U
N
I
T
1
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Driver's Name - Last BROWN |
First DONALD |
Middle T |
Suffix JR |
City KIRKLAND |
State IL - Illinois, US |
Zip 60146 |
Driver's Age 56 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender Male |
State IL - Illinois, US |
Class B - Veh w/26001 GVWR or more Towed unit is less than 10001 GVWR |
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 4 - Possible |
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: MASON CITY-MERCY |
Transported by: FRNAKLIN CO EMS |
Insurance Co. Name
|
Year 2011 |
Make Hyundai - HYUN |
Model
|
Style 4DR |
Approximate Cost to Repair or Replace 3000 |
Initial Travel Direction 2 - East |
Vehicle Action 01 - Movement essentially straight |
Speed Limit 55 |
Point of Initial Impact 01 - Front |
Most Damaged Area 01 - Front |
Extent of Damage 4 - Disabling damage |
Underride/Override 1 - None |
Total Occupants 1 |
Traffic Controls 06 - No Passing Zone (marked) |
Vehicle Config. 01 - Passenger car |
Cargo Body Type 01 - Not applicable |
Vehicle Defect 01 - None |
Driver Condition 8 - Other (explain in narrative) |
Vision Obscured 01 - Not obscured |
Contributing Circumstances, Driver (up to 2)
|
SEQUENCE OF EVENTS |
First Event 03 - Ran off road, left |
Second Event 04 - Crossed centerline/median |
Third Event
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Fourth Event 11 - Overturn/rollover |
Most Harmful Event (by vehicle) 11 - Overturn/rollover |
Emergency Vehicle Type 1 - Not applicable |
Emergency Status 3 - Not Applicable |
Carrier Name
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City
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State
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Zip
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Number of Axles
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Gross Vehicle Weight Rating
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Placard #
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Hazardous Materials Released?
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