TRAFFIC CRASH REPORT LOCAL INFORMATION

Transcription

1 PHOTOS TAKEN - -P - OTHER TRAIC CRASH REPORT LOCAL INORMATION * PDO UNDER STATE PRIVATE REPORTING NCY NCIC * REPORTING NCY NAME * PROPERTY REPORTABLE DOLLAR AMOUNT 05 Medina Township Police Department CRASH SEVERITY - ATAL - INJURY NUMBER O UNITS - PDO UNIT IN ERROR HIT/SKIP - SOLVED. UNSOLVED 98 - ANIMAL COUNTY * city * CITY, VILL, TOWNSHIP * CRASH DATE * TIME O CRASH DAY O WEEK Medina vill* TOWNSHIP * Medina //05 5 Mon DEGREES/MINUTES/SECONDS LATITUDE LONGITUDE :: :: O R DECIMAL DEGREES LATITUDE LONGITUDE RoADWAY DIVISION DIVIDED LANE DIRECTION O TRAVEL NUMBER O THRU LANES ROAD S OR MILEPOST DIVIDED UNDIVIDED N - NORTHBOUND S - SOUTHBOUND E - EASTBOUND W -WESTBOUND AL - ALLEY AV - AVENUE BL - BOULEVARD CR - CIRCLE CT - COURT DR - DRIVE HE - HEIGHTS HW - HIGHWAY LA - LANE MP - MILEPOST PK - PARKWAY PI - PIKE PL - PLACE RD - ROAD SQ - SQUARE ST - STREET TE - TERRACE TL - TRAIL WA - WAY LoCATION ROUTE NUMBER LOCATION ROUTE DISTANCE ROM REERENCE MILES EET YARDS REERENCE POINT USED -INTERSECTION -MILE POST -HOUSE NUMBER CRASH LOCATION DIR ROM RE 0 LoC PREIX O SR LoCATION ROAD NAME enn REERENCE ROUTE 0 - NOT AN INTERSECTION 0 - OUR- WAY INTERSECTION 0 - T-INTERSECTION - Y-INTERSECTION 05 - TRAIC CIRCLE/ ROUNDABOUT REERENCE ROUTE NUMBER 06 - IVE-POINT, OR MORE 07 - ON RAMP 08 - O RAMP 09 - CROSSOVER 0 - DRIVEWAY/ ALLEY ACCESS RE PREIX RD LOCATION ROAD REERENCE NAME (ROAD, MILEPOST, HOUSE #) - RAILWAY GRADE CROSSING - SHARED-USE PATHS OR TRAILS INTERSECTION ROUTE S IR - INTERSTATE ROUTE (INC. TURNPIKE) US - US ROUTE CR - NUMBERED COUNTY ROUTE SR - STATE ROUTE TR - NUMBERED TOWNSHIP ROUTE LOCATION O IRST HARMUL - ON ROADWAY - ON SHOULDE - IN MEDIAN - ON ROADSIDE REERENCE ROAD 5 - ON GORE 6 - OUTSIDE TRAICWAY ROAD CONTOUR - STRAIGHT LEVEL - STRAIGHT GRADE - CURVE LEVEL - CURVE GRADE ROAD S DRY 0 - WET 0 - SNOW - ICE 05 - SAND, MUD, DIRT, OIL, GRAVEL 06 - WATER (STANDING, MOVING) 07 - SLUSH 08 - DEBRIS * 09 - RUT, HOLES, BUMPS, UNEVEN PAVEMENT* 0 - OTHER * ONLY MANNER O CRASH COLLISION/IMPACT WEATHER 6 - NOT COLLISION BETWEEN TWO MOTOR VEHICLES IN TRANSPORT - REAR-END - HEAD-ON 5 - BACKING 6 - ANGLE 8 - SIDESWIPE, OPPOSITE DIRECTION - REAR-TO-REAR 7 - SIDESWIPE, -SAME DIRECTION - CLEAR - CLOUDY - OG,SMOG, SMOKE - RAIN 5 - SLEET, HAIL 6 - SNOW 7 - SEVERE CROSSWINDS 8 - BLOWING SAND,SOIL, DIRT, SNOW 9 - OTHER/UNKNOWN ROAD SURACE - CONCRETE - BLACKTOP, BITUMINOUS, ASPHALT - BRICK/BLOCK - SLAG, GRAVEL, STONE 5 - DIRT 6 - OTHER LIGHT S SECONDAR - DAYLIGHT - DAWN - DUSK - DARK - LIGHTED ROADWAY 5 - DARK - ROADWAY NOT LIGHTED 6 - DARK - UNKNOWN ROADWAY LIGHTING 7 - GLARE* 8 - OTHER * ONLY SCHOOL ZONE SCHOOL BUS YES, SCHOOL BUS DIRECTLY INVOLVED YES, SCHOOL BUS INDIRECTLY INVOLVED work ZONE workers PRESENT LAW ENORCEMENT PRESENT (OICER/VEHICLE) LAW ENORCEMENT PRESENT (VEHICLEONLY ) O WORK ZONE - L ANE CLOSURE - LANE SHIT/ CROSSOVER - WORK ON SHOULDER OR MEDIAN - INTERMITTENT OR MOVING WORK 5 - OTHER LOCATION O CRASH IN WORK ZONE - BEORE THE IRST WORK ZONE WARNING SIGN - ADVANCE WARNING AREA - TRANSITION AREA - ACTIVITY AREA 5 - TERMINATION AREA NARRATIVE Unit was stopped east bound on enn Rd at Weymouth Rd due to a traffic signal. Unit was south bound on Weymouth Rd. and turned west bound onto enn Rd. Unit went left of center and struck Unit in the front driver side door. Citation issued for improper turn. REPORT TAKEN BY POLICE NCY SUPPLEMENT (CORRECTION OR ADDITION TO AN EXISTING REPORT SENT TO ODPS) DATE CRASHREPORTED TIME CRASHREPORTED DISPATCH TIME ARRIVAL TIME TIME CLEARED OTHER INVESTIGATIONTIME TOTAL MINUTES // OICER'S NAME* OICER'S BADGE NUMBER CHECKED BY Harvey, Justin

2 UNIT OWNER ( SAME AS DRIVER ) Rak, Stephan, A OWNER ADDRESS: CITY, STATE, ZIP SAME AS DRIVER ) 587 Windsong Dr, Medina,, 56 LP STATE LICENSE PLATE NUMBER VEHICLE IDENTIICATION NUMBER OWNER PHONE NUMBER # S DAM SCALE - NONE - MINOR DAM AREA RONT GSA7 5NYH5AB UNCTIONAL VEHICLE YEAR 00 VEHICLE MAKE Honda VEHICLE MODEL Other VEHICLE COLOR BLU - DISABLING PROO O INSURANCE SHOWN INSURANCE COMPANY Grange POLICY NUMBER A67608 TOWED BY REAR CARRIER NAME, CARRIER PHONE US DOT HM PLACARD ID NO. HM CLASS NUMBER VEHICLE WEIGHT GVWR/GCWR - LESS THAN OR EQUAL TO 0K LBS - 0,00 TO 6,000K LBS - MORE THAN 6,000K LBS. HAZARDOUS MATERIAL CARGO BODY 0 - NO CARGO BODY /NOT APPLICABL BUS/ VAN (9-5 SEATS, INC DRIVER) 0 - BUS (6+ SEATS, INC DRIVER) - VEHICLE TOWING ANOTHER VEHICLE - DUMP 05 - LOGGING 06 - INTERMODAL CONTAINER CHASIS 07 - CARGO VAN/ENCLOSED BOX 08 - GRAIN, CHIPS, GRAVEL 09 - POLE 0 - CARGO TANK - LAT BED - CONCRETE MIXER - AUTO TRANSPORTER 5 - GARB /REUSE TRAICWAY DESCRIPTION - T WO-WAY, NOT DIVIDED - T WO-WAY, NOT DIVIDED, CONTINUOUS LET TURN LANE - T WO-WAY, DIVIDED, UNPROTECTED(PAINTED OR GRASS >T.) MEDIA - T WO-WAY, DIVIDED, POSITIVE MEDIANBARRIER 5 - ONE-WAY TRAICWAY HIT / SKIP UNIT LOCATION PRIOR TO IMPACT 0 - INTERSECTION - MARKED CROSSWAL 0 - INTERSECTION - NO CROSSWALK 0 - INTERSECTION OTHER - MIDBLOCK - MARKED CROSSWALK 05 - TRAVEL LANE - OTHER LOCATION 06 - BICYCLE LANE 07 - SHOULDER/ROADSIDE 08 - SIDEWALK 09 - MEDIAN/CROSSING ISLAND 0 - DRIVE WAY ACCESS - SHARED-USE PATH OR TRAIL - NON-TRAICWAY AREA O USE - PERSONAL - COMMERCIAL - GOVERNMENT IN EMERGENCY RESPONSE UNIT 06 PASSENGER VEHICLES (LESS THAN 9 PASSENGERS 0 - SUB -COMPACT 0 - COMPACT 0 - MID SIZE OR HIT/SKIP - ULL SIZE 05 - MINIVAN 06 - SPORT UTILITY VEHICLE 07 - PICKUP 08 - VAN MOTORIZED BICYCLE - SNOWMOBILE/ATV - OTHER PASSENGER VEHICLE MED/HEAVY TRUCKS OR COMBO UNITS > 0K LBS BUS/VAN/LIMO(9 OR MORE INCLUDING DRIVER) - SINGLE UNIT TRUCK OR VAN AXLE, 6 TIRES - SINGLE UNIT TRUCK ; + AXLES 5 - SINGLE UNIT TRUCK / TRAILER 6 - TRUCK/TRACTOR (BOBTAIL) 7 - TRACTOR/SEMI-TRAILER 8 - TRACTOR/DOUBLE 9 - TRACTOR/TRIPLES 0 - OTHER MED/HEAVY VEHICLE HAS HM PLACARD - BUS/VAN (9-5 SEATS, INC DRIVER) - BUS (6+ SEATS, INC DRIVER) - ANIMAL WITH RIDER - ANIMAL WITH BUGGY, WAGON, SURREY 5 - BICYCLE/PEDACYCLIST 6 - PEDESTRIAN/SKATER 7 - OTHER SPECIAL UNCTION0 - NONE 0 - TAXI RENTAL TRUCK (OVER 0K LBS) - BUS - SCHOOL (PUBLIC OR PRIVATE) 05 - BUS - TRANSIT 06 - BUS - CHARTER 07 - BUS - SHUTTLE 08 - BUS - OTHER 09 - AMBULANCE 0 - IRE - HIGHWAY/MAINTENANCE - MILITARY - POLICE - PUBLIC UTILITY 5 - OTHER GOVERNMENT 6 - CONSTRUCTION EQIP. 7 - ARM VEHICLE 8 - ARM EQUIPMENT 9 - MOTORHOME 0 - GOL CART - TRAIN - OTHER (EXPLAIN IN NARRATIVE) MOST DAMD AREA 0 - NONE CENTER RONT 0 - RIGHT RONT IMPACT ARE - RIGHT SIDE 05 - RIGHT REAR REAR CENTER 07 - LET REAR 08 - LET SIDE 09 - LET RONT 0 - TOP AND WINDOWS - UNDERCARRI - LOAD/TRAILER - TOTAL (ALL AREAS) - OTHER ACTION - NON- CONTACT - NON-COLLISION - STRIKING - STRUCK 5 - STRIKING/STRUCK PRE- CRASH ACTIONS 0 - STRAIGHT AHEAD 0 - BACKING 0 - CHANGING LANES - OVERTAKING/PASSING 05 - MAKING RIGHT TURN 06 - MAKING LET TURN 07 - MAKING U-TURN 08 - ENTERING TRAIC LANE 09 - LEAVING TRAIC LANE 0 - PARKED - SLOWING OR STOPPED IN TRAIC - DRIVERLESS - NEGOTIATING A CURVE - OTHER ACTIO 5 - ENTERING OR CROSSING SPECIIED LOCATIO 6 - WALKING,RUNNING, JOGGING, PLAYING, CYCLING 7 - WORKING 8 - PUSHING VEHICLE 9 - APPROACHING OR LEAVING VEHICLE 0 - STANDING - OTHER ACTION CONTRIBUTING CIRCUMSTANCE NONE 0 - AILURE TO YIELD 0 - RAN RED LIGHT - RAN STOP SIGN 05 - EXCEEDED SPEED LIMIT 06 - UNSAE SPEED 07 - IMPROPER TURN 08 - LET O CENTER 09 - OLLOWED TOO CLOSELY/ACDA 0 - IMPROPER LANE CHANGE /PASSING/O ROAD - IMPROPER BACKING - IMPROPER START ROM PARKED POSITION - STOPPED OR PARKED ILLEGALLY - OPERATING VEHICLE IN NEGLIGENT MANNER 5 - SWERING TO AVOID (DUE TO EXTERNAL S) 6 - WRONG SIDE/WRONG WAY 7 - ALURE TO CONTROL 8 - VISION OBSTRUCTION 9 - OPERATING DEECTIVE EQUIPMENT 0 - LOAD SHITING/ALLING/SPILLING - OTHER IMPROPER ACTION - NONE - IMPROPER CROSSING - DARTING 5 - LYING AND/OR ILLEGALLY IN ROADWAY 6 - ALURE TO YIELD RIGHT O WAY 7 - NOT VISIBLE (DARK CLOTHING) 8 - INATTENTIVE 9 - AILURE TO OBEY TRAIC SIGNS /SIGNALS/OICER 0 - WRONG SIDE O THE ROAD - OTHER ACTION VEHICLE DEECTS 0 - TURN SIGNALS 0 - HEAD LAMPS 0 - TAIL LAMPS - BRAKES 05 - STEERING 06 - TIRE BLOWOUT 07 - WORN OR SLICK TIRES 08 - TRAILER EQUIPMENT DEECTIVE 09 - MOTOR TROUBLE 0 - DISABLED ROM PRIOR ACCIDENT - OTHER DEECTS SEQUENCE O S IRST HARMUL Most HARMUL NON-COLLISION S 0 - OVERTURN/ROLLOVER 06 - EQUIPMENT AILURE 0 - IRE/EXPLOSION 0 - IMMERSION 07 - SEPARATION O UNITS - JACKKNIE 08 - RAN O ROAD RIGHT 05 - CARGO/EQUIPMENT LOSS OR SHIT 09 - RAN O ROAD LET COLLISION WITH IXED, OBJECT (BLOWN TIRE, BRAKE AILURE, ETC) 0 - CROSS MEDIAN - CROSS CENTER LINE OPPOSITE DIRECTION O TRAVEL - DOWNHILL RUNAWAY - OTHER NON-COLLISION COLLISION WITH PERSON, VEHICLE OR OBJECT NOT IXED - PEDESTRIAN 5 - PEDALCYCLE 6 - RAILWAY VEHICLE (TRAIN, ENGINE) 7 - ANIMAL - ARM 8 - ANIMAL - DEER 9 - ANIMAL -OTHER 0 - MOTOR VEHICLE IN TRANSPORT - PARKED MOTOR VEHICLE - WORK ZONE MAINTENANCE EQUIPMENT - STRUCK BY ALLING, SHITING CARGO OR ANYTHING SET IN MOTION BY A MOTOR VEHICLE - OTHER MOVABLE OBJECT 5 - IMPACT ATTENUATOR/CRASH CUSHION - MEDIAN CABLE BARRIER 6 - BRIDGE OVERHEAD STRUCTURE - MEDIAN GUARDRAIL BARRIER 7 - BRIDGE PIER OR ABUTMENT 5 - MEDIAN CONCRETE BARRIER 8 - BRIDGE PARAPET 6 - MEDIAN OTHER BARRIER 9 - BRIDGE RAIL 7 - TRAIC SIGN POST 0 - GUARDRAIL ACE 8 - OVERHEAD SIGN POST - GUARDRAILEND 9 - LIGHT/LUMINARIES SUPPORT - PORTABLE BARRIER 0 - UTILITY POLE - OTHER POST, POLE OR SUPPORT - CULVERT - CURB - DITCH 5 - EMBANKMENT 6 - ENCE 7 - MAILBOX 8 - TREE 9 - IRE HYDRANT 50 - WORK ZONE MAINTENANCE EQUIPMENT 5 - WALL, BUILDING, TUNNEL 5 - OTHER IXED OBJECT UNIT SPEED 0 STATED ESTIMATED POSTED SPEED 0 TRAIC CONTROL 0 - NO CONTROLS 0 - S TOP SIGN 0 - YIELD SIGN - TRAIC SIGNAL 05 - TRAIC LASHERS 06 - SCHOOL ZONE 07 - RAILROAD CROSSBUCKS - CROSSWALK LINES 08 - R AILROAD LASHERS - W ALK/DON'T WALK 09 - R AILROAD GATES 5 - O THER 0 - COSTRUCTION BARRICADE 6 - NOT REPORTED - PERSON (LAGGER, OICER - PAVEMENT MARKINGS UNIT DIRECTION ROM TO - NORTH - SOUTH - EAST - WEST 5 - NORTHEAST 6 - NORTHWEST 7 - SOUTHEAST 8 - SOUTHWEST

3 UNIT OWNER ( SAME AS DRIVER ) Miller, Russel, l OWNER ADDRESS: CITY, STATE, ZIP SAME AS DRIVER ) 65 Waterbury, Medina,, 56 LP STATE LICENSE PLATE NUMBER VEHICLE IDENTIICATION NUMBER OWNER PHONE NUMBER # S DAM SCALE - NONE - MINOR DAM AREA RONT DD5895 GAD5A UNCTIONAL VEHICLE YEAR 00 VEHICLE MAKE Chevrolet VEHICLE MODEL Cobalt VEHICLE COLOR RED - DISABLING PROO O INSURANCE SHOWN INSURANCE COMPANY Progressive POLICY NUMBER GAD5A70585 TOWED BY REAR CARRIER NAME, CARRIER PHONE US DOT HM PLACARD ID NO. HM CLASS NUMBER VEHICLE WEIGHT GVWR/GCWR - LESS THAN OR EQUAL TO 0K LBS - 0,00 TO 6,000K LBS - MORE THAN 6,000K LBS. HAZARDOUS MATERIAL CARGO BODY 0 - NO CARGO BODY /NOT APPLICABL BUS/ VAN (9-5 SEATS, INC DRIVER) 0 - BUS (6+ SEATS, INC DRIVER) - VEHICLE TOWING ANOTHER VEHICLE - DUMP 05 - LOGGING 06 - INTERMODAL CONTAINER CHASIS 07 - CARGO VAN/ENCLOSED BOX 08 - GRAIN, CHIPS, GRAVEL 09 - POLE 0 - CARGO TANK - LAT BED - CONCRETE MIXER - AUTO TRANSPORTER 5 - GARB /REUSE TRAICWAY DESCRIPTION - T WO-WAY, NOT DIVIDED - T WO-WAY, NOT DIVIDED, CONTINUOUS LET TURN LANE - T WO-WAY, DIVIDED, UNPROTECTED(PAINTED OR GRASS >T.) MEDIA - T WO-WAY, DIVIDED, POSITIVE MEDIANBARRIER 5 - ONE-WAY TRAICWAY HIT / SKIP UNIT LOCATION PRIOR TO IMPACT 0 - INTERSECTION - MARKED CROSSWAL 0 - INTERSECTION - NO CROSSWALK 0 - INTERSECTION OTHER - MIDBLOCK - MARKED CROSSWALK 05 - TRAVEL LANE - OTHER LOCATION 06 - BICYCLE LANE 07 - SHOULDER/ROADSIDE 08 - SIDEWALK 09 - MEDIAN/CROSSING ISLAND 0 - DRIVE WAY ACCESS - SHARED-USE PATH OR TRAIL - NON-TRAICWAY AREA O USE - PERSONAL - COMMERCIAL - GOVERNMENT IN EMERGENCY RESPONSE UNIT 0 PASSENGER VEHICLES (LESS THAN 9 PASSENGERS 0 - SUB -COMPACT 0 - COMPACT 0 - MID SIZE OR HIT/SKIP - ULL SIZE 05 - MINIVAN 06 - SPORT UTILITY VEHICLE 07 - PICKUP 08 - VAN MOTORIZED BICYCLE - SNOWMOBILE/ATV - OTHER PASSENGER VEHICLE MED/HEAVY TRUCKS OR COMBO UNITS > 0K LBS BUS/VAN/LIMO(9 OR MORE INCLUDING DRIVER) - SINGLE UNIT TRUCK OR VAN AXLE, 6 TIRES - SINGLE UNIT TRUCK ; + AXLES 5 - SINGLE UNIT TRUCK / TRAILER 6 - TRUCK/TRACTOR (BOBTAIL) 7 - TRACTOR/SEMI-TRAILER 8 - TRACTOR/DOUBLE 9 - TRACTOR/TRIPLES 0 - OTHER MED/HEAVY VEHICLE HAS HM PLACARD - BUS/VAN (9-5 SEATS, INC DRIVER) - BUS (6+ SEATS, INC DRIVER) - ANIMAL WITH RIDER - ANIMAL WITH BUGGY, WAGON, SURREY 5 - BICYCLE/PEDACYCLIST 6 - PEDESTRIAN/SKATER 7 - OTHER SPECIAL UNCTION0 - NONE 0 - TAXI RENTAL TRUCK (OVER 0K LBS) - BUS - SCHOOL (PUBLIC OR PRIVATE) 05 - BUS - TRANSIT 06 - BUS - CHARTER 07 - BUS - SHUTTLE 08 - BUS - OTHER 09 - AMBULANCE 0 - IRE - HIGHWAY/MAINTENANCE - MILITARY - POLICE - PUBLIC UTILITY 5 - OTHER GOVERNMENT 6 - CONSTRUCTION EQIP. 7 - ARM VEHICLE 8 - ARM EQUIPMENT 9 - MOTORHOME 0 - GOL CART - TRAIN - OTHER (EXPLAIN IN NARRATIVE) MOST DAMD AREA 0 - NONE CENTER RONT 0 - RIGHT RONT IMPACT ARE - RIGHT SIDE 05 - RIGHT REAR REAR CENTER 07 - LET REAR 08 - LET SIDE 09 - LET RONT 0 - TOP AND WINDOWS - UNDERCARRI - LOAD/TRAILER - TOTAL (ALL AREAS) - OTHER ACTION - NON- CONTACT - NON-COLLISION - STRIKING - STRUCK 5 - STRIKING/STRUCK PRE- CRASH ACTIONS STRAIGHT AHEAD 0 - BACKING 0 - CHANGING LANES - OVERTAKING/PASSING 05 - MAKING RIGHT TURN 06 - MAKING LET TURN 07 - MAKING U-TURN 08 - ENTERING TRAIC LANE 09 - LEAVING TRAIC LANE 0 - PARKED - SLOWING OR STOPPED IN TRAIC - DRIVERLESS - NEGOTIATING A CURVE - OTHER ACTIO 5 - ENTERING OR CROSSING SPECIIED LOCATIO 6 - WALKING,RUNNING, JOGGING, PLAYING, CYCLING 7 - WORKING 8 - PUSHING VEHICLE 9 - APPROACHING OR LEAVING VEHICLE 0 - STANDING - OTHER ACTION CONTRIBUTING CIRCUMSTANCE 0 - NONE 0 - AILURE TO YIELD 0 - RAN RED LIGHT - RAN STOP SIGN 05 - EXCEEDED SPEED LIMIT 06 - UNSAE SPEED 07 - IMPROPER TURN 08 - LET O CENTER 09 - OLLOWED TOO CLOSELY/ACDA 0 - IMPROPER LANE CHANGE /PASSING/O ROAD - IMPROPER BACKING - IMPROPER START ROM PARKED POSITION - STOPPED OR PARKED ILLEGALLY - OPERATING VEHICLE IN NEGLIGENT MANNER 5 - SWERING TO AVOID (DUE TO EXTERNAL S) 6 - WRONG SIDE/WRONG WAY 7 - ALURE TO CONTROL 8 - VISION OBSTRUCTION 9 - OPERATING DEECTIVE EQUIPMENT 0 - LOAD SHITING/ALLING/SPILLING - OTHER IMPROPER ACTION - NONE - IMPROPER CROSSING - DARTING 5 - LYING AND/OR ILLEGALLY IN ROADWAY 6 - ALURE TO YIELD RIGHT O WAY 7 - NOT VISIBLE (DARK CLOTHING) 8 - INATTENTIVE 9 - AILURE TO OBEY TRAIC SIGNS /SIGNALS/OICER 0 - WRONG SIDE O THE ROAD - OTHER ACTION VEHICLE DEECTS 0 - TURN SIGNALS 0 - HEAD LAMPS 0 - TAIL LAMPS - BRAKES 05 - STEERING 06 - TIRE BLOWOUT 07 - WORN OR SLICK TIRES 08 - TRAILER EQUIPMENT DEECTIVE 09 - MOTOR TROUBLE 0 - DISABLED ROM PRIOR ACCIDENT - OTHER DEECTS SEQUENCE O S IRST HARMUL Most HARMUL NON-COLLISION S 0 - OVERTURN/ROLLOVER 06 - EQUIPMENT AILURE 0 - IRE/EXPLOSION 0 - IMMERSION 07 - SEPARATION O UNITS - JACKKNIE 08 - RAN O ROAD RIGHT 05 - CARGO/EQUIPMENT LOSS OR SHIT 09 - RAN O ROAD LET COLLISION WITH IXED, OBJECT (BLOWN TIRE, BRAKE AILURE, ETC) 0 - CROSS MEDIAN - CROSS CENTER LINE OPPOSITE DIRECTION O TRAVEL - DOWNHILL RUNAWAY - OTHER NON-COLLISION COLLISION WITH PERSON, VEHICLE OR OBJECT NOT IXED - PEDESTRIAN 5 - PEDALCYCLE 6 - RAILWAY VEHICLE (TRAIN, ENGINE) 7 - ANIMAL - ARM 8 - ANIMAL - DEER 9 - ANIMAL -OTHER 0 - MOTOR VEHICLE IN TRANSPORT - PARKED MOTOR VEHICLE - WORK ZONE MAINTENANCE EQUIPMENT - STRUCK BY ALLING, SHITING CARGO OR ANYTHING SET IN MOTION BY A MOTOR VEHICLE - OTHER MOVABLE OBJECT 5 - IMPACT ATTENUATOR/CRASH CUSHION - MEDIAN CABLE BARRIER 6 - BRIDGE OVERHEAD STRUCTURE - MEDIAN GUARDRAIL BARRIER 7 - BRIDGE PIER OR ABUTMENT 5 - MEDIAN CONCRETE BARRIER 8 - BRIDGE PARAPET 6 - MEDIAN OTHER BARRIER 9 - BRIDGE RAIL 7 - TRAIC SIGN POST 0 - GUARDRAIL ACE 8 - OVERHEAD SIGN POST - GUARDRAILEND 9 - LIGHT/LUMINARIES SUPPORT - PORTABLE BARRIER 0 - UTILITY POLE - OTHER POST, POLE OR SUPPORT - CULVERT - CURB - DITCH 5 - EMBANKMENT 6 - ENCE 7 - MAILBOX 8 - TREE 9 - IRE HYDRANT 50 - WORK ZONE MAINTENANCE EQUIPMENT 5 - WALL, BUILDING, TUNNEL 5 - OTHER IXED OBJECT UNIT SPEED 0 STATED ESTIMATED POSTED SPEED 0 TRAIC CONTROL 0 - NO CONTROLS 0 - S TOP SIGN 0 - YIELD SIGN - TRAIC SIGNAL 05 - TRAIC LASHERS 06 - SCHOOL ZONE 07 - RAILROAD CROSSBUCKS - CROSSWALK LINES 08 - R AILROAD LASHERS - W ALK/DON'T WALK 09 - R AILROAD GATES 5 - O THER 0 - COSTRUCTION BARRICADE 6 - NOT REPORTED - PERSON (LAGGER, OICER - PAVEMENT MARKINGS UNIT DIRECTION ROM TO - NORTH - SOUTH - EAST - WEST 5 - NORTHEAST 6 - NORTHWEST 7 - SOUTHEAST 8 - SOUTHWEST

4 / / Rak, Stephan, A 0/0/96 5 M / 587 Windsong Dr, Medina,, 56 OL STATE OPERATOR LICENSE NUMBER RL70 OENSE CHARGED ( LOCAL CODE) EMS NCY MEDICAL ACILITY INJURED TAKEN TO SAETY EQUIPMENT USED OL CLASS NO VALID DL M/C END ALCOL/DRUG SUSPECTED ALCOL TEST STATUS ALCOL TEST ALCOL TEST VALUE OENSE DESCRIPTION CITATION NUMBER HANDS-REE DOT DEVICE USED DRUG TEST Miller, Caroline 05/5/996 9 / 65 Waterbury, Medina,, 56 OL STATE OPERATOR LICENSE NUMBER TZ6798 OENSE CHARGED ( LOCAL CODE) 5.6 EMS NCY MEDICAL ACILITY INJURED TAKEN TO SAETY EQUIPMENT USED OL CLASS NO VALID DL OENSE DESCRIPTION M/C END Rules for turns at intersections ALCOL/DRUG SUSPECTED ALCOL TEST STATUS CITATION NUMBER ALCOL TEST DOT ALCOL TEST VALUE HANDS-REE DEVICE USED DRUG TEST SAETY EQUIPMENT USED SAETY EQUIPMENT - NO INJURY / NONE REPORTE - POSSIBLE - NON-INCAPACITATING - INCAPACITATING 5 - ATAL - NOT TRANSPORTED / TREATED AT SCENE - EMS - POLICE - OTHER 0 - NONE USED - VEHICLE 0 - S HOULDER BELT ONLY USED 0 - LAP BELT ONLY USED - S HOULDER AND LAP BELT ONLY USED 05 - CHILD RESTRAINT SYSTEM-ORWARD ACING 06 - CHILD RESTRAINT SYSTEM-REAR ACING 07 - BOOSTER SEAT 08 - USED 09 - NONE USED 0 - USED - PROTECTIVE PADS USED (ELBOWS, KNEES, ETC) - RELECTIVE COATING - LIGHTING - OTHER 0 - RONT - LET SIDE ( DRIVER) 0 - RONT - MIDDLE 0 - RONT - RIGHT SIDE - SECOND - LET SIDE ( PASSENGER) 05 - SECOND - MIDDLE 06 - SECOND - RIGHT SIDE 07 - THIRD - LET SIDE ( SIDE CAR) 08 - THIRD - MIDDLE 09 - THIRD - RIGHT SIDE 0 - SLEEPER SECTION O CAB (TRUCK) - PASSENGER IN OTHER ENCLOSED CARGO AREA (NON-TRAILING UNIT SUCH AS A BUS, PICK-UP WITH CAP) - PASSENGER IN UNENCLOSED CARGO AREA - TRAILING UNIT - RIDING ON VEHICLE EXTERIOR (NON-TRAILING UNIT) OTHER - NOT DEPLOYED - DEPLOYED RONT - DEPLOYED SIDE - DEPLOYED BOTH RONT/SIDE 5 - NOT APPLICABLE 9 - DEPLOYMENT UNKNOWN OPERATOR LICENSE CLASS ALCOL/DRUG SUSPECTED - NOT EJECTED - TOTALLY EJECTED - PARTIALLY EJECTED - NOT APPLICABLE - NOT - EXTRICATED BY MECHANICAL MEANS - EXTRICATED BY NON-MECHANICAL MEANS - CLASS A - CLASS B - CLASS C - REGULAR CLASS (IO IS "D") 5 - MC/MOPED ONLY - APPARENTLY NORMAL - PHYSICAL IMPAIRMENT - EMOTIONL (DEPRESSED, ANGRY, DISTURBE - ILLNESS 5 - ELL ASLEEP, AINTED, ATIGUE 6 - UNDER THE INLUENCE O MEDICATIONS, DRUGS, ALCOL 7 - OTHER - NONE - YES - ALCOL SUSPECTED - YES -HBD NOTIMPAIRED - YES -DRUGS SUSPECTED 5 - YES -ALCOL AND DRUGS SUSPECTED ALCOL TEST STATUS ALCOL TEST DRUG TEST - NONE GIVEN - TEST REUSED - TEST GIVEN, CONTAMINATED SAMPLE/UNUSABL - TEST GIVEN, RESULTS KNOWN 5 - TEST GIVEN, RESULTS UNKNOWN - NONE - BLOOD - URINE - BREATH 5 - OTHER - NONE GIVEN - TEST REUSED - TEST GIVEN, CONTAMINATED SAMPLE/UNUSABL - TEST GIVEN, RESULTS KNOWN 5 - TEST GIVEN, RESULTS UNKNOWN - NONE - BLOOD - URINE - OTHER - NO DISTRACTION REPORTED - PHONE - TEXTING / ING - ELCTRONIC COMMUNICATION DEVICE 5 - OTHER ELECTRONIC DEVICE (NAVIGATION DEVICE, RADIO, DVD) 6 - OTHER INSIDE THE VEHICLE 7 - EXTERNAL DISTRACTION Miller, Allen 65 Waterbury, Medina,, 56 EMS NCY MEDICAL ACILITY INJURED TAKEN TO SAETY EQUIPMENT USED Rak, Lynn 587 Windsong Dr, Medina,, 56 EMS NCY MEDICAL ACILITY INJURED TAKEN TO SAETY EQUIPMENT USED DOT DOT 0/08/ // M

5 / WITNESS ADDENDUM SAETY EQUIPMENT US SAETY EQUIPMENT - NO INJURY / NONE REPORTE - POSSIBLE - NON-INCAPACITATING - INCAPACITATING 5 - ATAL - NOT TRANSPORTED / TREATED AT SCENE - EMS - POLICE - OTHER 0 - NONE USED - VEHICLE 0 - S HOULDER BELT ONLY USED 0 - LAP BELT ONLY USED - S HOULDER AND LAP BELT ONLY USE 05 - CHILD RESTRAINT SYSTEM-ORWARD AC 06 - CHILD RESTRAINT SYSTEM-REAR ACING 07 - BOOSTER SEAT 08 - USED 09 - NONE USED 0 - USED - PROTECTIVE PADS USED (ELBOWS, KNEES, ETC) - RELECTIVE COATING - LIGHTING - OTHER 0 - RONT - LET SIDE ( DRIVER) 0 - RONT - MIDDLE 0 - RONT - RIGHT SIDE - SECOND - LET SIDE ( PASSENGE 05 - SECOND - MIDDLE 06 - SECOND - RIGHT SIDE 07 - THIRD - LET SIDE ( SIDE CAR) 08 - THIRD - MIDDLE 09 - THIRD - RIGHT SIDE 0 - SLEEPER SECTION O CAB (TRUCK) - PASSENGER IN OTHER ENCLOSED CARGO AREA (NON-TRAILING UNIT SUCH AS A BUS, PICK-UP WITH CAP) - PASSENGER IN UNENCLOSED CARGO AREA - TRAILING UNIT - RIDING ON VEHICLE EXTERIOR (NON-TRAILING UNIT) OTHER - NOT DEPLOYED - DEPLOYED RONT - DEPLOYED SIDE - DEPLOYED BOTH RONT/SIDE 5 - NOT APPLICABLE 9 - DEPLOYMENT UNKNOWN - NOT EJECTED - TOTALLY EJECTED - PARTIALLY EJECTED - NOT APPLICABLE - NOT - EXTRICATED BY MECHANICAL MEANS - EXTRICATED BY NON-MECHANICAL MEANS