U
N
I
T
1
|
Driver's Name - Last HAYWORTH |
First ASHLEY |
Middle JEAN |
Suffix
|
City URBANDALE |
State IA - Iowa, US |
Zip 50323 |
Driver's Age 24 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender Female |
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
|
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 1 - None 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
|
Year 2006 |
Make Chevrolet - CHEV |
Model MAL |
Style 4D |
Approximate Cost to Repair or Replace 8000 |
Initial Travel Direction 1 - North |
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 3 - Functional damage |
Underride/Override 1 - None |
Total Occupants 2 |
Traffic Controls 07 - Warning sign |
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 22 - Vehicle in/from other roadway |
Second Event 06 - Evasive action (swerve, panic braking, etc.) |
Third Event
|
Fourth Event 21 - Vehicle in traffic |
Most Harmful Event (by vehicle) 04 - Crossed centerline/median |
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?
|
U
N
I
T
2
|
Driver's Name - Last WAGNER |
First GARY |
Middle DALE |
Suffix
|
City OTTUMWA |
State IA - Iowa, US |
Zip 525010000 |
Driver's Age 71 |
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
|
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 9 - Unknown |
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 CAPPS TRUCKING CORP |
Year 2007 |
Make Volvo - VOLV |
Model TRK |
Style SLP |
Approximate Cost to Repair or Replace 5000 |
Initial Travel Direction 1 - North |
Vehicle Action 01 - Movement essentially straight |
Speed Limit 65 |
Point of Initial Impact 02 - Right Front |
Most Damaged Area 03 - Right Side |
Extent of Damage 2 - Minor damage |
Underride/Override 1 - None |
Total Occupants 1 |
Traffic Controls 07 - Warning sign |
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 22 - Vehicle in/from other roadway |
Second Event 21 - Vehicle in traffic |
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 CAPPS TRUCKING CORP |
City PACKWOOD |
State IA - Iowa, US |
Zip 52580 |
Number of Axles 5 |
Gross Vehicle Weight Rating 80000 |
Placard #
|
Hazardous Materials Released? 2 - No |
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 1 - None apparent |
Location
|
First Harmful Event of Crash (use codes 11-42 only) 21 - Vehicle in traffic |
Manner of Crash/Collision 6 - Sideswipe, same direction |
Roadway 11 - Non-contact vehicle |
Type
|
Light Conditions 4 - Dark, roadway lighted |
Surface Conditions 1 |
Type of Roadway Junction/Feature 11 - Four-way intersection |
Workers Present?
|
D I A G R A M
0 |
|
NARRATIVE |
UNIT ONE WAS TRAVELING NORTHBOUND IN THE RIGHT LANE OF HIGHWAY 5. UNIT TWO WAS TRAVELING NORTHBOUND IN THE LEFT LANE OF HIGHWAY 5. AS BOTH UNITS APPROACHED THE INTERSECTION OF HIGHWAY 316, A NON-CONTACT VEHICLE CROSSED THE ROADWAY WESTBOUND FROM HIGHWAY 316. UNIT ONE TOOK EVASIVE ACTION, BRAKING AND MERGING INTO THE INSIDE LANE. UNIT ONE SIDESWIPED UNIT TWO. BOTH UNIT ONE AND UNIT TWO PULLED OFF OF THE ROADWAY AND PARKED ON THE RIGHT SHOULDER. THE UNIDENTIFIED NON-CONTACT VEHICLE TURNED SOUTH ONTO HIGHWAY 5 AND LEFT THE SCENE. |
|
Officer
MAJOR |
Badge No. 049 |
Time Officer Notified of Accident 21:19 |
Time Officer Arrived At Scene 21:19 |
Name of Agency P02 |
Date of Report 1/4/2011 |
Investigation made at scene? Yes |
T.I. #
|
Any questions about this report may be directed to the following address:
Iowa State Patrol District 02 Office
1619 Truro Pavement
Osceola,IA 50213-8383
Phone: (641) 342-2108
Fax: (641) 342-4653