Iowa State Patrol: Department of Public Safety

Crash Information

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N 		Date of Accident
12/11/2010		 Time of Accident
02:03 PM 		County
Pottawattamie - 78		 Accident occurred within corporate limits of (city)
 Law Enforcement Case Number:
2010069859
Literal Description
11.8MM 80EB] 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
269558.6
Y-Coordinate
4577989.
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1 		Driver's Name - Last
SCOTT		 First
DANIEL		 Middle
FORD		 Suffix
City
DENVER		 State
CO - Colorado, US		 Zip
80218
Driver's Age
48		 Citation Charge Code 1
 Citation Charge 1
Gender
Male		 State
CO - Colorado, 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
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
 Trapped
1 - Not trapped
Transported to:
MERCY HOSPITAL		 Transported by:
UNDERWOOD RESCUE
Insurance Co. Name
RUSH INC
Year
2005		 Make
Volvo - VOLV		 Model
SEMI		 Style
SEMI		 Approximate Cost to Repair or Replace
20000
Initial Travel Direction
1 - North		 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
4 - Disabling 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
01 - Not obscured		 Contributing Circumstances, Driver (up to 2)
SEQUENCE OF EVENTS First Event
12 - Jackknife		 Second Event
 Third Event
 Fourth Event
 Most Harmful Event (by vehicle)
12 - Jackknife
Emergency Vehicle Type
1 - Not applicable		 Emergency Status
3 - Not Applicable
Carrier Name
RUSH INC		 City
ARLINGTON HEIGHT		 State
IL - Illinois, US		 Zip
60004
Number of Axles
2		 Gross Vehicle Weight Rating
80000		 Placard #
 Hazardous Materials Released?
2 - No
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If Property other than vehicles damaged explain Object Damaged
11.80MM 80EB LINEAR POST		 Estimate of Damage
Owner's Name - Last
STATE OF IOWA DOT		 First
 Middle
 Suffix
Owner Company Name
City
 State
 Zip
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)
12 - Jackknife
Manner of Crash/Collision
1 - Non-collision		 Roadway
01 - None apparent		 Type
Light Conditions
1 - Daylight		 Surface Conditions
8		 Type of Roadway Junction/Feature
01 - No special feature		 Workers Present?
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NARRATIVE

SEMI WAS TRAVELING NORTH IN SEVERE WINDS, BLOWING SNOW, IN BLIZZARD CONDITIONS. TRAILER WAS EMPTY AND STARTED TO SLIDE OFF THE ROADWAY CAUSING THE TRUCK AND TRAILER TO GO ON IT'S SIDE. DRIVER COMPLAINED OF BACK AND LEG PAIN AND WAS TRANSPORTED TO MERCY HOSPITAL IN COUNCIL BLUFFS.
Officer
SIELEMAN 		Badge No.
266		 Time Officer Notified of Accident
14:03		 Time Officer Arrived At Scene
14:13
Name of Agency
P03		 Date of Report
12/11/2010		 Investigation made at scene?
 T.I. #


Any questions about this report may be directed to the following address:
Iowa State Patrol District 03 Office
2025 Hunt Ave
Council Bluffs,IA 51503-4254
Phone: (712) 328-8001
Fax: (712) 328-1504