Iowa State Patrol: Department of Public Safety

Crash Information

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N 		Date of Accident
6/22/2011		 Time of Accident
01:15 PM 		County
Floyd - 34		 Accident occurred within corporate limits of (city)
 Law Enforcement Case Number:
2011036370
Literal Description
T064 / 155TH and TIMBER 		Legal Intervention?
Yes		 Private Property?
No
X-Coordinate:
528176.3
Y-Coordinate
4775748.
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1 		Driver's Name - Last
 First
 Middle
 Suffix
City
 State
 Zip
Driver's Age
 Citation Charge Code 1
 Citation Charge 1
Gender
 State
 Class
0 - ID		 Endorsements
None		 Restrictions

None		 Citation Charge Code 2
 Citation Charge 2
Alcohol Test Given?
3 - Urine		 Drug Test Given?
3 - Urine		 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
1 - None used		 Airbag Deployment
5 - Not deployed		 Airbag Switch Status
3 - No ON/OFF switch present		 Ejection
1 - Not ejected		 Ejection Path
 Trapped
2 - Freed by non-mechanical means
Transported to:
FUNERAL HOME		 Transported by:
AMR
Insurance Co. Name
Year
2002		 Make
Chevrolet - CHEV		 Model
K1500 SILVERADO		 Style
PICK UP		 Approximate Cost to Repair or Replace
2000
Initial Travel Direction
2 - East		 Vehicle Action
03 - Turning right		 Speed Limit
55		 Point of Initial Impact
05 - Rear		 Most Damaged Area
05 - Rear		 Extent of Damage
2 - Minor damage		 Underride/Override
1 - None
Total Occupants
1		 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
9 - Unknown		 Vision Obscured
01 - Not obscured		 Contributing Circumstances, Driver (up to 2)
SEQUENCE OF EVENTS First Event
06 - Evasive action (swerve, panic braking, etc.)		 Second Event
21 - Vehicle in traffic		 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?
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2 		Driver's Name - Last
WILLIAMSON		 First
TYREL		 Middle
ROBERT		 Suffix
City
OSAGE		 State
IA - Iowa, US		 Zip
50461
Driver's Age
29		 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

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
3 - Non-incapacitating		 Occupant Protection
2 - Shoulder and lap belt used		 Airbag Deployment
5 - Not deployed		 Airbag Switch Status
3 - No ON/OFF switch present		 Ejection
1 - Not ejected		 Ejection Path
 Trapped
1 - Not trapped
Transported to:
NOT TRANSPORTED		 Transported by:
Insurance Co. Name
Year
2009		 Make
Ford - FORD		 Model
CROWN VIC		 Style
4 DOOR		 Approximate Cost to Repair or Replace
1500
Initial Travel Direction
2 - East		 Vehicle Action
03 - Turning right		 Speed Limit
55		 Point of Initial Impact
01 - Front		 Most Damaged Area
01 - Front		 Extent of Damage
2 - Minor damage		 Underride/Override
1 - None
Total Occupants
1		 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
 Third Event
 Fourth Event
 Most Harmful Event (by vehicle)
21 - Vehicle in traffic
Emergency Vehicle Type
2 - Police		 Emergency Status
1 - Yes, in emergency
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)
06 - Rain		 Environment
1 - None apparent		 Location
 First Harmful Event of Crash (use codes 11-42 only)
21 - Vehicle in traffic
Manner of Crash/Collision
3 - Rear-end		 Roadway
01 - None apparent		 Type
Light Conditions
1 - Daylight		 Surface Conditions
2		 Type of Roadway Junction/Feature
11 - Four-way intersection		 Workers Present?
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NARRATIVE

Officer
HAUGEN 		Badge No.
114		 Time Officer Notified of Accident
13:15		 Time Officer Arrived At Scene
13:16
Name of Agency
P08		 Date of Report
6/23/2011		 Investigation made at scene?
Yes		 T.I. #


Any questions about this report may be directed to the following address:
Iowa State Patrol District 08 Office
4425 Washington Avenue
Mason City,IA 50401-7002
Phone: (641) 424-3625
Fax: (641) 423-8381