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
05:15 PM 		County
Polk - 77		 Accident occurred within corporate limits of (city)
Des Moines - 1945		 Law Enforcement Case Number:
2011001888
Literal Description
I-80 WB AT 2ND AVE 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
448987.9
Y-Coordinate
4611042.
U
N
I
T

1 		Driver's Name - Last
CHAMPION		 First
DANIELLE		 Middle
MARIE		 Suffix
City
ALTOONA		 State
IA - Iowa, US		 Zip
500090000
Driver's Age
17		 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
2 - Shoulder and lap belt used		 Airbag Deployment
1 - Deployed front of person		 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
Pontiac - PONT		 Model
GRM		 Style
2D		 Approximate Cost to Repair or Replace
3500
Initial Travel Direction
4 - West		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
65		 Point of Initial Impact
08 - Left Front		 Most Damaged Area
08 - Left Front		 Extent of Damage
3 - Functional damage		 Underride/Override
1 - None
Total Occupants
01		 Traffic Controls
01 - No controls present		 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
36 - Concrete barrier (median or right side)		 Second Event
 Third Event
 Fourth Event
 Most Harmful Event (by vehicle)
36 - Concrete barrier (median or right side)
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?
P
R
O
P
E
R
T
Y

D
A
M
A
G
E
If Property other than vehicles damaged explain Object Damaged
01		 Estimate of Damage
Owner's Name - Last
 First
 Middle
 Suffix
Owner Company Name
City
 State
 Zip
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)
36 - Concrete barrier (median or right side)
Manner of Crash/Collision
1 - Non-collision		 Roadway
02 - Road surface condition		 Type
Light Conditions
2 - Dusk		 Surface Conditions
4		 Type of Roadway Junction/Feature
01 - No special feature		 Workers Present?
D
I
A
G
R
A
M

0
NARRATIVE

VEHICLE #1 WAS TRAVELING WEST BOUND WHEN THE DRIVER LOST CONTROL OF HER VEHICLE, ON THE SNOW COVERED ROAD, AND STRUCK THE CENTER CONCRETE BARRIER. THE VEHICLE SPUN AROUND COMING TO REST ON THE SOUTH SHOULDER FACING EAST.
Officer
KUNERT 		Badge No.
382		 Time Officer Notified of Accident
17:15		 Time Officer Arrived At Scene
17:20
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