U
N
I
T
1
|
Driver's Name - Last LOCKMAN |
First LINDA |
Middle LOUISE |
Suffix
|
City BLOOMFIELD |
State IA - Iowa, US |
Zip 525370000 |
Driver's Age 24 |
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 4 - Possible |
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 1999 |
Make Plymouth - PLYM |
Model NEO |
Style 4D |
Approximate Cost to Repair or Replace 1600 |
Initial Travel Direction 4 - West |
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 02 |
Traffic Controls 88 - Other control (explain in narrative) |
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 06 - Evasive action (swerve, panic braking, etc.) |
Second Event 23 - Parked motor vehicle |
Third Event
|
Fourth Event
|
Most Harmful Event (by vehicle) 23 - Parked motor vehicle |
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
|
First
|
Middle
|
Suffix
|
City
|
State
|
Zip
|
Driver's Age
|
Citation Charge Code 1
|
Citation Charge 1
|
Gender
|
State
|
Class
|
Endorsements None |
Restrictions
None |
Citation Charge Code 2
|
Citation Charge 2
|
Alcohol Test Given?
|
Drug Test Given?
|
Citation Charge Code 3
|
Citation Charge 3
|
Citation Charge Code 4
|
Citation Charge 4
|
Seating Position
|
Injury Status
|
Occupant Protection
|
Airbag Deployment
|
Airbag Switch Status
|
Ejection
|
Ejection Path
|
Trapped
|
Transported to:
|
Transported by:
|
Insurance Co. Name
|
Year 2008 |
Make Chevrolet - CHEV |
Model TRAILBLAZER |
Style SUV |
Approximate Cost to Repair or Replace 4000 |
Initial Travel Direction
|
Vehicle Action 12 - Legally Parked |
Speed Limit 55 |
Point of Initial Impact 06 - Left Rear |
Most Damaged Area 06 - Left Rear |
Extent of Damage 2 - Minor damage |
Underride/Override 1 - None |
Total Occupants 00 |
Traffic Controls 88 - Other control (explain in narrative) |
Vehicle Config. 04 - Sport utility vehicle |
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 23 - Parked motor vehicle |
Second Event
|
Third Event
|
Fourth Event
|
Most Harmful Event (by vehicle) 23 - Parked motor vehicle |
Emergency Vehicle Type 2 - Police |
Emergency Status 1 - Yes, in emergency |
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 2 - Shoulder |
Weather Conditions (up to two) 04 - Fog, smoke |
Environment 2 - Weather condition |
Location
|
First Harmful Event of Crash (use codes 11-42 only) 23 - Parked motor vehicle |
Manner of Crash/Collision 3 - Rear-end |
Roadway 02 - Road surface condition |
Type
|
Light Conditions 5 - Dark, roadway not lighted |
Surface Conditions 3 |
Type of Roadway Junction/Feature 01 - No special feature |
Workers Present?
|
D I A G R A M
0 |
|
NARRATIVE |
**** EXPLAIN THE TRAFFIC CONTROLS FOR UNIT 001 **** EXPLAIN THE TRAFFIC CONTROLS FOR UNIT 002 VEHICLE 1 WAS WESTBOUND ON HIGHWAY 2. VEHICLE 2 WAS PARKED UNOCCUPIED ON THE NORTH SHOULDER FACING WESTBOUND WITH THE EMERGENCY LIGHTS ACTIVATED AT A PREVIOUS ACCIDENT. VEHICLE 1 TRIED TO SLOW AS IT APPROACHED VEHICLE 2. VEHICLE 1 LOST CONTROL ON THE 100% ICE COVERED ROAD AND STRUCK VEHICLE 2 IN THE REAR. VEHICLE 1 CAME TO REST ON THE NORTH SHOULDER FACING NORTH. VEHICLE 2 CAME TO REST HALF ON THE ROADWAY AND HALF ON THE SHOULDER. |
|
Officer
DANIELS |
Badge No. 089 |
Time Officer Notified of Accident 20:34 |
Time Officer Arrived At Scene 21:02 |
Name of Agency P02 |
Date of Report 1/30/2011 |
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