U
N
I
T
1
|
Driver's Name - Last WHITE |
First MARLO |
Middle MAX |
Suffix
|
City ALDEN |
State IA - Iowa, US |
Zip 50006 |
Driver's Age 56 |
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
None |
Citation Charge Code 2
|
Citation Charge 2
|
Alcohol Test Given? 4 - Breath |
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 3 - Non-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
|
Trapped 1 - Not trapped |
Transported to: IOWA FALLS HOSPITAL |
Transported by: ALDEN AMBULANCE |
Insurance Co. Name
|
Year 2002 |
Make Chevrolet - CHEV |
Model 3500 |
Style PICKUP |
Approximate Cost to Repair or Replace 10000 |
Initial Travel Direction 3 - South |
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 5 - Override, moving vehicle |
Total Occupants 01 |
Traffic Controls 01 - No controls present |
Vehicle Config. 02 - Four-tire light truck (pick-up, panel) |
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 21 - Vehicle in traffic |
Second Event 03 - Ran off road, left |
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 WESTFALL |
First VICTORIA |
Middle LINN |
Suffix
|
City ALDEN |
State IA - Iowa, US |
Zip 50006 |
Driver's Age 17 |
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 1 - Fatal |
Occupant Protection 2 - Shoulder and lap belt used |
Airbag Deployment 6 - Not applicable |
Airbag Switch Status 3 - No ON/OFF switch present |
Ejection 3 - Totally ejected |
Ejection Path
|
Trapped 1 - Not trapped |
Transported to: MERCY HOSPITAL DES MOINES |
Transported by: AIR AMBULANCE |
Insurance Co. Name
|
Year 1991 |
Make Pontiac - PONT |
Model GRAND PRIX |
Style CAR |
Approximate Cost to Repair or Replace 2500 |
Initial Travel Direction 2 - East |
Vehicle Action 01 - Movement essentially straight |
Speed Limit 55 |
Point of Initial Impact 07 - Left Side |
Most Damaged Area 07 - Left Side |
Extent of Damage 5 - Severe, vehicle totaled |
Underride/Override 2 - Underride, compartment intrusion |
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 21 - Vehicle in traffic |
Second Event 01 - Ran off road, right |
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?
|
P
R
O
P
E
R
T
Y
D
A
M
A
G
E
|
If Property other than vehicles damaged explain |
Object Damaged STOP SIGN |
Estimate of Damage 100 |
Owner's Name - Last
|
First
|
Middle
|
Suffix
|
Owner Company Name HARDIN COUNTY |
City ELDORA |
State IA - Iowa, US |
Zip
|
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) 01 - Clear |
Environment 1 - None apparent |
Location
|
First Harmful Event of Crash (use codes 11-42 only) 21 - Vehicle in traffic |
Manner of Crash/Collision 5 - Broadside |
Roadway 01 - None apparent |
Type
|
Light Conditions 1 - Daylight |
Surface Conditions 1 |
Type of Roadway Junction/Feature 11 - Four-way intersection |
Workers Present?
|
D I A G R A M
0 |
|
NARRATIVE |
UNIT 1 SOUTHBOUND C AVE / DOGWWOOD AVE. UNIT 2 EASTBOUND ON HARDIN AVE/HARDIN ST. BOTH VEHICLES ENTER INTO INTERSECTION. UNIT 1 COLLIDES INTO DRIVER'S DOOR OF UNIT 2. BOTH VEHICLE TRAVEL SOUTH EAST INTO DITCH. DRIVER UNIT 2 EJECTED DESPITE SEATBELT USE DUE TO SEVERITY OF THE DAMAGE SUSTAINED TO VEHICLE. |
|
Officer
MORENZ |
Badge No. 230 |
Time Officer Notified of Accident 08:08 |
Time Officer Arrived At Scene 09:11 |
Name of Agency P07 |
Date of Report 5/3/2011 |
Investigation made at scene?
|
T.I. #
|
Any questions about this report may be directed to the following address:
Iowa State Patrol District 07 Office
2437 235th St
Ft Dodge,IA 50501-8465
Phone: (515) 972-4213
Fax: (515) 972-4218