Local Report Number * Crash Severity Hit/Skip. Road Types or Milepost AL - Alley AV - Avenue BL - Boulevard. CR - Circle CT- Court DR - Drive

Transcription

1 Photos Taken OH- OH-P OH- Other County * Traffic Crash Report Local Information City * Village * wnship * PDO Under State Reportable Dollar Amount Private Property Reporting Agency NCIC * Crash Severity Hit/Skip Reporting Agency Name * Distance Reference Dir Ref O Reference Reference Ref Prefix Reference Name (Road, Milepost, House #) Miles 0 Feet F E E,W Type E E,W Yards - Fatal - Injury - PDO Units Unit in error - Solved - Unsolved 98 - Animal City, Village, wnship * Crash Date * Time Crash Day Week Degrees / Minutes / Seconds Decimal Degrees Latitude Longitude O Latitude Longitude o / // o / // - R Roadway Division Divided Undivided Location Type Reference Point Used - Intersection - Mile Post - House Road Contour - Straight Level - Straight Grade - Curve Level Manner Crash Collision/Impact Road Surface 8 Narrative - Not Collision Between Two s In Transport - Concrete - Blacktop, Bituminous, Asphalt - Brick/Block Work Zone.. Divided Lane Direction Travel W N - Northbound S - Southbound Location Crash Location - Curve Grade - Rear-End - Head-On - Rear-to-Rear - Slag, Gravel, Stone - Dirt - Other Workers Present Law Enforcement Present (Officer/Vehicle Law Enforcement Present (Vehicle Only) GARFIELD HTS 0 E - Eastbound W - Westbound Loc. Prefix E,W 0 - Not an intersection 0 - Four-way Intersection 0 - T-Intersection 0 - Y-Intersection 0 - Traffic Circle/Roundabout Road Conditions Thru Lanes Location Road name - Backing - Angle 7 - Sideswipe, Same Direction Light conditions Type Work Zone GARFIELD HEIGHTS 0 GRANGER 0 - Five-point, or more 07 - On Ramp 08 - Off Ramp 09 - Crossover 0 - Driveway/Alley Access Road Types or Milepost AL - Alley AV - Avenue BL - Boulevard 0 - Dry 0 - Wet 0 - Snow 0 - Ice 8 - Sideswipe, Opposite Direction - Daylight - Dawn - Dusk - Dark - Lighted Roadway - Lane Closure - Lane Shift/Crossover - Work on Shoulder or Median UNIT WAS W/B ON GRANGER AT E. STOPPED FOR THE TRAFFIC LIGHT. UNIT WAS TRAVELING BEHIND UNIT WHEN UNIT STRUCK UNIT FROM BEHIND, CAUSING UNIT TO STRIKE UNIT FROM BEHIND. UNIT THEN FLED THE SCENE CR - Circle CT- Court DR - Drive - Railway Grade Crossing - Shared-Use Paths or Trails HE - Heights HW - Highway LA - Lane Location Road Type MP - Milepost PK - Parkway PI - Pike Types IR - Interstate (inc. turnpike) US - US SR - State Intersection 0 - Sand, Mud, Dirt, Oil, gravel 0 - Water (Standing, Moving) 07 - Slush 08 - Debris* Weather - Intermittent or Moving Work - Other R D 8 - Clear - Cloudy - Fog, Smog, Smoke Location Harmful - On Roadway - On Shoulder - In Median - On Roadside ST - Street TE - Terrace TL - Trail WA - Way CR - ed County TR - ed wnship Reference Road Type - On Gore - Outside Trafficway 09 - Rut, Holes, Bumps, Uneven Pavement* 0 - Other * Condition Only - Rain - Sleet, Hail - Snow - Dark - Roadway Not Lighted - Dark - Unknown Roadway Lighting 7 - Glare* 8 - Other * Condition Only Location Crash in Work Zone - Before the first Work Zone Warning Sign - Advance Warning Area - Transition Area PL - Place RD - Road SQ - Square 7 - Severe Crosswinds 8 - Blowing Sand, Soil, Dirt, Snow 9 - Other/Unknown School Zone S T School Bus Yes, School Bus Directly Involved Yes, School Bus Indirectly Involved - Activity Area - Termination Area T U E Report Taken By Police Agency Date Crash Reported HSY700 (Rev 0/) Time Crash Reported Supplement (Correction or Addition to an Existing Report Sent to ODPS) Dispatch Time Arrival Time Time Cleared Officer's Name * Officer's Badge Checked By C. Crespo 09 Other Investigation Time tal Minutes S M. Berdysz

2 Owner Owner Name: Last,, Middle ( Same As Driver) ( Same As Driver) Pro CASON FELICIA HOLLY --88 GWS997 Company Policy wed By Carrier Name, FORD Ford FUS Fusion BLU Blue ACCEPTANCE F A H P 0 H A 7 A R 0 7 A&H ( Same As Driver) 870 NITRA AVE MAPLE HEIGHTS OH None - Minor - Functional - Disabling 0 0 Location Prior to Impact 0 - Intersection - Marked Crosswalk 0 - Intersection - No Crosswalk 0 - Intersection - Other 0 - Midblock - Marked Crosswalk 0 - Travel Lane - Other Location 0 - Bicycle Lane 0 - Driveway Access - Shared-Use Path or Trail - Non-Trafficway Area HSY80 OHU (Rev 0/) - Less Than or Equal to 0k Lbs. - 0,00 to,000 Lbs - More Than,000 Lbs. 0 - None 0 - Taxi 0 - Rental Truck (Over 0K Lbs) 0 - Bus - School (Public or Private) 0 - Bus - Transit Type Use - Personal - Commercial - Government In Emergency 0 - No /Not Applicable 0 - Bus/Van(9- Seats, Inc.Driver) Bus(+ Seats, Inc Driver) 0 - Vehicle wing Another Vehicle 0 - Logging 0 - Fire - Highway/Maintenance - Military - Police - Public Utility - Other Government - Construction Equip. 0 - Sub-Compact 0 - Compact 0 - Mid Size 0 - Full Size 0 - Minivan Motorized Bicycle - Snowmobile/ATV - Other Passenger Vehicle 7 - Farm Vehicle 8 - Farm 9 - Motorhome 0 - Golf Cart - Train - Other (Explain in Narrative) 0 - Cargo Tank - Flat Bed - Dump - Concrete Mixer - Auto Transporter - Garbage/Refuse - Two-Way, Not Divided - Two-Way, Not Divided, Continuous Left Turn Lane - Two-Way, Divided, Unprotected (Painted or Grass> Ft.) Median - Two-Way, Divided, Positive Median Barrier - One-Way Trafficway Med/Heavy Trucks or Combo Units>0k lbs - Single Unit Truck or Van axle, tires - Single Unit Truck + axles - Single Unit Truck/Trailer - Truck/Tractor(Bobtail) 7 - Tractor/Semi-Trailer 8 - Tractor/Double 9 - Tractor/Triples 0 - Other Med/Heavy Vehicle Has HM Placard 0 - None 0 - Center Front 0 - Right Front Impact Area 0 - Right Side 0 - Right Rear Pre-Crash s 0 - Straight Ahead 0 - Backing 0 - Changing Lanes 0 - Overtaking/Passing 0 - Making Right Turn 0 - None 0 - Failure to Yield Ran Red Light 0 - Ran Stop Sign 0 - Exceeded Speed Limit 08 - Left Center 0 - Improper Lane Change Sequence s Parked - Slowing or Stopped in Traffic - Driverless Harmful Harmful - Pedestrian - Parked - Pedalcycle - Work Zone Maintenance - Railway Vehicle (Train,Engine) - Struck by Falling, Shifting Cargo 7 - Animal - Farm 8 - Animal - Deer 9 - Animal - Other - Other Movable Object 0 - in Transport No Controls 0 - Stop Sign 0 - Yield Sign 0 - Traffic Signal 0 - Traffic Flashers - Negotiating a Curve - Other - Improper Backing - Improper Start Parked Position - Stopped or Parked Illegally - Operating Vehicle in Negligent Manner - Swerving to Avoid (Due to External Conditions) - Wrong Side/Wrong Way 7 - Failure to Control 8 - Vision Obstruction 9 - Operating Defective 0 - Load Shifing/Falling/Spilling - Other Improper 0 Non-Collision s 0 - Overturn/Rollover 0 - Fire/Explosion 0 - Immersion 0 - Jackknife 0- Cargo/ Loss or Shift - Impact Attenuator/Crash Cushion - Bridge Overhead Structure 7 - Bridge Pier or Abutment 8 - Bridge Parapet 9 - Bridge Rail 0 - Guardrail Face - Guardrail End - Portable Barrier 0 - Construction Barricade - Person (Flagger, Officer) - Pavement Markings 0 - p and Windows - Undercarriage - Load/Trailer - tal (All Areas) - Other - Entering or Crossing Specified Location - Walking, Running, Jogging, Playing, Cycling 7 - Working 8 - Pushing Vehicle 9 - Approaching or Leaving Vehicle 0 - Standing - None - Improper Crossing - Darting - Lying and/or Illegally in Roadway - Failure to Yield Right Way 7 - Not Visible (Dark Clothing) 8 - Inattentive 9 - Failure to Obey Traffic Signs 0 - Wrong Side the Road - Other 0 - Failure 07 - Separation Units - Median Cable Barrier - Median Guardrail Barrier - Median Concrete Barrier - Median Other Barrier 7 - Traffic Sign Post 8 - Overhead Sign Post 9 - Light/Luminaries Support 0 - Utility Pole - Crosswalk Lines - Walk/Don't Walk - Other - Not Reported - Bus/Van (9- Seats, Inc Driver) - Bus(+ Seats, Inc Driver) - Animal with Rider - Animal with Buggy, Wagon, Surrey - Bicycle/Pedacyclist - Pedestrian/Skater 7 - Other 0 - Cross Median - Cross Center Line Opposite Direction Travel - Downhill Runaway - Other Non-Collision - Other Post, Pole - Culvert - Curb - Ditch - Enbankment - Fence 7 Mailbox - North - South - East - West - Non-Contact - Non-Collision - Striking - Struck - Striking/Struck - Other 0 - Turn Signals 0 - Head Lamps 0 - Tail Lamps 0 - Brakes 0 - Steering 08 - Trailer Defective 0 - Disabled Prior Accident - Other Defects 8 - Tree 9 - Fire Hydrant 0 - Work Zone Maintenance - Wall, Building, Tunnel - Other Fixed Object - Northeast

3 Owner Owner Name: Last,, Middle ( Same As Driver) ( Same As Driver) 0 0 Pro MOORE KRYSTAL ANDREA GGC0 Company Policy wed By Carrier Name, F M Z U 7 E 7 Z B 8 9 ( Same As Driver) 9 E TH ST CLEVELAND OH FORD Ford FOC Focus BLK Black - None - Minor - Functional - Disabling 0 Location Prior to Impact 0 - Intersection - Marked Crosswalk 0 - Intersection - No Crosswalk 0 - Intersection - Other 0 - Midblock - Marked Crosswalk 0 - Travel Lane - Other Location 0 - Bicycle Lane 0 - Driveway Access - Shared-Use Path or Trail - Non-Trafficway Area HSY80 OHU (Rev 0/) - Less Than or Equal to 0k Lbs. - 0,00 to,000 Lbs - More Than,000 Lbs. 0 - None 0 - Taxi 0 - Rental Truck (Over 0K Lbs) 0 - Bus - School (Public or Private) 0 - Bus - Transit Type Use - Personal - Commercial - Government In Emergency 0 - No /Not Applicable 0 - Bus/Van(9- Seats, Inc.Driver) Bus(+ Seats, Inc Driver) 0 - Vehicle wing Another Vehicle 0 - Logging 0 - Fire - Highway/Maintenance - Military - Police - Public Utility - Other Government - Construction Equip. 0 - Sub-Compact 0 - Compact 0 - Mid Size 0 - Full Size 0 - Minivan Motorized Bicycle - Snowmobile/ATV - Other Passenger Vehicle 7 - Farm Vehicle 8 - Farm 9 - Motorhome 0 - Golf Cart - Train - Other (Explain in Narrative) 0 - Cargo Tank - Flat Bed - Dump - Concrete Mixer - Auto Transporter - Garbage/Refuse - Two-Way, Not Divided - Two-Way, Not Divided, Continuous Left Turn Lane - Two-Way, Divided, Unprotected (Painted or Grass> Ft.) Median - Two-Way, Divided, Positive Median Barrier - One-Way Trafficway Med/Heavy Trucks or Combo Units>0k lbs - Single Unit Truck or Van axle, tires - Single Unit Truck + axles - Single Unit Truck/Trailer - Truck/Tractor(Bobtail) 7 - Tractor/Semi-Trailer 8 - Tractor/Double 9 - Tractor/Triples 0 - Other Med/Heavy Vehicle Has HM Placard 0 - None 0 - Center Front Right Front Impact Area 0 - Right Side 0 - Right Rear 0 Pre-Crash s 0 - Straight Ahead 0 - Backing 0 - Changing Lanes 0 - Overtaking/Passing 0 - Making Right Turn 0 - None 0 - Failure to Yield Ran Red Light 0 - Ran Stop Sign 0 - Exceeded Speed Limit 08 - Left Center 0 - Improper Lane Change Sequence s Parked - Slowing or Stopped in Traffic - Driverless Harmful Harmful - Pedestrian - Parked - Pedalcycle - Work Zone Maintenance - Railway Vehicle (Train,Engine) - Struck by Falling, Shifting Cargo 7 - Animal - Farm 8 - Animal - Deer 9 - Animal - Other - Other Movable Object 0 - in Transport No Controls 0 - Stop Sign 0 - Yield Sign 0 - Traffic Signal 0 - Traffic Flashers - Negotiating a Curve - Other - Improper Backing - Improper Start Parked Position - Stopped or Parked Illegally - Operating Vehicle in Negligent Manner - Swerving to Avoid (Due to External Conditions) - Wrong Side/Wrong Way 7 - Failure to Control 8 - Vision Obstruction 9 - Operating Defective 0 - Load Shifing/Falling/Spilling - Other Improper 0 Non-Collision s 0 - Overturn/Rollover 0 - Fire/Explosion 0 - Immersion 0 - Jackknife 0- Cargo/ Loss or Shift - Impact Attenuator/Crash Cushion - Bridge Overhead Structure 7 - Bridge Pier or Abutment 8 - Bridge Parapet 9 - Bridge Rail 0 - Guardrail Face - Guardrail End - Portable Barrier 0 - Construction Barricade - Person (Flagger, Officer) - Pavement Markings 0 - p and Windows - Undercarriage - Load/Trailer - tal (All Areas) - Other - Entering or Crossing Specified Location - Walking, Running, Jogging, Playing, Cycling 7 - Working 8 - Pushing Vehicle 9 - Approaching or Leaving Vehicle 0 - Standing - None - Improper Crossing - Darting - Lying and/or Illegally in Roadway - Failure to Yield Right Way 7 - Not Visible (Dark Clothing) 8 - Inattentive 9 - Failure to Obey Traffic Signs 0 - Wrong Side the Road - Other 0 - Failure 07 - Separation Units - Median Cable Barrier - Median Guardrail Barrier - Median Concrete Barrier - Median Other Barrier 7 - Traffic Sign Post 8 - Overhead Sign Post 9 - Light/Luminaries Support 0 - Utility Pole - Crosswalk Lines - Walk/Don't Walk - Other - Not Reported - Bus/Van (9- Seats, Inc Driver) - Bus(+ Seats, Inc Driver) - Animal with Rider - Animal with Buggy, Wagon, Surrey - Bicycle/Pedacyclist - Pedestrian/Skater 7 - Other 0 - Cross Median - Cross Center Line Opposite Direction Travel - Downhill Runaway - Other Non-Collision - Other Post, Pole - Culvert - Curb - Ditch - Enbankment - Fence 7 Mailbox - North - South - East - West - Non-Contact - Non-Collision - Striking - Struck - Striking/Struck - Other 0 - Turn Signals 0 - Head Lamps 0 - Tail Lamps 0 - Brakes 0 - Steering 08 - Trailer Defective 0 - Disabled Prior Accident - Other Defects 8 - Tree 9 - Fire Hydrant 0 - Work Zone Maintenance - Wall, Building, Tunnel - Other Fixed Object - Northeast

4 Owner Owner Name: Last,, Middle ( ü Same As Driver) ( ü Same As Driver) Pro GADUS MICHAEL J FOS89 Company Policy wed By Carrier Name, -70- F A L P 8 S 9 T A 9 7 ( ü Same As Driver) 0 BENHOFF DR MAPLE HTS OH 7 FORD Ford ESC Escort WHI White 0 - None - Minor - Functional - Disabling 0 Location Prior to Impact 0 - Intersection - Marked Crosswalk 0 - Intersection - No Crosswalk 0 - Intersection - Other 0 - Midblock - Marked Crosswalk 0 - Travel Lane - Other Location 0 - Bicycle Lane 0 - Driveway Access - Shared-Use Path or Trail - Non-Trafficway Area HSY80 OHU (Rev 0/) - Less Than or Equal to 0k Lbs. - 0,00 to,000 Lbs - More Than,000 Lbs. 0 - None 0 - Taxi 0 - Rental Truck (Over 0K Lbs) 0 - Bus - School (Public or Private) 0 - Bus - Transit Type Use - Personal - Commercial - Government In Emergency 0 - No /Not Applicable 0 - Bus/Van(9- Seats, Inc.Driver) Bus(+ Seats, Inc Driver) 0 - Vehicle wing Another Vehicle 0 - Logging 0 - Fire - Highway/Maintenance - Military - Police - Public Utility - Other Government - Construction Equip. 0 - Sub-Compact 0 - Compact 0 - Mid Size 0 - Full Size 0 - Minivan Motorized Bicycle - Snowmobile/ATV - Other Passenger Vehicle 7 - Farm Vehicle 8 - Farm 9 - Motorhome 0 - Golf Cart - Train - Other (Explain in Narrative) 0 - Cargo Tank - Flat Bed - Dump - Concrete Mixer - Auto Transporter - Garbage/Refuse - Two-Way, Not Divided - Two-Way, Not Divided, Continuous Left Turn Lane - Two-Way, Divided, Unprotected (Painted or Grass> Ft.) Median - Two-Way, Divided, Positive Median Barrier - One-Way Trafficway Med/Heavy Trucks or Combo Units>0k lbs - Single Unit Truck or Van axle, tires - Single Unit Truck + axles - Single Unit Truck/Trailer - Truck/Tractor(Bobtail) 7 - Tractor/Semi-Trailer 8 - Tractor/Double 9 - Tractor/Triples 0 - Other Med/Heavy Vehicle Has HM Placard 0 - None 0 - Center Front 0 - Right Front Impact Area 0 - Right Side 0 - Right Rear Pre-Crash s 0 - Straight Ahead 0 - Backing 0 - Changing Lanes 0 - Overtaking/Passing 0 - Making Right Turn 0 - None 0 - Failure to Yield Ran Red Light 0 - Ran Stop Sign 0 - Exceeded Speed Limit 08 - Left Center 0 - Improper Lane Change Sequence s Parked - Slowing or Stopped in Traffic - Driverless Harmful Harmful - Pedestrian - Parked - Pedalcycle - Work Zone Maintenance - Railway Vehicle (Train,Engine) - Struck by Falling, Shifting Cargo 7 - Animal - Farm 8 - Animal - Deer 9 - Animal - Other - Other Movable Object 0 - in Transport No Controls 0 - Stop Sign 0 - Yield Sign 0 - Traffic Signal 0 - Traffic Flashers - Negotiating a Curve - Other - Improper Backing - Improper Start Parked Position - Stopped or Parked Illegally - Operating Vehicle in Negligent Manner - Swerving to Avoid (Due to External Conditions) - Wrong Side/Wrong Way 7 - Failure to Control 8 - Vision Obstruction 9 - Operating Defective 0 - Load Shifing/Falling/Spilling - Other Improper Non-Collision s 0 - Overturn/Rollover 0 - Fire/Explosion 0 - Immersion 0 - Jackknife 0- Cargo/ Loss or Shift - Impact Attenuator/Crash Cushion - Bridge Overhead Structure 7 - Bridge Pier or Abutment 8 - Bridge Parapet 9 - Bridge Rail 0 - Guardrail Face - Guardrail End - Portable Barrier 0 - Construction Barricade - Person (Flagger, Officer) - Pavement Markings 0 - p and Windows - Undercarriage - Load/Trailer - tal (All Areas) - Other - Entering or Crossing Specified Location - Walking, Running, Jogging, Playing, Cycling 7 - Working 8 - Pushing Vehicle 9 - Approaching or Leaving Vehicle 0 - Standing - None - Improper Crossing - Darting - Lying and/or Illegally in Roadway - Failure to Yield Right Way 7 - Not Visible (Dark Clothing) 8 - Inattentive 9 - Failure to Obey Traffic Signs 0 - Wrong Side the Road - Other 0 - Failure 07 - Separation Units - Median Cable Barrier - Median Guardrail Barrier - Median Concrete Barrier - Median Other Barrier 7 - Traffic Sign Post 8 - Overhead Sign Post 9 - Light/Luminaries Support 0 - Utility Pole - Crosswalk Lines - Walk/Don't Walk - Other - Not Reported - Bus/Van (9- Seats, Inc Driver) - Bus(+ Seats, Inc Driver) - Animal with Rider - Animal with Buggy, Wagon, Surrey - Bicycle/Pedacyclist - Pedestrian/Skater 7 - Other 0 - Cross Median - Cross Center Line Opposite Direction Travel - Downhill Runaway - Other Non-Collision - Other Post, Pole - Culvert - Curb - Ditch - Enbankment - Fence 7 Mailbox - North - South - East - West - Non-Contact - Non-Collision - Striking - Struck - Striking/Struck - Other 0 - Turn Signals 0 - Head Lamps 0 - Tail Lamps 0 - Brakes 0 - Steering 08 - Trailer Defective 0 - Disabled Prior Accident - Other Defects 8 - Tree 9 - Fire Hydrant 0 - Work Zone Maintenance - Wall, Building, Tunnel - Other Fixed Object - Northeast

5 / / Occupant / Name: Last,, Middle Date Birth 0 BOGAN DAMIEN JE 0 Injuries Injured Taken By EMS Agency Medical Facility Injured Taken Safety Used OL State Operator License OL Class No Valid OL M/C End 870 NITRA AVE MAPLE HEIGHTS OH Condition Alcohol/Drug Suspected Alcohol Test Status Alcohol Test Type Alcohol Test Value Drug Test Status Drug Test Type TS00 Offense Charged Offense Description Citation ( Local Code ) Hands-Free Device Used M / Name: Last,, Middle Date Birth 0 GADUS MICHAEL J M Injuries Injured Taken By EMS Agency Medical Facility Injured Taken Safety Used OL State Operator License OL Class No Valid OL 0 BENHOFF DR MAPLE HTS OH Condition Alcohol/Drug Suspected Alcohol Test Status Alcohol Test Type Alcohol Test Value Drug Test Status Drug Test Type M/C RP99 End Offense Charged ( Local Code ) Offense Description Citation Hands-Free Device Used 0. 0 Injuries - No Injury/None Reported - Possible - Non-Incapacitating - Incapacitating - Fatal Seating Position Injured Taken By 0 - Front - Left Side ( Driver) 0 - Front - Middle 0 - Front - Right Side 0 - Second - Left Side ( Passenger) 0 - Second - Middle 0 - Second - Right Side - Not Transported / Treated at Scene - EMS - Police - Other Safety Used 0 - None Used - Vehicle Occupant 0 - Shoulder Belt Only Used 0 - Lap Belt Only Used 0 - Shoulder Belt and Lap Belt Used 07 - Third - Left Side ( Side Car) 08 - Third - Middle 09 - Third - Right Side 0 - Sleeper Section Cab (Truck) - Passenger in Other Enclosed Cargo Area (Non-Trailing Unit Such as a Bus, Pick-up with Cab) Safety 0 - Child Restraint System-Forward Facing 0 - Child Restraint System-Rear Facing 07 - Booster Seat 08 - Used - Passenger in Unenclosed Cargo Area - Trailing Unit - Riding on Vehicle Exterior (Non-Trailing Unit) - - Other 09 - None Used 0 - Used - Protective Pads Used (Elbows, Knees, Etc) Air Bag Usage - Reflective Clothing - Lighting - Other - Not Deployed - Deployed Front - Deployed Side - Deployed Both Front/Side - Not Applicable 9 - Deployment Unknown Ejection Trapped Operator License Class Condition Alcohol/Drug Suspected - Not Ejected - tally Ejected - Partially Ejected - Not Applicable - Not Trapped - Extricated by Mechanical Means - Extricated by Non-Mechanical Means - Class A - Class B - Class C - Regular Class (Ohio is "D") - MC/Moped Only - Apparently Normal - Physical Impairment - Emotional (Depressed, Angry, Disturbed) - Illness - Fell Asleep, Fainted, Fatigued - Under The Influence Medications, Drugs, Alcohol 7 - Other - None - Yes - Alcohol Suspected - Yes - HBD Not Impaired - Yes - Drugs Suspected - Yes - Alcohol and Drugs Suspected Alcohol Test Status - None Given - Test Refused - Test Given, Contaminated Sample/Unusable - Test Given, Results Known - Test Given, Results Unknown Alcohol Test Type - None - Blood - Urine - Breath - Other Drug Test Status - None Given - Test Refused - Test Given, Contaminated Sample/Unusable - Test Given, Results Known - Test Given, Results Unknown Drug Test Type - None - Blood - Urine - Other - No Distraction Reported - Phone - Texting/ ing - Electronic Communication Device - Other Electronic Device (Navigation Device, Radio, DVD) - Other Inside the Vehicle 7 - External Distraction Occupant Name: Last,, Middle Date Birth 0 CRENSHAW BRYTNEE LO Injuries Injured Taken By EMS Agency Medical Facility Injured Taken Safety Used 870 NITRA MAPLE HTS OH F Occupant Injuries Name: Last,, Middle Injured Taken By EMS Agency Medical Facility Injured Taken Safety Used Date Birth Seating Position Age Air Bag Usage Gender Ejection Trapped HSY80 (Rev 0/)