Crash Information

L O C A T I O N	Date of Accident 2/6/2011	Time of Accident 01:35 PM	County Allamakee - 03	Accident occurred within corporate limits of (city)	Law Enforcement Case Number: 2011009485
	Literal Description NORTH FORK HOLLOW RD measuring 709 Meters South from NORTH FORK HOLLOW RD and MCCABE DR				Legal Intervention? No	Private Property? No
					X-Coordinate: 623021.7
					Y-Coordinate 4785526.

U N I T 1	Driver's Name - Last TILLMAN			First MARY			Middle CATHERINE		Suffix
	City CRESCO			State IA - Iowa, US				Zip 521360000
	Driver's Age 56					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 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 1999		Make Chrysler - CHRY		Model TOW		Style VN		Approximate Cost to Repair or Replace 3000
	Initial Travel Direction 3 - South	Vehicle Action 01 - Movement essentially straight	Speed Limit 55	Point of Initial Impact 02 - Right Front	Most Damaged Area 02 - Right Front	Extent of Damage 3 - Functional damage	Underride/Override 1 - None
	Total Occupants 02	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 01 - Ran off road, right	Second Event 33 - Ditch/embankment	Third Event	Fourth Event	Most Harmful Event (by vehicle) 33 - Ditch/embankment
	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 4 - Roadside	Weather Conditions (up to two) 03 - Cloudy	Environment 1 - None apparent	Location	First Harmful Event of Crash (use codes 11-42 only) 33 - Ditch/embankment
Manner of Crash/Collision 1 - Non-collision	Weather Conditions (up to two) 03 - Cloudy	Roadway 02 - Road surface condition	Type
Light Conditions 1 - Daylight	Surface Conditions 4	Type of Roadway Junction/Feature 01 - No special feature	Workers Present?

P
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Name- Last
SPIEKER

First
DONALD

Middle
MARCUS SCOTT

Suffix

City

State

Zip Code

Age
17

Sex
Male

Unit No.
01

Seating Position
03 - Front: Right Side

Injury Status
4 - Possible

Occupant Protection
2 - Shoulder and lap belt used

Airbag Deployment
5 - Not deployed

Airbag Switch Status
9 - Unknown

Ejection
1 - Not ejected

Ejection Path
1 - Not ejected/not applicable

Trapped
1 - Not trapped

Transported to:
VETERANS MEMORIAL WAUKON

Transported by:
VMH 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

VEHICLE 1 WAS SOUTHBOUND WHEN IT BEGAN TO SLIDE IN THE CURVE THEN ENTERED THE WEST DITCH WHERE IT CAME TO REST ON ITS WHEELS FACING SOUTH.

Officer HANSEN	Badge No. 092	Time Officer Notified of Accident 13:21	Time Officer Arrived At Scene 13:29
Name of Agency P10	Date of Report 2/6/2011	Investigation made at scene? Yes	T.I. #

Any questions about this report may be directed to the following address:
Iowa State Patrol District 10 Office
15239 35th St
Oelwein,IA 50662-9446
Phone: (319) 283-5521
Fax: (319) 283-2046