U
N
I
T
1
|
Driver's Name - Last HULSEBERG |
First ROBERT |
Middle WILLIAM |
Suffix
|
City WILLIAMSBURG |
State IA - Iowa, US |
Zip 52361 |
Driver's Age 60 |
Citation Charge Code 1 321.303 |
Citation Charge 1 UNSAFE PASS |
Gender Male |
State IA - Iowa, US |
Class A - Veh w/26001 GVWR or more Towed unit is 10001 GVWR or more |
Endorsements
|
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 2 - Freed by non-mechanical means |
Transported to: GREAT RIVER MEDICAL CENTER |
Transported by: LOUISA COUNTY AMBULANCE |
Insurance Co. Name FAAS FEED & GRAIN INC |
Year 2003 |
Make
|
Model TRACTOR |
Style CONV. |
Approximate Cost to Repair or Replace 15000 |
Initial Travel Direction 3 - South |
Vehicle Action 05 - Overtaking/passing |
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. 07 - Truck/trailer |
Cargo Body Type 03 - Dump truck (grain, gravel) |
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 04 - Crossed centerline/median |
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 FAAS FEED & GRAIN INC |
City NORTH ENGLISH |
State IA - Iowa, US |
Zip 52316 |
Number of Axles 5 |
Gross Vehicle Weight Rating 80000 |
Placard #
|
Hazardous Materials Released?
|
U
N
I
T
2
|
Driver's Name - Last MARLOWE |
First TERRY |
Middle LEE |
Suffix
|
City BLUE GRASS |
State IA - Iowa, US |
Zip 52726 |
Driver's Age 71 |
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 N - Tank |
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 9 - Unknown |
Airbag Switch Status 9 - Unknown |
Ejection 1 - Not ejected |
Ejection Path
|
Trapped 1 - Not trapped |
Transported to: MUSCATINE HOSPITAL |
Transported by: LOUISA COUNTY AMBULANCE |
Insurance Co. Name
|
Year 2004 |
Make Ford - FORD |
Model F-250 |
Style CREW CAB |
Approximate Cost to Repair or Replace 15000 |
Initial Travel Direction 3 - South |
Vehicle Action 03 - Turning right |
Speed Limit 55 |
Point of Initial Impact 08 - Left Front |
Most Damaged Area 08 - Left Front |
Extent of Damage 5 - Severe, vehicle totaled |
Underride/Override 1 - None |
Total Occupants 05 |
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 04 - Crossed centerline/median |
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?
|
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 5 - Broadside |
Roadway 01 - None apparent |
Type
|
Light Conditions 1 - Daylight |
Surface Conditions 1 |
Type of Roadway Junction/Feature 05 - Farm/residential drive |
Workers Present?
|
P
E
R
S
O
N
|
I
N
J
U
R
E
D
|
Name- Last BROCKERT |
First RUSSELL |
Middle D |
Suffix
|
City
|
State
|
Zip Code
|
Age 40 |
Sex Male |
Unit No. 02 |
Seating Position 99 - Unknown |
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 1 - Not ejected/not applicable |
Trapped 1 - Not trapped |
Transported to: GREAT RIVER MEDICAL CENTER |
Transported by: PRIVATE VEHICLE |
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 99. UNIT 2 WAS ALSO SOUTHBOUND ATTEMPTING TO TURN LEFT INTO A FARM DRIVE. UNIT 1 ATTEMPTED TO PASS UNIT 2 AND STRUCK THE FRONT OF THE PICKUP. THE TRACTOR TRAILER ROLLED ONTO IT'S SIDE SPILLING IT'S LOAD ON THE ROAD AND THE DITCH. |
|
Officer
GRIER |
Badge No. 356 |
Time Officer Notified of Accident 09:09 |
Time Officer Arrived At Scene 09:23 |
Name of Agency P13 |
Date of Report 12/8/2010 |
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