					Citation Charge Code 1		Citation Charge 1
	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		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 1 - None 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:					Transported by:
	Insurance Co. Name
	Year 2008		Make Ford - FORD		Model F-250		Style P.U		Approximate Cost to Repair or Replace 0
	Initial Travel Direction 2 - East	Vehicle Action 09 - Backing	Speed Limit 25	Point of Initial Impact 99 - Unknown	Most Damaged Area 99 - Unknown	Extent of Damage 1 - None	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 01 - Ran off road, right	Second Event 33 - Ditch/embankment	Third Event	Fourth Event	Most Harmful Event (by vehicle) 33 - Ditch/embankment
	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 6 - Outside Trafficway	Weather Conditions (up to two) 01 - Clear	Environment 1 - None apparent	Location	First Harmful Event of Crash (use codes 11-42 only) 33 - Ditch/embankment
Manner of Crash/Collision 1 - Non-collision	Weather Conditions (up to two) 01 - Clear	Roadway 04 - Ruts, holes, bumps	Type
Light Conditions 1 - Daylight	Surface Conditions 1	Type of Roadway Junction/Feature 01 - No special feature	Workers Present?

P
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S
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N

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J
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E
D

Name- Last
SMITH

First
DANNY

Middle
LEE

Suffix

City

State

Zip Code

Age
68

Sex
Male

Unit No.
1

Seating Position
12 - Unenclosed Cargo Area

Injury Status
1 - Fatal

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
5 - Through back window/tailgate

Trapped
1 - Not trapped

Transported to:
GREAT RIVER MEDICAL CENTER

Transported by:
BURLINGTON 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 BACKING DOWN AN ALLEY AT AN AUCTION. THE DRIVER AND INJURED PERSON WERE BOTH WORKING FOR THE AUCTION COMPANY. DANNY SMITH WAS SITTING IN A TALL CHAIR IN THE BACK OF THE PICKUP. THE PICKUP STRUCK AN EMBANKMENT AND DANNY FELL OUT OF THE PICKUP ONTO THE GROUND. DANNY SMITH DIED AS A RESULT OF INJURIES SUSTAINED IN THE COLLISION.

Officer GRIER	Badge No. 356	Time Officer Notified of Accident 12:20	Time Officer Arrived At Scene 13:23
Name of Agency P13	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 13 Office
1300 S Grand Ave
Mt Pleasant,IA 52641-1862
Phone: (319) 385-8715
Fax: (319) 385-2743