CRASH DATE, TIME, SEVERITY, AND LOCATION Town Name. New Canaan CRASH FACTORS AND CONDITIONS

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1 Page of 7 Number of Motor Vehicles: Automobiles, Motorcycles, etc. Number of Non-Motorists: Pedestrians, Bicyclists, etc. 0 Form PR- REV July 24. Crash Summary (Front) Date of Crash (YYYYMMDD) Latitude Longitude TRAFFICWAY OWNERSHIP. Public Road 02. Private Road TRAFFICWAY CLASS. Trafficway, On Road 02. Trafficway, Not on Road 03. Non-Trafficway. Parking Lot LIGHT CONDITIONS. Daylight 02. Dawn 03. Dusk. Dark- Lighted 05. Dark- Not Lighted 06. Dark Unknown Lighting Time ( ) CRASH DATE, TIME, SEVERITY, AND LOCATION Town Name Town # New Canaan Crash occurred on (street name or route #) at its intersection with (street name or route #) Oenoke Ridge Rd, RTE 24 If not at an intersection: WEATHER CONDITIONS (choose up to 2). Clear 02. Cloudy 03. Fog, Smog, Smoke. Rain 05. Sleet or Hail 06. Freezing Rain/Drizzle 07. Snow 08. Blowing Snow 09. Severe Crosswinds 0. Blowing Sand, Soil, Dirt TRAFFICWAY SURFACE CONDITIONS. Dry 02. Wet Snow. Slush 05. Ice/Frost 06. Moving Water 07. Sand 08. Mud, Dirt, Gravel 09. Oil 0. Standing Water WORK ZONE. No 03 distance TYPE OF INTERSECTION. Not an Intersection 02. Four-Way Intersection 03. T-Intersection. Y-Intersection 05. L-Intersection 06. Traffic Circle 07. Roundabout 08. Five-Point, or More Feet Tenths of Mile N, S, E, W N at of name of nearest intersecting road, town line, or mile marker Hemlock Hill Rd. CRASH FACTORS AND CONDITIONS LOCATION OF FIRST HARMFUL EVENT FIRST HARMFUL EVENT. On Roadway 02. Shoulder Non-Collision: 03. Median. Overturn/Rollover. Roadside 02. Fire / Explosion 05. Gore 03. Immersion, Full or Partial 06. Separator. Jackknife 05. Cargo/Equipment Loss or Shift 07. In Parking Lane or Zone 06. Fell/Jumped from Vehicle 08. Off-Roadway Location Unknown 07. Thrown or Falling Object 09. Outside Right-of-Way (trafficway) 08. Other Non-Collision CRASH-SPECIFIC LOCATION. Non-Junction 02. Intersection 03. Intersection-Related. Entrance / Exit Ramp 05. Entrance / Exit Ramp-Related 06. Railway Grade Crossing 07. Crossover-Related 08. Driveway Access 09. Driveway Access-Related 0. Shared-Use Path or Trail. Through Roadway 2. Acceleration / Deceleration Lane 3. On A Bridge 4. HOV Lane 5. Service or Rest Area 6. Weigh Station 7. Other Location Not Listed Above Within an Interchange Area (median, shoulder and roadside) SCHOOL BUS RELATED. No, a school bus was directly involved 03. Yes, a school bus was indirectly involved LOCATION. Before the First Work Zone Warning Sign 02. Advance Warning Area 03. Transition Area. Activity Area 05. Termination Area 90 Collision with Person, Vehicle, or Non-Fixed Object: 09. Pedestrian 0. Pedal cycle/pedal-cyclist. Other Non-motorist 2. Railway Vehicle (train, engine) 40. Deer 3. Animal Other Than Deer (live) 4. Motor Vehicle in Operation 5. Parked Motor Vehicle 6. Struck by Falling, Shifting Cargo or Anything Set in Motion by Motor Vehicle 7. Work Zone/Maintenance Equipment 8. Other Non-Fixed Object Collision With Fixed Object: 9. Impact Attenuator/Crash Cushion 20. Bridge Overhead Structure 2. Bridge Pier or Support 22. Bridge Rail 23. Cable Barrier 24. Culvert 25. Curb 26. Ditch 27. Embankment 28. Guardrail Face 29. Guardrail End 30. Concrete Traffic Barrier 3. Other Traffic Barrier 32. Tree (standing) 33. Utility Pole/Light Support 34. Traffic Sign Support 35. Traffic Signal Support 36. Fence 37. Mailbox 38. Other Post, Pole or Support 39. Other Fixed Object (wall, building, tunnel, etc.) WORK ZONE CRASH INFORMATION TYPE. Lane Closure 02. Lane Shift / Crossover 03. Work on Shoulder or Median. Intermittent or Moving Work Crash Severity Fatal Injury PDO MANNER OF IMPACT (Applies to: multi-vehicle crashes) Front to Rear 02. Front to Front 03. Angle. Sideswipe, Same Direction 05. Sideswipe, Opposite Direction 06. Rear to Side 07. Rear to Rear WORKERS PRESENT. No CONTRIBUTING CIRCUMSTANCES, ENVIRONMENTAL (choose up to 3). Weather Conditions 02. Visual Obstruction(s) 03. Glare. Animal(s) in Roadway CONTRIBUTING CIRCUMSTANCES, ROAD (choose up to 3). Backup Due to Prior Crash 02. Backup Due to Prior Non-recurring Incident 03. Backup Due to Regular Congestion. Toll Booth/Plaza Related 05. Road Surface Condition (wet, icy, snow, slush, etc.) 06. Debris 07. Ruts, Holes, Bumps 08. Work Zone (construction/ maintenance/utility) 09. Worn, Travel-Polished Surface 0. Obstruction in Roadway 00. Traffic Control Device Inoperative, Missing, or Obscured 2. Shoulder (none, low, soft, high) 3. Non-Highway Work Complete all for crashes occurring in a Work Zone ENFORCEMENT PRESENT. No

2 Page 2 of 7 Form PR- REV July 24. Crash Summary (Back) DIAGRAM Vehicles were moved prior to police arrival NARRATIVE Officers Narrative: Describe any unusual circumstances associated with the crash, including officer's observations. Refer to each by motor vehicle number and/or non-motorist number Oenoke Ridge Rd, Rt. 24, is a two lane rd. divided by a yellow line. The roadway was wet, conditions were fog, and it was daylight. Vehicle was traveling south on Oenoke Ridge Rd, Rt. 24, at approx. /0 of a mile north of Hemlock Hill Rd., a large deer ran into the roadway from the east side of the road and into the path of Vehicle. Vehicle struck the deer with the front end. The deer then rolled onto the hood, into the windshield and up and over the roof. Witness was stopped near the location in a driveway just south and off of the northbound lane side of the roadway. Witness stated he saw the deer running across property from the east and into the northbound lane and then into the southbound lane just as vehicle was approaching. Witness stated there was not enough time for impact to be avoided. Both operator and witness stated the deer lay in the southbound lane briefly, then got up on all fours and ran off onto property toward the west. Upon my arrival, deer was gone but I observed deer fur all over Vehicle, and damage to the front end hood and roof. Operator was not injured. Vehicle was towed from the scene by New Canaan Auto Body mostly due to the shattered windshield. Related Incident Number CTDOT-05 Case Status O - Open C - Closed C Officer Signature: John Smith Officer First Name John This report is a revision to a previously submitted report Officer Last Name Smith Supervisor:Bill Jones Badge Number 23 Police Agency Code Date & Time : Date & Time :

3 Page 3 of 7 Motor Vehicle ID: Number of occupants in Vehicle : (including the driver) VIN: V Make: Ford Model: Edge Road on which vehicle was traveling: Rte 46 SEQUENCE OF EVENTS (choose up to four, in chronological order) Non-Collision. Overturn/Rollover 02. Fire / Explosion 03. Immersion, Full or Partial. Jackknife 05. Cargo/Equipment Loss or Shift 06. Equipment Failure (blown tire, brake failure, etc) 07. Separation of Units 08. Ran Off Roadway Right 09. Ran Off Roadway Left 0. Cross Median. Cross Center Line 2. Downhill Runaway 3. Fell/Jumped From Motor Vehicle 4. Reentering Roadway 5. Thrown or Falling Object 6. Other Non-Collision Collision With Person, Motor Vehicle, or Non-Fixed Object 7. Pedestrian 8. Pedal Cycle/Pedal-cyclist 9. Other Non-motorist 20. Railway Vehicle (train, engine) 2. Animal (live) 22. Motor Vehicle In Motion 23. Parked Motor Vehicle 24. Struck By Falling, Shifting Cargo or Anything Set In Motion By Motor Vehicle 25. Work Zone/Maintenance Equipment 26. Other Non-Fixed Object Collision With Fixed Object 27. Impact Attenuator/Crash Cushion 28. Bridge Overhead Structure 29. Bridge Pier or Support 30. Bridge Rail 3. Cable Barrier 32. Culvert 33. Curb 34. Ditch 35. Embankment 36. Guardrail Face 37. Guardrail End 38. Concrete Traffic Barrier 39. Other Traffic Barrier 40. Tree (standing) 4. Utility Pole 42. Traffic Sign Support 43. Traffic Signal Support 44. Other Post, Pole, or Support 45. Fence 46. Mailbox st 2 nd 3 rd 4 th 2 Most Harmful Event Other Fixed Object (wall, building, tunnel, etc.) 48. Light Support Form PR- REV July 24. Color: Red Year: MOTOR VEHICLE ACTION. Straight Ahead 02. Negotiating a Curve 03. Backing. Changing Lanes 05. Overtaking/Passing Motor Vehicle 06. Turning Right 07. Turning Left 08. Making U-Turn 09. Leaving Traffic Lane 0. Entering Traffic Lane. Slowing 2. Parked 3. Stopped in Traffic 4. Overtaking/Passing Cyclist 5. Wrong Way or Wrong Side 6. Traveling in Bike Lane CONTRIBUTING CIRCUMSTANCES MOTOR VEHICLE (choose up to 2). Brakes 02. Exhaust System 03. Body, Doors. Steering 05. Power Train 06. Suspension 07. Tires 08. Wheels 09. Lights (head, signal, tail) 0. Windows/Windshield. Mirrors 2. Wipers 3. Truck Coupling / Trailer Hitch / Safety Chains TOWED TO New Canaan Auto Body MOTOR VEHICLE INFORMATION 00 POSTED/STATUTORY SPEED LIMIT (record the posted/statutory value as miles per hour). Not Posted 0, 5, 20, 25, 30, 35, 40, 45 50, 55, 60, 65, 70, 75, 80, 85 Motor Vehicle Information (Front) Complete One Sheet Per Motor Vehicle 99 VIN missing or removed Driver Evaded Responsibility Direction of Travel N, S, E, W MOTOR VEHICLE CRASH INFORMATION TOWED. Towed Due to Disabling Damage 02. Towed, But Not Due to Disabling Damage 03. Not Towed Plate #: PB&JR Plate State: CT BODY TYPE. Passenger Car 02. (Sport) Utility Vehicle Passenger Van. Cargo Van (<0,000 lbs GVWR) 05. Pickup 06. Motor Home 07. School Bus 08. Transit Bus 09. Motor Coach 0. Other Bus. Motorcycle 2. Moped 3. Low Speed Vehicle 4. Golf Cart 5. All Terrain Vehicle (ATV) 6. Snowmobile 7. Other Light Trucks (0,000 lbs GVWR or less) 8. Medium/Heavy Trucks (more than 0,000 lbs GVWR) INSURANCE INFORMATION Invalid Plate No Plate INSURANCE COMPANY INSURANCE POLICY NUMBER INSURANCE EXPIRATION DATE (yyyymmdd) State Farm S MOTOR VEHICLE DAMAGE EXTENT OF DAMAGE. No Visible Damage 02. Minor Damage 03. Functional Damage. Disabling Damage Vehicle was not in roadway Unknown direction Use diagram above for values -2 See user guide for other vehicle diagrams. Initial Contact Point 3. Non-Collision 4. Top 5. Undercarriage 6. Cargo loss Damaged Areas (choose up to 3) 4. Top 5. Undercarriage 7. All Areas 2 2 Total lanes in roadway: 2 Bike lanes/sharrows present MOTOR VEHICLE TYPE. Motor Vehicle in Operation 02. Parked Motor Vehicle 03. Working Vehicle/Equipment. Non-Collision Vehicle TRAFFICWAY DESCRIPTION. Two-Way, Not Divided 02. Two-Way, Not Divided w/ 03 a Continuous Left Turn Lane 03. Two-Way, Divided, Unprotected (Painted >4 Feet) Median. Two-Way, Divided, Positive Median Barrier 05. One-Way Trafficway ROADWAY GRADE. Level 02. Uphill 03. Hill Crest. Downhill 05. Sag (bottom) ROADWAY ALIGNMENT. Straight 02. Curve Left 03. Curve Right TRAFFIC CONTROL DEVICE TYPE. No Control Device 02. Person (flagger, law enforcement, crossing guard, etc.) 03. Traffic Control Signal. Flashing Traffic Control Signal 05. School Zone Sign/Device 06. Stop Sign 07. Yield Sign 08. Warning Sign 09. Railway Crossing Device 0. Marked Uncontrolled Crosswalk. Pedestrian Button 2. Bicycle Detection TRAFFIC CONTROL DEVICE FUNCTIONAL?. No 03. Missing

4 Page 4 of 7 Vehicle Owner Name (Last, First, Middle, Suffix) Form PR- REV July 24. Motor Vehicle Information (Back) Complete One Sheet Per Motor Vehicle MOTOR VEHICLE OWNERSHIP INFORMATION Information same as driver Street Address or Post Office Box City State/Prov Country Postal Code United States Address (optional) Phone (optional) SPECIAL VEHICLE FUNCTION. No Special Function 02. Taxi 03. Vehicle Used as School Bus. Vehicle Used as Other Bus 05. Military 06. Police 07. Ambulance 08. Fire Truck 09. Non-Transport Emergency 0. Incident Response Services Vehicle MOTOR VEHICLE INFORMATION SPECIAL VEHICLES EMERGENCY VEHICLE. Non-Emergency Situation, Not Transporting Patient 02. Non-Emergency Transport of Passenger 03. Emergency Operation, Emergency Warning Equipment Not in Use. Emergency Operation, Emergency Warning Equipment in Use BUS USE. Not a Bus 02. School 03. Transit/Commuter. Intercity 05. Charter/Tour 06. Shuttle Complete if public or private property other than vehicles were damaged in the crash NATURE AND EXTENT OF DAMAGE TO PROPERTY N/A PROPERTY DAMAGED NAME OF OWNER OF PROPERTY N/A NATURE AND EXTENT OF DAMAGE TO PROPERTY 2 NAME OF OWNER OF PROPERTY 2 NATURE AND EXTENT OF DAMAGE TO PROPERTY 3 NAME OF OWNER OF PROPERTY 3

5 Page 5 of 7 Name (Last, First, Middle, Suffix): ACTION BY OFFICER Taken. Verbal Warning 02. Written Warning 03. Infraction. Arrest/Summons 00 Motor Vehicle ID: Person ID: Street Address Happy Place or PO Box: City: Newington LICENSE INFO LICENSE NUMBER CT Doe, Lucy, Lu DRIVER LICENSE JURISDICTION. Not Licensed 02. State Tribal Nation. U.S. Government 05. Canadian Province 06. Mexican State 07. International License (other than Mexico and Canada) 08. Valid License (other country) LICENSE CLASS. Class A 02. Class B 03. Class C. Class D 05. Class M COMMERCIAL LICENSE. No ENDORSEMENTS A - Activity Vehicles F - Taxi, Livery, Motor Coach H - Hazardous Materials M - Motorcycles N - Tank Vehicles P - Passenger Q - Fire Fighting Vehicles S - School Bus T - Double/Triple Trailers V - Student Transportation X - Combination of Tank Vehicle and Hazardous Materials EJECTION. Not Ejected 02. Ejected, Partially 03. Ejected, Totally AIRBAG. Not Deployed 02. Deployed-Front 03. Deployed-Side. Deployed-Curtain 05. Deployed-Other 06. Deployed-Combination SPEED RELATED. No 02. Racing 03. Exceeded Speed Limit. Too Fast for Conditions Form PR- REV July 24. State or Prov: RESTRAINT SYSTEM Used-Motor Vehicle Occupant. Shoulder and Lap Belt Used 02. Shoulder Belt Only Used 03. Lap Belt Only Used. Restraint Used Type Unknown Motor Vehicle Driver Information Complete One Sheet Per Driver HELMET USE. No Helmet 02. DOT-Compliant Motorcycle Helmet 03. Helmet, Other Than DOT-Compliant Motorcycle Helmet. Helmet, Unknown If DOT-Compliant INJURY STATUS K. Fatal Injury A. Suspected Serious Injury B. Suspected Minor Injury C. Possible Injury O. No Apparent Injury O CT ENFORCEMENT ACTIONS TAKEN VIOLATION STATUTES Postal 06 Code: GENDER. Male 02. Female 99. Unknown Phone/ (optional): DRIVER INFORMATION SEATING POSITION FIRST DIGIT _. Front Row SECOND DIGIT _. Left Seat (usually the motor vehicle or motorcycle driver except for postal vehicles and some foreign vehicles) _2. Middle Seat _3. Right Seat _8. Other Seat INJURY AND EMS INFORMATION TRANSPORTED TO FIRST EMS COMPANY NAME MEDICAL FACILITY BY. Not Transported EMS RUN NUMBER 02. EMS Air 03. EMS Ground INTENDED RECEIVING FACILITY. Law Enforcement DATE OF BIRTH (YYYYMMDD) DRIVER ACTIONS (choose up to 4). No Contributing Action 02. Ran Off Roadway 03. Failed to Yield Right-of-Way. Ran Red Light 05. Ran Stop Sign 06. Disregarded Other Traffic Sign 07. Disregarded Other Road Markings 08. Improper Turn 09. Improper Backing 0. Improper Passing. Wrong Side or Wrong Way 2. Followed Too Closely 3. Failed to Keep in Proper Lane 4. Operated Vehicle in Reckless Aggressive Manner 5. Operated Motor Vehicle in Inattentive, Careless, Negligent, or Erratic Manner 6. Swerved or Avoided Due to Wind, Motor Vehicle, Object, Non-Motorist in Roadway, etc. 7. Over-Correcting/Over-Steering 8. Overtaking Cyclist Contributing Action DRIVER DISTRACTED BY. Not Distracted 02. Manually Operating an Electronic Communication Device (Texting, etc) 03. Talking on Hands-Free Electronic Device. Talking on Hand-Held Electronic Device 05. Other Activity, Electronic Device 06. Passenger 07. Other Inside the Vehicle (eating, hygiene, etc.) 08. Outside the Vehicle CONDITION AT TIME OF CRASH (choose up to 2). Apparently Normal 02. Physically Impaired 03. Emotional (depressed, angry, etc.). Ill (sick), Fainted Asleep or Fatigued 06. Under the Influence (Medications/Drugs/Alcohol) 99. Unknown DRUG/ALCOHOL INFORMATION ALCOHOL TEST STATUS TYPE OF ALCOHOL TEST. Test Not Given. Blood 02. Test Refused Urine 03. Test Given 03. Breath 99. Unknown if Tested TYPE OF DRUG TEST DRUG TEST STATUS. Test Not Given 02. Test Refused 03. Test Given 99. Unknown if Tested 99. Blood 02. Urine

6 Page 6 of 7 Form PR- REV July 24. Appendix A: Narrative Continued Complete this sheet if more space is needed for the narrative NARRATIVE CONTINUED (i)

7 Page 7 of 7 Number of Witnesses: Form PR- REV July 24. Appendix E: Witness Complete this sheet for all witnesses to the crash Please complete this Appendix form for witnesses to a crash. Each Appendix form can document information for up to three witnesses. Multiple forms can be used if necessary. Actual witness statements should be collected on department statement sheets and witnesses should be identified using unique Person ID numbers. PERSON ID NAME: ADDRESS: CITY: 2 Samantha Drew 973 Charlie Dr. Newington DATE OF BIRTH (YYYYMMDD): or PROV: WITNESS INFORMATION CT POSTAL CODE: 06 WITNESS MENT TYPE (choose all that apply; max 2). No Statement Taken 02. Provided Written Statement 03. Willing to Provide a Written Statement. Oral Statement Only 05. Statement Confirmed by other Witness WITNESS MENT SOURCE (choose all that apply; max 4). Observed Crash Occur 02. Overheard Statements by Person Involved 03. Observed illegal activities by persons involved in the crash prior to police arrival. Observed other illegal behavior by a vehicle involved in the crash or resulting in the crash occurring WITNESS OBSERVATION VERIFICATION (choose all that apply; max 3). Sight Lines Verified By Reporting Officer 02. Sight Lines Verified By Other Officer 03. Sight Lines Confirmed by Other Witness. Verification Not Possible 05. Verification Not Undertaken 05 PERSON ID NAME: Not Applicable ADDRESS: CITY: DATE OF BIRTH (YYYYMMDD): or PROV: POSTAL CODE: WITNESS MENT TYPE (choose all that apply; max 2). No Statement Taken 02. Provided Written Statement 03. Willing to Provide a Written Statement. Oral Statement Only 05. Statement Confirmed by other Witness WITNESS MENT SOURCE (choose all that apply; max 4). Observed Crash Occur 02. Overheard Statements by Person Involved 03. Observed illegal activities by persons involved in the crash prior to police arrival. Observed other illegal behavior by a vehicle involved in the crash or resulting in the crash occurring WITNESS OBSERVATION VERIFICATION (choose all that apply; max 3). Sight Lines Verified By Reporting Officer 02. Sight Lines Verified By Other Officer 03. Sight Lines Confirmed by Other Witness. Verification Not Possible 05. Verification Not Undertaken PERSON ID NAME: Not Applicable ADDRESS: CITY: DATE OF BIRTH (YYYYMMDD): or PROV: POSTAL CODE: WITNESS MENT TYPE (choose all that apply; max 2). No Statement Taken 02. Provided Written Statement 03. Willing to Provide a Written Statement. Oral Statement Only 05. Statement Confirmed by other Witness WITNESS MENT SOURCE (choose all that apply; max 4). Observed Crash Occur 02. Overheard Statements by Person Involved 03. Observed illegal activities by persons involved in the crash prior to police arrival. Observed other illegal behavior by a vehicle involved in the crash or resulting in the crash occurring WITNESS OBSERVATION VERIFICATION (choose all that apply; max 3). Sight Lines Verified By Reporting Officer 02. Sight Lines Verified By Other Officer 03. Sight Lines Confirmed by Other Witness. Verification Not Possible 05. Verification Not Undertaken