U
N
I
T
1
|
Driver's Name - Last SMITH |
First BRIAN |
Middle CRAIG |
Suffix
|
City ACKWORTH |
State IA - Iowa, US |
Zip 500010000 |
Driver's Age 40 |
Citation Charge Code 1 321.321 |
Citation Charge 1 FAILURE TO YIELD UPON ENTERING THROUGH HIGHWAY |
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
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 5 - Uninjured |
Occupant Protection 2 - Shoulder and lap belt used |
Airbag Deployment 9 - Unknown |
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 Ford - FORD |
Model F15 |
Style PK |
Approximate Cost to Repair or Replace 5000 |
Initial Travel Direction 2 - East |
Vehicle Action 01 - Movement essentially straight |
Speed Limit 55 |
Point of Initial Impact 02 - Right Front |
Most Damaged Area 02 - Right Front |
Extent of Damage 5 - Severe, vehicle totaled |
Underride/Override 1 - None |
Total Occupants 2 |
Traffic Controls 04 - Stop signs |
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
|
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 NORMAN |
First LACY |
Middle LYNN |
Suffix
|
City LUBBOCK |
State TX - Texas, US |
Zip 79423 |
Driver's Age 25 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender Female |
State TX - Texas, 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 5 - Uninjured |
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:
|
Transported by:
|
Insurance Co. Name
|
Year 2006 |
Make Mercury - MERC |
Model MON |
Style MD |
Approximate Cost to Repair or Replace 4000 |
Initial Travel Direction 1 - North |
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 5 |
Traffic Controls 01 - No controls present |
Vehicle Config. 03 - Van or mini-van |
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
|
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 LIGHT POST |
Estimate of Damage 3000 |
Owner's Name - Last
|
First
|
Middle
|
Suffix
|
Owner Company Name STATE OF IOWA(DOT) |
City
|
State
|
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?
|
P
E
R
S
O
N
|
I
N
J
U
R
E
D
|
Name- Last PAGE |
First BAILEY |
Middle JO |
Suffix
|
City
|
State
|
Zip Code
|
Age 23 |
Sex Male |
Unit No. 2 |
Seating Position 07 - Rear: Left Side |
Injury Status 3 - Non-incapacitating |
Occupant Protection 9 - Unknown |
Airbag Deployment 9 - Unknown |
Airbag Switch Status 9 - Unknown |
Ejection 1 - Not ejected |
Ejection Path 1 - Not ejected/not applicable |
Trapped 1 - Not trapped |
Transported to: MERCY HOSPITAL |
Transported by: NORWALK 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 JACKSON |
First LEONA |
Middle JEAN |
Suffix
|
City
|
State
|
Zip Code
|
Age 67 |
Sex Female |
Unit No. 2 |
Seating Position 07 - Rear: Left Side |
Injury Status 3 - Non-incapacitating |
Occupant Protection 9 - Unknown |
Airbag Deployment 9 - Unknown |
Airbag Switch Status 9 - Unknown |
Ejection 1 - Not ejected |
Ejection Path 1 - Not ejected/not applicable |
Trapped 1 - Not trapped |
Transported to: MERCY HOSPITAL |
Transported by: NORWALK 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 |
UNIT 1 WAS ATTEMPTING TO CROSS HWY 69 ONTO HWY 65 FROM G-58. UNIT 2 WAS TRAVELING NORTHBOUND ON HWY 69. THE DRIVER OF UNIT 1 DID NOT SEE UNIT 2 APPROACHING THE INTERSECTION OF THE TWO HIGHWAYS AND PULLED OUT IN FRONT OF UNIT 2. UNIT 2 WAS UNABLE TO AVOID UNIT 1 AND STRUCK THE TRUCK IN THE FRONT RIGHT. BOTH VEHICLES WERE TOTALED. TWO PASSENGERS OF UNIT 2 WERE TRANSPORTED TO MERCY HOSPITAL IN DES MOINES BY AMBULANCE. |
|
Officer
KLEIN |
Badge No. 152 |
Time Officer Notified of Accident 14:05 |
Time Officer Arrived At Scene 14:16 |
Name of Agency P02 |
Date of Report 6/20/2011 |
Investigation made at scene? Yes |
T.I. #
|
Any questions about this report may be directed to the following address:
Iowa State Patrol District 02 Office
1619 Truro Pavement
Osceola,IA 50213-8383
Phone: (641) 342-2108
Fax: (641) 342-4653