U
N
I
T
1
|
Driver's Name - Last SORENSON |
First RAYMOND |
Middle FRANK |
Suffix
|
City JEFFERSON |
State IA - Iowa, US |
Zip 501292442 |
Driver's Age 76 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender Male |
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
|
Citation Charge Code 2
|
Citation Charge 2
|
Alcohol Test Given? 2 - Blood |
Drug Test Given? 2 - Blood |
Citation Charge Code 3
|
Citation Charge 3
|
Citation Charge Code 4
|
Citation Charge 4
|
Seating Position 01 - Front: Left Side / Motorcycle Driver |
Injury Status 1 - Fatal |
Occupant Protection 1 - None used |
Airbag Deployment 2 - Deployed side of person |
Airbag Switch Status 3 - No ON/OFF switch present |
Ejection 1 - Not ejected |
Ejection Path
|
Trapped 3 - Extricated by mechanical means |
Transported to: GREEN COUNTY MEDICAL CENTER |
Transported by: GREEN COUNTY AMBULANCE |
Insurance Co. Name
|
Year 2001 |
Make Chevrolet - CHEV |
Model VENTURE |
Style MINIVAN |
Approximate Cost to Repair or Replace 1000 |
Initial Travel Direction 2 - East |
Vehicle Action 01 - Movement essentially straight |
Speed Limit 55 |
Point of Initial Impact 08 - Left Front |
Most Damaged Area 08 - Left Front |
Extent of Damage 5 - Severe, vehicle totaled |
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 99 - Unknown |
Driver Condition 9 - Unknown |
Vision Obscured 01 - Not obscured |
Contributing Circumstances, Driver (up to 2)
|
SEQUENCE OF EVENTS |
First Event 04 - Crossed centerline/median |
Second Event 06 - Evasive action (swerve, panic braking, etc.) |
Third Event
|
Fourth Event
|
Most Harmful Event (by vehicle) 21 - Vehicle in traffic |
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 GARNER |
First MAGENTA |
Middle MELINDA |
Suffix
|
City JEFFERSON |
State IA - Iowa, US |
Zip 501292442 |
Driver's Age 31 |
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 2 - Incapacitating |
Occupant Protection 2 - Shoulder and lap belt used |
Airbag Deployment 1 - Deployed front of person |
Airbag Switch Status 9 - Unknown |
Ejection 1 - Not ejected |
Ejection Path
|
Trapped 1 - Not trapped |
Transported to: GREEN COUNTY MEDICAL CENTER |
Transported by: GREENE COUNTY AMBULANCE |
Insurance Co. Name
|
Year 1996 |
Make Mazda - MAZD |
Model 626 |
Style SEDAN |
Approximate Cost to Repair or Replace 1000 |
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 04 |
Traffic Controls 01 - No controls present |
Vehicle Config. 01 - Passenger car |
Cargo Body Type 01 - Not applicable |
Vehicle Defect 99 - Unknown |
Driver Condition 1 - Apparently normal |
Vision Obscured 01 - Not obscured |
Contributing Circumstances, Driver (up to 2)
|
SEQUENCE OF EVENTS |
First Event 21 - Vehicle in traffic |
Second Event
|
Third Event
|
Fourth Event
|
Most Harmful Event (by vehicle) 21 - Vehicle in traffic |
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) 10 - Blowing sand, soil, dirt, snow |
Environment 2 - Weather condition |
Location
|
First Harmful Event of Crash (use codes 11-42 only) 21 - Vehicle in traffic |
Manner of Crash/Collision 5 - Broadside |
Roadway 02 - Road surface condition |
Type
|
Light Conditions 1 - Daylight |
Surface Conditions 3 |
Type of Roadway Junction/Feature 01 - No special feature |
Workers Present?
|
P
E
R
S
O
N
|
I
N
J
U
R
E
D
|
Name- Last WILCOX |
First DAVID |
Middle DEAN |
Suffix
|
City
|
State
|
Zip Code
|
Age 35 |
Sex Male |
Unit No. 01 |
Seating Position 03 - Front: Right Side |
Injury Status 3 - Non-incapacitating |
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 1 - Not ejected/not applicable |
Trapped 1 - Not trapped |
Transported to: GREENE COUNTY MEDICAL CENTER |
Transported by: GREENE COUNTY AMBULANCE |
NON-MOTORIST |
Type
|
Location
|
Action
|
Condition
|
Safety Equipment
|
Contributing Circumstances
|
Unit No. of Vehicle Striking
|
P
E
R
S
O
N
|
I
N
J
U
R
E
D
|
Name- Last MCALLISTER |
First NIKKI |
Middle J |
Suffix
|
City
|
State
|
Zip Code
|
Age 26 |
Sex Female |
Unit No. 02 |
Seating Position 03 - Front: Right Side |
Injury Status 2 - Incapacitating |
Occupant Protection 2 - Shoulder and lap belt used |
Airbag Deployment 1 - Deployed front of person |
Airbag Switch Status 3 - No ON/OFF switch present |
Ejection 1 - Not ejected |
Ejection Path 1 - Not ejected/not applicable |
Trapped 3 - Extricated by mechanical means |
Transported to: GREENE COUNTY MEDICAL CENTER |
Transported by: GREENE COUNTY AMBULANCE |
NON-MOTORIST |
Type
|
Location
|
Action
|
Condition
|
Safety Equipment
|
Contributing Circumstances
|
Unit No. of Vehicle Striking
|
P
E
R
S
O
N
|
I
N
J
U
R
E
D
|
Name- Last GARNER |
First CALEB |
Middle R |
Suffix
|
City
|
State
|
Zip Code
|
Age 3 |
Sex Male |
Unit No. 02 |
Seating Position 09 - Rear: Right Side |
Injury Status 3 - Non-incapacitating |
Occupant Protection 5 - Child safety seat used |
Airbag Deployment 6 - Not applicable |
Airbag Switch Status 3 - No ON/OFF switch present |
Ejection 1 - Not ejected |
Ejection Path 1 - Not ejected/not applicable |
Trapped 1 - Not trapped |
Transported to: GREENE COUNTY MEDICAL CENTER |
Transported by: GREENE COUNTY AMBULANCE |
NON-MOTORIST |
Type
|
Location
|
Action
|
Condition
|
Safety Equipment
|
Contributing Circumstances
|
Unit No. of Vehicle Striking
|
P
E
R
S
O
N
|
I
N
J
U
R
E
D
|
Name- Last EDWARDS |
First LOGAN |
Middle E |
Suffix
|
City
|
State
|
Zip Code
|
Age 2 |
Sex Male |
Unit No. 02 |
Seating Position 07 - Rear: Left Side |
Injury Status 3 - Non-incapacitating |
Occupant Protection 5 - Child safety seat used |
Airbag Deployment 6 - Not applicable |
Airbag Switch Status 3 - No ON/OFF switch present |
Ejection 1 - Not ejected |
Ejection Path 1 - Not ejected/not applicable |
Trapped 1 - Not trapped |
Transported to: GREENE COUNTY MEDICAL CENTER |
Transported by: GREENE COUNTY 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 |
V1 WAS EASTBOUND ON US HWY 30. V2 WAS WESTBOUND ON US HWY 30. THE ROADWAY WAS 100% SNOW / ICE COVERED. SNOW WAS BLOWING ACROSS THE ROADWAY. V1 LOST CONTROL AND SPUN OUT INTO THE ONCOMING LANE OF TRAVEL. V2 STRUCK V1 BROADSIDE AFTER V1 SLID SIDEWAYS IN THE WESTBOUND LANE. THE COLLISION RESULTED IN THE DEATH OF THE DRIVER OF V1. |
|
Officer
OLESEN |
Badge No. 486 |
Time Officer Notified of Accident 16:30 |
Time Officer Arrived At Scene 18:08 |
Name of Agency P04 |
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 04 Office
3710 Highway 30 E
Denison,IA 51442-7560
Phone: (712) 263-4621
Fax: (712) 263-2325