U
N
I
T
1
|
Driver's Name - Last VANZEE |
First LESLIE |
Middle JANE |
Suffix
|
City PELLA |
State IA - Iowa, US |
Zip 502190000 |
Driver's Age 35 |
Citation Charge Code 1 321.322(1) |
Citation Charge 1 FAIL TO OBEY STOP SIGN AND YIELD RIGHT OF WAY |
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
B - Cor Lenses |
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 3 - Non-incapacitating |
Occupant Protection 2 - Shoulder and lap belt used |
Airbag Deployment 1 - Deployed front of person |
Airbag Switch Status 9 - Unknown |
Ejection 1 - Not ejected |
Ejection Path
|
Trapped 1 - Not trapped |
Transported to: PELLA HOSPITAL |
Transported by: AMBULANCE |
Insurance Co. Name
|
Year 2002 |
Make Dodge - DODG |
Model CARAVAN |
Style VAN |
Approximate Cost to Repair or Replace 5000 |
Initial Travel Direction 4 - West |
Vehicle Action 02 - Turning left |
Speed Limit 55 |
Point of Initial Impact 08 - Left Front |
Most Damaged Area 08 - Left Front |
Extent of Damage 4 - Disabling damage |
Underride/Override 1 - None |
Total Occupants 3 |
Traffic Controls 04 - Stop signs |
Vehicle Config. 03 - Van or mini-van |
Cargo Body Type 01 - Not applicable |
Vehicle Defect 99 - Unknown |
Driver Condition 1 - Apparently normal |
Vision Obscured 01 - Not obscured |
Contributing Circumstances, Driver (up to 2)
|
SEQUENCE OF EVENTS |
First Event 21 - Vehicle in traffic |
Second Event
|
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
|
City
|
State
|
Zip
|
Number of Axles
|
Gross Vehicle Weight Rating
|
Placard #
|
Hazardous Materials Released?
|
U
N
I
T
2
|
Driver's Name - Last BUSICK |
First SIR |
Middle JON |
Suffix
|
City MELCHER |
State IA - Iowa, US |
Zip 501630000 |
Driver's Age 58 |
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
B - Cor Lenses |
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 2 - Incapacitating |
Occupant Protection 2 - Shoulder and lap belt used |
Airbag Deployment 1 - Deployed front of person |
Airbag Switch Status 9 - Unknown |
Ejection 1 - Not ejected |
Ejection Path
|
Trapped 3 - Extricated by mechanical means |
Transported to: MERCY MEDICAL |
Transported by: HELICOPTER |
Insurance Co. Name
|
Year 2002 |
Make General Motors - GMC |
Model SON |
Style PK |
Approximate Cost to Repair or Replace 8000 |
Initial Travel Direction 1 - North |
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 1 |
Traffic Controls 01 - No controls present |
Vehicle Config. 02 - Four-tire light truck (pick-up, panel) |
Cargo Body Type 01 - Not applicable |
Vehicle Defect 01 - None |
Driver Condition 9 - Unknown |
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
|
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) 01 - Clear |
Environment 1 - None apparent |
Location
|
First Harmful Event of Crash (use codes 11-42 only) 22 - Vehicle in/from other roadway |
Manner of Crash/Collision 4 - Angle, oncoming left turn |
Roadway 01 - None apparent |
Type
|
Light Conditions 1 - Daylight |
Surface Conditions 1 |
Type of Roadway Junction/Feature 12 - T - intersection |
Workers Present?
|
P
E
R
S
O
N
|
I
N
J
U
R
E
D
|
Name- Last LIGHTFOOT |
First CHARITY |
Middle A |
Suffix
|
City
|
State
|
Zip Code
|
Age 15 |
Sex Female |
Unit No. 1 |
Seating Position 03 - Front: Right Side |
Injury Status 3 - Non-incapacitating |
Occupant Protection 2 - Shoulder and lap belt used |
Airbag Deployment 1 - Deployed front of person |
Airbag Switch Status 9 - Unknown |
Ejection 1 - Not ejected |
Ejection Path 1 - Not ejected/not applicable |
Trapped 1 - Not trapped |
Transported to: PELLA HOSPITAL |
Transported by: AMBULANCE |
NON-MOTORIST |
Type
|
Location
|
Action
|
Condition
|
Safety Equipment
|
Contributing Circumstances
|
Unit No. of Vehicle Striking
|
P
E
R
S
O
N
|
I
N
J
U
R
E
D
|
Name- Last VAN ZEE |
First HALEIGH |
Middle
|
Suffix
|
City
|
State
|
Zip Code
|
Age 7 |
Sex Female |
Unit No. 1 |
Seating Position 04 - Center: Left Side / Motorcycle Passenger |
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: PELLA HOSPITAL |
Transported by: 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 ONE WAS TURNING SOUTH ONTO HIGHWAY 14 FROM WESTBOUND G-28. UNIT TWO WAS TRAVELING NORTHBOUND ON HIGHWAY 14 APPROACHING G-28. UNIT ONE FAILED TO YIELD TO UNIT TWO PRIOR TO ENTERING HIGHWAY 14. UNIT TWO STRUCK UNIT ONE IN THE FRONT LEFT CORNER, IN THE NORTHBOUND LANE OF HIGHWAY 14. BOTH UNIT ONE AND UNIT TWO CAME TO REST ON ROADWAY SIDE BY SIDE FACING NORTHWEST. |
|
Officer
MAJOR |
Badge No. 049 |
Time Officer Notified of Accident 15:28 |
Time Officer Arrived At Scene 15:39 |
Name of Agency P02 |
Date of Report 1/13/2011 |
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