U
N
I
T
1
|
Driver's Name - Last IVERSON |
First LYLE |
Middle S |
Suffix
|
City ROCK ISLAND |
State IL - Illinois, US |
Zip 61201 |
Driver's Age 88 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender Male |
State IL - Illinois, US |
Class D - Chauffeur |
Endorsements None |
Restrictions
L - Veh w/o Airbrakes |
Citation Charge Code 2
|
Citation Charge 2
|
Alcohol Test Given? 2 - Blood |
Drug Test Given? 2 - Blood |
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 1 - Deployed front of person |
Airbag Switch Status 9 - Unknown |
Ejection 1 - Not ejected |
Ejection Path
|
Trapped 1 - Not trapped |
Transported to: FUNERAL HOME - GUTTENBERG |
Transported by: GUTTENBERG AMBULANCE |
Insurance Co. Name
|
Year 1997 |
Make Mercury - MERC |
Model 4 DOOR |
Style PC |
Approximate Cost to Repair or Replace 10000 |
Initial Travel Direction 3 - South |
Vehicle Action 08 - Leaving traffic lane |
Speed Limit 55 |
Point of Initial Impact 01 - Front |
Most Damaged Area 01 - Front |
Extent of Damage 4 - Disabling 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 9 - Unknown |
Vision Obscured 01 - Not obscured |
Contributing Circumstances, Driver (up to 2)
|
SEQUENCE OF EVENTS |
First Event 04 - Crossed centerline/median |
Second Event 21 - Vehicle in traffic |
Third Event
|
Fourth Event
|
Most Harmful Event (by vehicle) 04 - Crossed centerline/median |
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 SIMON |
First ELIZABETH |
Middle RAELYNN |
Suffix
|
City GUTTENBERG |
State IA - Iowa, US |
Zip 520520000 |
Driver's Age 25 |
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 01 - Front: Left Side / Motorcycle Driver |
Injury Status 2 - Incapacitating |
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 3 - Extricated by mechanical means |
Transported to: GUTTENBERG HOSP |
Transported by: GUTTENBERG AMBULANCE |
Insurance Co. Name
|
Year 1996 |
Make Oldsmobile - OLDS |
Model CUT |
Style 4D |
Approximate Cost to Repair or Replace 5000 |
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 3 |
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 06 - Evasive action (swerve, panic braking, etc.) |
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?
|
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) 03 - Cloudy |
Environment 1 - None apparent |
Location
|
First Harmful Event of Crash (use codes 11-42 only) 21 - Vehicle in traffic |
Manner of Crash/Collision 2 - Head-on |
Roadway 01 - None apparent |
Type
|
Light Conditions 1 - Daylight |
Surface Conditions 2 |
Type of Roadway Junction/Feature 01 - No special feature |
Workers Present?
|
P
E
R
S
O
N
|
I
N
J
U
R
E
D
|
Name- Last ALLBEE |
First TAMMY |
Middle L |
Suffix
|
City
|
State
|
Zip Code
|
Age 38 |
Sex Female |
Unit No. 2 |
Seating Position 09 - Rear: Right Side |
Injury Status 3 - Non-incapacitating |
Occupant Protection 2 - Shoulder and lap belt used |
Airbag Deployment 6 - Not applicable |
Airbag Switch Status 3 - No ON/OFF switch present |
Ejection 1 - Not ejected |
Ejection Path 1 - Not ejected/not applicable |
Trapped 1 - Not trapped |
Transported to: GUTTENBERG HOSPITAL |
Transported by: GUTTENBERG 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 SCHERBRING |
First NATHAN |
Middle D |
Suffix
|
City
|
State
|
Zip Code
|
Age 27 |
Sex Male |
Unit No. 2 |
Seating Position 03 - Front: Right Side |
Injury Status 3 - Non-incapacitating |
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 1 - Not ejected/not applicable |
Trapped 1 - Not trapped |
Transported to: GUTTENBERG HOSPITAL |
Transported by: GUTTENBERG 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 ONE WAS TRAVELING SOUTH ON HIGHWAY 52. UNIT TWO WAS TRAVELING NORTH. UNIT ONE CROSSED THE CENTER LINE AND COLLIDED WITH UNIT TWO HEAD-ON. |
|
Officer
TRIMBLE |
Badge No. 312 |
Time Officer Notified of Accident 15:17 |
Time Officer Arrived At Scene 15:37 |
Name of Agency P10 |
Date of Report 11/11/2012 |
Investigation made at scene? Yes |
T.I. #
|
Any questions about this report may be directed to the following address:
Iowa State Patrol District 10 Office
15239 35th St
Oelwein,IA 50662-9446
Phone: (319) 283-5521
Fax: (319) 283-2046