Crash Information

L O C A T I O N	Date of Accident 1/2/2011	Time of Accident 07:45 PM	County Worth - 98	Accident occurred within corporate limits of (city)	Law Enforcement Case Number: 2011000285
	Literal Description SB INTERSTATE 35/481 FT N OF 209MM				Legal Intervention? No	Private Property? No
					X-Coordinate: 471720.0
					Y-Coordinate 4800994.

U N I T 1	Driver's Name - Last VANDERPLOEG			First MARK			Middle JOHN		Suffix
	City CLEAR LAKE			State IA - Iowa, US				Zip 504280000
	Driver's Age 40					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 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 5 - Not deployed	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 2003		Make Chevrolet - CHEV		Model EXPRESS		Style VAN		Approximate Cost to Repair or Replace 5000
	Initial Travel Direction 3 - South	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 7	Traffic Controls 01 - No controls present	Vehicle Config. 03 - Van or mini-van	Cargo Body Type 01 - Not applicable	Vehicle Defect 02 - Brakes	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 01 - Ran off road, right	Third Event	Fourth Event	Most Harmful Event (by vehicle) 11 - Overturn/rollover
	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 2 - Shoulder	Weather Conditions (up to two) 01 - Clear	Environment 1 - None apparent	Location	First Harmful Event of Crash (use codes 11-42 only) 11 - Overturn/rollover
Manner of Crash/Collision 1 - Non-collision	Weather Conditions (up to two) 01 - Clear	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
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Name- Last
GRELL

First
BEVERLY

Middle
JO

Suffix

City

State

Zip Code

Age
61

Sex
Female

Unit No.
1

Seating Position
07 - Rear: Left Side

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
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
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A
G
R
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M

0

NARRATIVE

VEH 1 WAS SOUTHBOUND ON I35 AT THE 209MM. DUE TO A BRAKE MALFUNCTION THE DRIVER LOST CONTROL AND VEH 1 ROLLED INTO THE WEST DITCH.

Officer PALAS	Badge No. 265	Time Officer Notified of Accident 19:50	Time Officer Arrived At Scene 20:05
Name of Agency P08	Date of Report 1/2/2011	Investigation made at scene? Yes	T.I. #

Any questions about this report may be directed to the following address:
Iowa State Patrol District 08 Office
4425 Washington Avenue
Mason City,IA 50401-7002
Phone: (641) 424-3625
Fax: (641) 423-8381