Iowa State Patrol: Department of Public Safety

Crash Information

L
O
C
A
T
I
O
N 		Date of Accident
1/10/2011		 Time of Accident
04:30 PM 		County
Dallas - 25		 Accident occurred within corporate limits of (city)
 Law Enforcement Case Number:
2011001881
Literal Description
NB/EB INTERSTATE 0080 104 MM 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
410142.3
Y-Coordinate
4597034.
U
N
I
T

1 		Driver's Name - Last
WCHALA-GOMO		 First
NAGEB		 Middle
BENJAMIN		 Suffix
City
DES MOINES		 State
IA - Iowa, US		 Zip
503140000
Driver's Age
40		 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
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
3 - No ON/OFF switch present		 Ejection
1 - Not ejected		 Ejection Path
 Trapped
1 - Not trapped
Transported to:
N/A		 Transported by:
Insurance Co. Name
Year
2001		 Make
Ford - FORD		 Model
EC2		 Style
VAN		 Approximate Cost to Repair or Replace
2000
Initial Travel Direction
2 - East		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
70		 Point of Initial Impact
01 - Front		 Most Damaged Area
01 - Front		 Extent of Damage
2 - Minor damage		 Underride/Override
1 - None
Total Occupants
01		 Traffic Controls
01 - No controls present		 Vehicle Config.
03 - Van or mini-van		 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
03 - Ran off road, left		 Second Event
30 - Bridge/bridge rail/overpass		 Third Event
 Fourth Event
 Most Harmful Event (by vehicle)
30 - Bridge/bridge rail/overpass
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
1 - On Roadway		 Weather Conditions (up to two)
08 - Snow		 Environment
1 - None apparent		 Location
 First Harmful Event of Crash (use codes 11-42 only)
30 - Bridge/bridge rail/overpass
Manner of Crash/Collision
1 - Non-collision		 Roadway
02 - Road surface condition		 Type
Light Conditions
1 - Daylight		 Surface Conditions
4		 Type of Roadway Junction/Feature
02 - Bridge/overpass/underpass		 Workers Present?
D
I
A
G
R
A
M

0
NARRATIVE

UNIT 1 WAS DRIVING EASTBOUND ON INTERSTATE 80 NEAR THE 104 MILE MARKER. UNIT 1 WAS DRIVING TOO FAST FOR CONDITIONS AND LOST CONTROL. UNIT 1 WENT OFF THE LEFT SIDE OF THE ROADWAY STRIKING A GUARDRAIL. UNIT 1 SUFFERED MINOR DAMAGE.
Officer
CUNNINGHAM 		Badge No.
073		 Time Officer Notified of Accident
16:30		 Time Officer Arrived At Scene
17:13
Name of Agency
P01		 Date of Report
1/10/2011		 Investigation made at scene?
Yes		 T.I. #


Any questions about this report may be directed to the following address:
Iowa State Patrol District 01 Office
260 NW 48th Place
Des Moines,IA 50313-2299
Phone: (515) 725-0010
Fax: (515) 725-0011