U
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I
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1
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Driver's Name - Last STALEY |
First JULIE |
Middle ANN |
Suffix
|
City CHARTER OAK |
State IA - Iowa, US |
Zip 514390000 |
Driver's Age 52 |
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
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
|
Injury Status
|
Occupant Protection
|
Airbag Deployment
|
Airbag Switch Status
|
Ejection
|
Ejection Path
|
Trapped
|
Transported to:
|
Transported by:
|
Insurance Co. Name
|
Year 2004 |
Make Cadillac - CADI |
Model SRX |
Style SW |
Approximate Cost to Repair or Replace 6000 |
Initial Travel Direction
|
Vehicle Action
|
Speed Limit
|
Point of Initial Impact
|
Most Damaged Area
|
Extent of Damage
|
Underride/Override
|
Total Occupants
|
Traffic Controls
|
Vehicle Config.
|
Cargo Body Type
|
Vehicle Defect
|
Driver Condition
|
Vision Obscured
|
Contributing Circumstances, Driver (up to 2)
|
SEQUENCE OF EVENTS |
First Event
|
Second Event
|
Third Event
|
Fourth Event
|
Most Harmful Event (by vehicle)
|
Emergency Vehicle Type
|
Emergency Status
|
Carrier Name
|
City
|
State
|
Zip
|
Number of Axles
|
Gross Vehicle Weight Rating
|
Placard #
|
Hazardous Materials Released?
|