U
N
I
T
1
|
Driver's Name - Last
ISHANKHODJAEV |
First
FARKHOD |
Middle
|
Suffix
|
City
CHARLESTON |
State
SC - South Carolina, US |
Zip
29407 |
Driver's Age
35 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender
Male |
State
PA - Pennsylvania, US |
Class
A - Veh w/26001 GVWR or more Towed unit is 10001 GVWR or more |
Endorsements
|
Restrictions
|
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
5 - Not deployed |
Airbag Switch Status
9 - Unknown |
Ejection
1 - Not ejected |
Ejection Path
|
Trapped
1 - Not trapped |
Transported to:
|
Transported by:
|
Insurance Co. Name
AEW TRUCKING, INC |
Year
2009 |
Make
|
Model
FRHT |
Style
SEMI |
Approximate Cost to Repair or Replace
1000 |
Initial Travel Direction
1 - North |
Vehicle Action
01 - Movement essentially straight |
Speed Limit
70 |
Point of Initial Impact
05 - Rear |
Most Damaged Area
05 - Rear |
Extent of Damage
2 - Minor damage |
Underride/Override
1 - None |
Total Occupants
1 |
Traffic Controls
01 - No controls present |
Vehicle Config.
09 - Tractor/semi-trailer |
Cargo Body Type
02 - Van/enclosed box |
Vehicle Defect
01 - None |
Driver Condition
1 - Apparently normal |
Vision Obscured
12 - Blowing snow |
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
AEW TRUCKING, INC |
City
CREST HILL |
State
IL - Illinois, US |
Zip
60440 |
Number of Axles
5 |
Gross Vehicle Weight Rating
80000 |
Placard #
|
Hazardous Materials Released?
|
U
N
I
T
2
|
Driver's Name - Last
GAASVIG |
First
GEORGE |
Middle
EUGENE |
Suffix
|
City
BEMIDJI |
State
MN - Minnesota, US |
Zip
56619 |
Driver's Age
65 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender
Male |
State
MN - Minnesota, US |
Class
A - Veh w/26001 GVWR or more Towed unit is 10001 GVWR or more |
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
1 - Switch in ON position |
Ejection
1 - Not ejected |
Ejection Path
|
Trapped
1 - Not trapped |
Transported to:
|
Transported by:
|
Insurance Co. Name
|
Year
2007 |
Make
Toyota - TOYT |
Model
SVSIE |
Style
VAN |
Approximate Cost to Repair or Replace
10000 |
Initial Travel Direction
1 - North |
Vehicle Action
01 - Movement essentially straight |
Speed Limit
70 |
Point of Initial Impact
01 - Front |
Most Damaged Area
01 - Front |
Extent of Damage
5 - Severe, vehicle totaled |
Underride/Override
1 - None |
Total Occupants
2 |
Traffic Controls
01 - No controls present |
Vehicle Config.
03 - Van or mini-van |
Cargo Body Type
01 - Not applicable |
Vehicle Defect
01 - None |
Driver Condition
1 - Apparently normal |
Vision Obscured
12 - Blowing snow |
Contributing Circumstances, Driver (up to 2)
|
| SEQUENCE OF EVENTS |
First Event
21 - Vehicle in traffic |
Second Event
06 - Evasive action (swerve, panic braking, etc.) |
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)
08 - Snow |
Environment
2 - Weather condition |
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
4 |
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
GAASVIG |
First
KAYDELL |
Middle
BLANCHE |
Suffix
|
City
|
State
|
Zip Code
|
Age
65 |
Sex
Female |
Unit No.
2 |
Seating Position
03 - Front: Right Side |
Injury Status
3 - Non-incapacitating |
Occupant Protection
2 - Shoulder and lap belt used |
Airbag Deployment
1 - Deployed front of person |
Airbag Switch Status
1 - Switch in ON position |
Ejection
1 - Not ejected |
Ejection Path
1 - Not ejected/not applicable |
Trapped
1 - Not trapped |
Transported to:
|
Transported by:
|
| NON-MOTORIST |
Type
|
Location
|
Action
|
Condition
|
Safety Equipment
|
Contributing Circumstances
|
Unit No. of Vehicle Striking
|
D
I
A
G
R
A
M
0 |
 |
| NARRATIVE |
ON 12-11-10 AT APPROXIMATELY 1000 HRS A PERSONAL INJURY ACCIDENT OCCURRED ON I29 AT MM 128. VEHICLE ONE WAS COMPLETELY STOPPED ON THE ROADWAY DUE TO MULTIPLE VEHILCES. VEHICLE TWO REAR ENDED VEHICLE ONE. SEVERE WINDS, BLOWING SNOW AND ZERO VISIBILITY. PASSENGER OF VEHICLE RECEIVED MINOR INJURIES. VEHICLE ONE HAD MINOR DAMAGES. VEHICLE TWO HAD SEVERE FRONT END DAMAGE. |
|
Officer
YANEFF |
Badge No.
177 |
Time Officer Notified of Accident
10:00 |
Time Officer Arrived At Scene
10:00 |
Name of Agency
P04 |
Date of Report
12/11/2010 |
Investigation made at scene?
Yes |
T.I. #
|
Any questions about this report may be directed to the following address:
Iowa State Patrol District 04 Office
3710 Highway 30 E
Denison,IA 51442-7560
Phone: (712) 263-4621
Fax: (712) 263-2325