Iowa State Patrol: Department of Public Safety

Crash Information

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N 		Date of Accident
3/22/2011		 Time of Accident
12:08 AM 		County
Scott - 82		 Accident occurred within corporate limits of (city)
 Law Enforcement Case Number:
2011018523
Literal Description
I80 WB MM 303 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
714196.7
Y-Coordinate
4608286.
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1 		Driver's Name - Last
MAY		 First
JEFFREY		 Middle
ALAN		 Suffix
City
BETTENDORF		 State
IA - Iowa, US		 Zip
527220000
Driver's Age
48		 Citation Charge Code 1
 Citation Charge 1
Gender
Male		 State
IA - Iowa, US		 Class
A - Veh w/26001 GVWR or more Towed unit is 10001 GVWR or more		 Endorsements
N - Tank		 Restrictions

N - Non-resident CDL		 Citation Charge Code 2
 Citation Charge 2
Alcohol Test Given?
2 - Blood		 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
9 - Unknown		 Airbag Deployment
5 - Not deployed		 Airbag Switch Status
9 - Unknown		 Ejection
1 - Not ejected		 Ejection Path
 Trapped
1 - Not trapped
Transported to:
TRINITY HOSPITAL		 Transported by:
MEDIC AMBULANCE
Insurance Co. Name
Year
2002		 Make
Subaru - SUBA		 Model
IMPREZA		 Style
4D		 Approximate Cost to Repair or Replace
6000
Initial Travel Direction
9 - Unknown		 Vehicle Action
99 - Unknown		 Speed Limit
65		 Point of Initial Impact
99 - Unknown		 Most Damaged Area
03 - Right Side		 Extent of Damage
4 - Disabling damage		 Underride/Override
9 - Unknown
Total Occupants
01		 Traffic Controls
99 - Unknown		 Vehicle Config.
01 - Passenger car		 Cargo Body Type
01 - Not applicable		 Vehicle Defect
99 - Unknown		 Driver Condition
6 - Under the influence of alcohol/drugs/medications		 Vision Obscured
99 - Unknown		 Contributing Circumstances, Driver (up to 2)
SEQUENCE OF EVENTS First Event
99 - Unknown		 Second Event
 Third Event
 Fourth Event
 Most Harmful Event (by vehicle)
99 - Unknown
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?
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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
 Make
 Model
 Style
 Approximate Cost to Repair or Replace
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?
ACCIDENT ENVIRONMENT ROADWAY CHARACTERISTICS
Major Contributing Circumstances:		 WORKZONE RELATED? SEQUENCE OF EVENTS
Location of First Harmful Event
9 - Unknown		 Weather Conditions (up to two)
03 - Cloudy		 Environment
9 - Unknown		 Location
 First Harmful Event of Crash (use codes 11-42 only)
99 - Unknown
Manner of Crash/Collision
9 - Unknown		 Roadway
99 - Unknown		 Type
Light Conditions
5 - Dark, roadway not lighted		 Surface Conditions
2		 Type of Roadway Junction/Feature
99 - Unknown		 Workers Present?
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NARRATIVE

UNIT 1 WAS FOUND ON I80 WESTBOUND NEAR THE 303 MILE MARKER PARKED ON THE NORTH SHOULDER WITH SEVERE DAMAGE. IT IS UNKNOWN WHERE THE ACCIDENT OCCURRED OR WHAT HAPPENED SINCE THE DRIVER COULD NOT REMEMBER. HE JUST SAID SOMEONE HIT HIS CAR ON I80.
Officer
VOTROUBEK 		Badge No.
375		 Time Officer Notified of Accident
00:08		 Time Officer Arrived At Scene
00:25
Name of Agency
P12		 Date of Report
3/22/2011		 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