U
N
I
T
1
|
Driver's Name - Last WEGMANN |
First COLTON |
Middle JAMES |
Suffix
|
City EDGEWOOD |
State IA - Iowa, US |
Zip 52042 |
Driver's Age 19 |
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? 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 1 - None used |
Airbag Deployment 6 - Not applicable |
Airbag Switch Status 3 - No ON/OFF switch present |
Ejection 1 - Not ejected |
Ejection Path
|
Trapped 1 - Not trapped |
Transported to: MANCHESTER HOSPITAL |
Transported by: AMBULANCE |
Insurance Co. Name
|
Year 2012 |
Make
|
Model RANGER XP 800 |
Style UTV |
Approximate Cost to Repair or Replace 2500 |
Initial Travel Direction 2 - East |
Vehicle Action 88 - Other (explain in narrative) |
Speed Limit
|
Point of Initial Impact 02 - Right Front |
Most Damaged Area 02 - Right Front |
Extent of Damage 3 - Functional damage |
Underride/Override 1 - None |
Total Occupants 4 |
Traffic Controls 01 - No controls present |
Vehicle Config. 88 - Other (explain in narrative) |
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 11 - Overturn/rollover |
Second Event
|
Third Event
|
Fourth Event
|
Most Harmful Event (by vehicle) 11 - Overturn/rollover |
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?
|