U
N
I
T
1
|
Driver's Name - Last CALVERT |
First KENNETH |
Middle EUGENE |
Suffix
|
City DAVENPORT |
State IA - Iowa, US |
Zip 528070000 |
Driver's Age 81 |
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 N - Tank |
Restrictions
B - Cor Lenses |
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 2 - Deployed side of person |
Airbag Switch Status 3 - No ON/OFF switch present |
Ejection 1 - Not ejected |
Ejection Path
|
Trapped 1 - Not trapped |
Transported to:
|
Transported by:
|
Insurance Co. Name
|
Year 2010 |
Make Dodge - DODG |
Model CALIBER |
Style 4DR |
Approximate Cost to Repair or Replace 3000 |
Initial Travel Direction 4 - West |
Vehicle Action 01 - Movement essentially straight |
Speed Limit 70 |
Point of Initial Impact 07 - Left Side |
Most Damaged Area 07 - Left Side |
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 13 - Other non-collision |
Second Event
|
Third Event
|
Fourth Event
|
Most Harmful Event (by vehicle) 13 - Other non-collision |
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 NICHOLS |
First RICHARD |
Middle R |
Suffix
|
City IOWA CITY |
State IA - Iowa, US |
Zip 52246 |
Driver's Age 54 |
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 N - Tank |
Restrictions
B - Cor Lenses |
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 2001 |
Make
|
Model GRND CHER |
Style SUV |
Approximate Cost to Repair or Replace 200 |
Initial Travel Direction 2 - East |
Vehicle Action 01 - Movement essentially straight |
Speed Limit 70 |
Point of Initial Impact 08 - Left Front |
Most Damaged Area 10 - Under Carriage |
Extent of Damage 4 - Disabling damage |
Underride/Override 1 - None |
Total Occupants 01 |
Traffic Controls 01 - No controls present |
Vehicle Config. 04 - Sport utility vehicle |
Cargo Body Type 01 - Not applicable |
Vehicle Defect 04 - Blowout |
Driver Condition 1 - Apparently normal |
Vision Obscured 01 - Not obscured |
Contributing Circumstances, Driver (up to 2)
|
SEQUENCE OF EVENTS |
First Event 09 - Equipment failure (tires, brakes, etc.) |
Second Event 13 - Other non-collision |
Third Event
|
Fourth Event
|
Most Harmful Event (by vehicle) 09 - Equipment failure (tires, brakes, etc.) |
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) 08 - Snow |
Environment 8 - Other (explain in narrative) |
Location
|
First Harmful Event of Crash (use codes 11-42 only) 13 - Other non-collision |
Manner of Crash/Collision 1 - Non-collision |
Roadway 01 - None apparent |
Type
|
Light Conditions 1 - Daylight |
Surface Conditions 1 |
Type of Roadway Junction/Feature 01 - No special feature |
Workers Present?
|
D I A G R A M
0 |
|
NARRATIVE |
UNIT 1 WAS WEST BOUND ON I-80. A WHEEL CAME OFF AN EAST BOUND UNIT 2. THE WHEEL TRAVEL LED ACROSS THE MEDIAN AND STRUCK SIDE OF UNIT 1. UNIT 1 PULLED OFF THE SIDE OF THE ROAD. UNIT 2 CAME TO REST ON THE EAST BOUND SHOULDER. |
|
Officer
NEVILLE |
Badge No. 328 |
Time Officer Notified of Accident 08:33 |
Time Officer Arrived At Scene 08:44 |
Name of Agency P12 |
Date of Report 2/11/2011 |
Investigation made at scene? Yes |
T.I. #
|
Any questions about this report may be directed to the following address:
Iowa State Patrol District 12 Office
22365 20th Ave
Stockton,IA 52769-9612
Phone: (563) 284-9501
Fax: (563) 284-9504