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Driver's Name - Last BEAVER |
First DANIEL |
Middle JONATHAN |
Suffix
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City MASON CITY |
State IA - Iowa, US |
Zip 504012328 |
Driver's Age 27 |
Citation Charge Code 1 321.288 |
Citation Charge 1 FAILURE TO MAINTAIN CONTROL |
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 2 321.445 |
Citation Charge 2 FAILURE TO WEAR SEATBELT |
Alcohol Test Given? 1 - None |
Drug Test Given? 1 - None |
Citation Charge Code 3
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Citation Charge 3
|
Citation Charge Code 4
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Citation Charge 4
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Seating Position 01 - Front: Left Side / Motorcycle Driver |
Injury Status 2 - Incapacitating |
Occupant Protection 1 - None used |
Airbag Deployment 5 - Not deployed |
Airbag Switch Status 9 - Unknown |
Ejection 1 - Not ejected |
Ejection Path
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Trapped 3 - Extricated by mechanical means |
Transported to: MERCY HOSPITAL, MASON CITY |
Transported by: MASON CITY AMBULANCE |
Insurance Co. Name
|
Year 1997 |
Make Ford - FORD |
Model F15 |
Style 3D |
Approximate Cost to Repair or Replace 10000 |
Initial Travel Direction 4 - West |
Vehicle Action 01 - Movement essentially straight |
Speed Limit 65 |
Point of Initial Impact 07 - Left Side |
Most Damaged Area 07 - Left Side |
Extent of Damage 5 - Severe, vehicle totaled |
Underride/Override 1 - None |
Total Occupants 3 |
Traffic Controls 01 - No controls present |
Vehicle Config. 02 - Four-tire light truck (pick-up, panel) |
Cargo Body Type 10 - Small utility (one axle) |
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 06 - Evasive action (swerve, panic braking, etc.) |
Second Event 03 - Ran off road, left |
Third Event
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Fourth Event 11 - Overturn/rollover |
Most Harmful Event (by vehicle) 11 - Overturn/rollover |
Emergency Vehicle Type 1 - Not applicable |
Emergency Status 3 - Not Applicable |
Carrier Name
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City
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State
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Zip
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Number of Axles
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Gross Vehicle Weight Rating
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Placard #
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Hazardous Materials Released?
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