Iowa State Patrol: Department of Public Safety

Crash Information

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N 		Date of Accident
1/11/2011		 Time of Accident
03:26 AM 		County
Dallas - 25		 Accident occurred within corporate limits of (city)
 Law Enforcement Case Number:
2011002016
Literal Description
Interstate 0080 (Milepost 100) 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
400022.5
Y-Coordinate
4596255.
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1 		Driver's Name - Last
HERNANDEZ		 First
GERZIN		 Middle
A		 Suffix
City
ROXBURY		 State
MA - Massachusetts, US		 Zip
02119
Driver's Age
24		 Citation Charge Code 1
 Citation Charge 1
Gender
Male		 State
MA - Massachusetts, US		 Class
D - Chauffeur		 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
9 - Unknown		 Ejection
1 - Not ejected		 Ejection Path
 Trapped
1 - Not trapped
Transported to:
 Transported by:
Insurance Co. Name
Year
2001		 Make
Dodge - DODG		 Model
CARAVAN		 Style
VAN		 Approximate Cost to Repair or Replace
4000
Initial Travel Direction
2 - East		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
70		 Point of Initial Impact
08 - Left Front		 Most Damaged Area
08 - Left Front		 Extent of Damage
2 - Minor damage		 Underride/Override
1 - None
Total Occupants
2		 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
13 - Other non-collision		 Second Event
35 - Guardrail		 Third Event
 Fourth Event
 Most Harmful Event (by vehicle)
35 - Guardrail
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
2 - Weather condition		 Location
 First Harmful Event of Crash (use codes 11-42 only)
13 - Other non-collision
Manner of Crash/Collision
1 - Non-collision		 Roadway
02 - Road surface condition		 Type
Light Conditions
5 - Dark, roadway not lighted		 Surface Conditions
4		 Type of Roadway Junction/Feature
02 - Bridge/overpass/underpass		 Workers Present?
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NARRATIVE

UNIT 1 WAS EAST BOUND WHEN IT LOST CONTROL AND STRUCK THE GUARDRAIL THEN CAME TO REST IN THE MEDIAN.
Officer
SALESBERRY 		Badge No.
284		 Time Officer Notified of Accident
03:26		 Time Officer Arrived At Scene
04:10
Name of Agency
P01		 Date of Report
1/11/2011		 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