Iowa State Patrol: Department of Public Safety

Crash Information


L
O
C
A
T
I
O
N
Date of Accident
12/10/2010
Time of Accident
05:49 PM
County
Davis - 26
Accident occurred within corporate limits of (city)
Law Enforcement Case Number:
2010069727
Literal Description
HWY.63 SOUTHBOUND 758 FT. NORTH OF MO. LINE
Legal Intervention?
No
Private Property?
No
X-Coordinate:
540275.0
Y-Coordinate
4495053.
U
N
I
T

1
Driver's Name - Last
MCKIM
First
HAROLD
Middle
THEODORE
Suffix
City
ALBIA
State
IA - Iowa, US
Zip
52351
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
N - Tank
Restrictions

N - Non-resident CDL
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
1 - Fatal
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
2 - Freed by non-mechanical means
Transported to:
WAGLERS FUNERAL HOME
Transported by:
WAGLERS FUNERAL HOME
Insurance Co. Name
Year
2007
Make
Buick - BUIC
Model
LUCERNE
Style
4DR
Approximate Cost to Repair or Replace
10000
Initial Travel Direction
3 - South
Vehicle Action
01 - Movement essentially straight
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
02
Traffic Controls
01 - No controls present
Vehicle Config.
01 - Passenger car
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
25 - Animal
Second Event
03 - Ran off road, left
Third Event
Fourth Event
37 - Tree
Most Harmful Event (by vehicle)
25 - Animal
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?
P
R
O
P
E
R
T
Y

D
A
M
A
G
E
If Property other than vehicles damaged explain Object Damaged
NONE
Estimate of Damage
Owner's Name - Last
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)
01 - Clear
Environment
6 - Animal in roadway
Location
First Harmful Event of Crash (use codes 11-42 only)
25 - Animal
Manner of Crash/Collision
1 - Non-collision
Roadway
01 - None apparent
Type
Light Conditions
5 - Dark, roadway not lighted
Surface Conditions
1
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
MCKIM
First
CAROLYN
Middle
JANE
Suffix
City
State
Zip Code
Age
67
Sex
Female
Unit No.
01
Seating Position
03 - Front: Right Side
Injury Status
3 - Non-incapacitating
Occupant Protection
4 - Shoulder belt only 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:
DAVIS COUNTY HOSPITAL
Transported by:
DAVIS CO. 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 TRAVELING SOUTH BOUND HWY. 63 AT THE 1-MM. UNIT #1 STRUCK A DEER AND RAN OFF THE ROAD TO THE RIGHT WHERE IT STRUCK A TREE. THE DRIVER WAS PRONOUNCED DEAD AT THE SCENE AND THE PASSENGER WAS TRANSPORTED TO THE HOSPITAL WITH MINOR INJURIES.
Officer
BORELLI
Badge No.
338
Time Officer Notified of Accident
18:14
Time Officer Arrived At Scene
19:09
Name of Agency
P13
Date of Report
12/10/2010
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