TRAFFIC CRASH REPORT *DENOTES MANDATORY FIELD FOR SUPPLEMENT REPORT LOCAL REPORT NUMBER *

Transcription

1 PHOTOS SECONDARY CRASH COUNTY* LOCATION REFERENCE 8 US TRAFFIC CRASH REPORT *DENOTES MANDATORY FIELD FOR SUPPLEMENT REPORT * LOCAL INFORMATION X - X - E0 -P LOCALITY* - CITY - VILLAGE - TOWNSHIP ROUTE ROUTE NUMBER ROUTE ROUTE NUMBER REFERENCE POINT SR - INTERSECTION - MILE POST - HOUSE # DISTANCE FROM REFERENCE 0.00 OTHER PRIVATE PROPERTY DIRECTION FROM REFERENCE REPORTING AGENCY NAME * Hamilton Township LOCATION: CITY, VILLAGE, TOWNSHIP* Hamilton (Township of) - NORTH - EAST - WEST DISTANCE UNIT OF MEASURE - MILES - FEET - YARDS LOCATION OF FIRST HARMFUL EVENT - ON ROADWAY - ON SHOULDER - IN MEDIAN - ON ROADSIDE - ON GORE 6 - OUTSIDE TRAFFIC WAY 7 - ON RAMP 8 - OFF RAMP 8 PREFIX - NORTH - EAST - WEST PREFIX - NORTH - EAST - WEST LOCATION ROAD NAME REFERENCE ROAD NAME (ROAD, MILEPOST, HOUSE #) ROUTE IR - INTERSTATE ROUTE (TP) US - FEDERAL US ROUTE SR - STATE ROUTE CR - NUMBERED COUNTY ROUTE TR - NUMBERED TOWNSHIP ROUTE 9 - CROSSOVER 0 - DRIVEWAY/ALLEY ACCESS - RAILWAY GRADE CROSSING - SHARED USE PATHS OR TRAILS - BIKE - TOLL BOOTH AL - ALLEY AV - AVENUE BL - BOULEVARD CR - CIRCLE CT - COURT DR - DRIVE HE - HEIGHTS ROAD HW - HIGHWAY LA - MP - MILEPOST OV - OVAL PK - PARKWAY PI - PIKE PL - PLACE NCIC * HIT/SKIP NUMBER OF UNITS SOLVED - UNSOLVED RD - ROAD SQ - SQUARE ST - STREET TE - TERRACE TL - TRAIL WA - WAY MANNER OF CRASH COLLISION/IMPACT - NOT COLLISION - REAR-TO-REAR BETWEEN - BACKING TWO MOTOR 6 - ANGLE S IN TRANSPORT 7 - SIDESWIPE, SAME DIRECTION 8 - SIDESWIPE, OPPOSITE DIRECTION - REAR-END - HEAD-ON ROAD ROAD X CRASH DATE / TIME* 0/09/09 8: LATITUDE DECIMAL DEGREES 9.90 LONGITUDE DECIMAL DEGREES ROADWAY INTERSECTION RELATED WITHIN INTERSECTION OR ON APPROACH WITHIN INTERCHANGE AREA ROADWAY DIVIDED DIRECTION OF TRAVEL - NORTH - EAST - WEST UNIT IN ERROR 98 - ANIMAL 9 CRASH SEVERITY - FATAL - SERIOUS INJURY SUSPECTED - MINOR INJURY SUSPECTED - INJURY POSSIBLE - PROPERTY DAMAGE ONLY NUMBER OF APPROACHES MEDIAN - DIVIDED FLUSH MEDIAN ( < FEET ) - DIVIDED FLUSH MEDIAN ( FEET ) - DIVIDED, DEPRESSED MEDIAN - DIVIDED, RAISED MEDIAN (ANY ) WORK ZONE RELATED WORKERS PRESENT LAW ENFORCEMENT PRESENT ACTIVE SCHOOL ZONE LIGHT CONDITION - DAYLIGHT - DAWN/DUSK - DARK - LIGHTED ROADWAY - DARK - ROADWAY NOT LIGHTED - DARK - UNKNOWN ROADWAY LIGHTING WORK ZONE - CLOSURE - SHIFT/ CROSSOVER - WORK ON SHOULDER OR MEDIAN - INTERMITTENT OR MOVING WORK - OTHER - CLEAR - CLOUDY - FOG, SMOG, SMOKE - RAIN - SLEET, HAIL LOCATION OF CRASH IN WORK ZONE WEATHER 6 - SNOW - BEFORE THE ST WORK ZONE WARNING SIGN - ADVANCE WARNING AREA - TRANSITION AREA - ACTIVITY AREA - TERMINATION AREA 7 - SEVERE CROSSWINDS 8 - BLOWING SAND, SOIL, DIRT, SNOW 9 - FREEZING RAIN OR FREEZING DRIZZLE CONTOUR - STRAIGHT LEVEL - STRAIGHT GRADE - CURVE LEVEL - CURVE GRADE 9 - OTHER /UNKNOWN - DRY - WET - SNOW CONDITIONS - ICE - SAND, MUD, DIRT, OIL, GRAVEL 6 - WATER (STANDING, MOVING) 7 - SLUSH SURFACE - CONCRETE - BLACKTOP, BITUMINOUS, ASPHALT - BRICK/BLOCK - SLAG, GRAVEL, STONE - DIRT 9 - OTHER / UNKNOWN NARRATIVE On /9//9 at approximately 8 hours Unit # was traveling south on South State Route 8 in the right hand turn lane and when at the traffic light continued to make a right hand turn onto west US Route, having the right of way. Unit # was traveling behind Unit # and failed to maintain the assured clear distance ahead, striking the rear of Unit # while they were both turning right onto east US Route. Unit # admitted fault in the accident. Both units denied medical attention and were wearing their seat belts at the time of the accident. CRASH REPORTED DATE / TIME 0/09/09 8: TOTAL TIME OTHER ROADWAY CLOSED INVESTIGATION TIME TOTAL MINUTES DISPATCH DATE / TIME 0/09/09 8: OFFICER'S NAME* Treon OFFICER'S BADGE NUMBER* ARRIVAL DATE / TIME 0/09/09 8: CHECKED OFFICER'S NAME* Wall, Sg. Chris SCENE CLEARED DATE / TIME 0/09/09 9: CHECKED OFFICER'S BADGE NUMBER* X REPORT POLICE AGENCY MOTORIST X SUPPLEMENT (CORRECTION OR ADDITION TO AN EXISTING REPORT SENT TO ODPS) PAGE OF

2 O W N E R V E H I C L E E V E N T S (s) UNIT # OWNER ( MORGAN, WILLIS OWNER ( LP STATE INSURANCE X VERIFIED COMMERCIAL UNIT SPECIAL FUNCTION DEFECTS NON-MOTORIST LOCATION AT IMPACT 8 LICENSE PLATE # 60YRH - TURN SIGNALS - HEAD LAMPS - TAIL LAMPS OF USE GOVERNMENT - PASSENGER CAR - PASSENGER VAN (MINIVAN) - SPORT UTILITY - PICK UP - INTERSECTION - - INTERSECTION - UN - INTERSECTION - OTHER IN EMERGENCY RESPONSE - BRAKES - STEERING # S 6 - VAN (9- SEATS) 7 - MOTORCYCLE -WHEELED 8 - MOTORCYCLE -WHEELED 9 - AUTOCYCLE 0 - MOPED OR MOTORIZED BICYCLE - CARGO VAN - ALL TERRAIN (ATV/UTV) # OF TRAILING UNITS - NONE - TAXI - ELECTRONIC RIDE SHARING - SCHOOL TRANSPORT - BUS - TRANSIT/COMMUTER - NON-CONTACT - NON-COLLISION - STRIKING - STRUCK - BOTH STRIKING & STRUCK PRE-CRASH S - NONE - FAILURE TO YIELD - RAN RED LIGHT - RAN STOP SIGN - UNSAFE SPEED CONTRIBUTING 6 - IMPROPER TURN CIRCUMSTANCES 7 - LEFT OF CENTER SEQUENCE OF EVENTS 6 0 INSURANCE COMPANY MOTORISTS MUTUAL - OVERTURN/ROLLOVER - FIRE/EXPLOSION - IMMERSION - JACKKNIFE - CARGO / LOSS OR SHIFT 6 - FAILURE - IMPACT ATTENUATOR / CRASH CUSHION 6 - BRIDGE OVERHEAD STRUCTURE 7 - BRIDGE PIER OR ABUTMENT 8 - BRIDGE PARAPET 9 - BRIDGE RAIL 0 - GUARDRAIL FACE 7 INDIAN LAKE DRIVE, MAINEVILLE,, 09 COMMERCIAL CARRIER: NAME, ADDRESS, CITY, STATE, ZIP INTERLOCK DEVICE EQUIPPED CARGO BODY UNIT HIT/SKIP UNIT WAS OPERATING IN AUTONOMOUS MODE WHEN CRASH OCCURRED? - YES - NO - NO CARGO BODY / NOT APPLICABLE - BUS - TOWING ANOTHER MOTOR 6 - BUS - CHARTER/TOUR 7 - BUS - INTERCITY 8 - BUS - SHUTTLE 9 - BUS - OTHER 0 - AMBULANCE - LOGGING 6 - TIRE BLOWOUT - MIDBLOCK - - TRAVEL - OTHER LOCATION 6 - BICYCLE - STRAIGHT AHEAD - BACKING - CHANGING S - OVERTAKING/PASSING - MAKING RIGHT TURN 6 - MAKING LEFT TURN 7 - MAKING U-TURN 8 - ENTERING TRAFFIC 8 - FOLLOWING TOO CLOSE /ACDA 9 - IMPROPER CHANGE 0 - IMPROPER PASSING - DROVE OFF ROAD - IMPROPER BACKING FIRST HARMFUL EVENT IDENTIFICATION # TBUEEBC979 INSURANCE POLICY # US DOT # WEIGHT GVWR/GCWR - 0K LBS. - 0,00-6K LBS. - > 6K LBS. 0 AUTONOMOUS MODE LEVEL - INTERMODAL CONTAINER CHASSIS 6 - CARGOVAN /ENCLOSED BOX 7 - SEPARATION OF UNITS 8 - RAN OFF ROAD RIGHT 9 - RAN OFF ROAD LEFT 0 - CROSS MEDIAN - CROSS CENTERLINE - OPPOSITE DIRECTION OF TRAVEL - MEDIAN CONCRETE 6 - MEDIAN OTHER 7 - TRAFFIC SIGN POST A - GOLF CART - SNOWMOBILE - SINGLE UNIT TRUCK - SEMI-TRACTOR 6 - FARM 7 - MOTORHOME 0 - NO AUTOMATION - DRIVER ASSISTANCE - PARTIAL AUTOMATION - FIRE - MILITARY - POLICE - PUBLIC UTILITY - CONSTRUCTION EQUIP. 7 - GRAIN/CHIPS/GRAVEL 8 - POLE 9 - CARGO TANK 0 - FLAT BED 7 - WORN OR SLICK TIRES 9 - MOTOR TROUBLE 8 - TRAILER DEFECTIVE 7 - SHOULDER/ROADSIDE 8 - SIDEWALK 9 - MEDIAN/CROSSING ISLAND 9 - LEAVING TRAFFIC 0 - PARKED - SLOWING OR STOPPED IN TRAFFIC - DRIVERLESS - NEGOTIATING A CURVE - ENTERING OR CROSSING SPECIFIED LOCATION - IMPROPER START FROM A PARKED - STOPPED OR PARKED ILLEGALLY - SWERVING TO AVOID 6 - WRONG WAY 7 - VISION OBSTRUCTION - PEDALCYCLE 6 - RAILWAY 7 - ANIMAL - FARM 8 - ANIMAL - DEER MOST HARMFUL EVENT COLOR GRY 0 - DISABLED FROM PRIOR ACCIDENT MAKE TOYOTA HAZARDOUS MATERIAL MATERIAL RELEASED PLACARD CLASS # PLACARD ID # 8 - LIMO (LIVERY ) 9 - BUS (6+ PASSENGERS) 0 - OTHER - HEAVY - ANIMAL WITH RIDER OR ANIMAL-DRAWN 6 - FARM 7 - MOWING 8 - SNOW REMOVAL 9 - TOWING 0 - SAFETY SERVICE PATROL 0 - DRIVEWAY ACCESS - SHARED USE PATHS OR TRAILS - FIRST RESPONDER AT INCIDENT SCENE - WALKING, RUNNING, JOGGING, PLAYING 6 - WORKING 7 - PUSHING 8 - APPROACHING OR LEAVING - PEDESTRIAN/SKATER - WHEELCHAIR (ANY ) - OTHER NON-MOTORIST 6 - BICYCLE 7 - TRAIN 9 - STANDING 0 - OTHER NON-MOTORIST 8 - OPERATING DEFECTIVE 9 - LOAD SHIFTING /FALLING/SPILLING 0 - IMPROPER CROSSING - LYING IN ROADWAY - NOT DISCERNIBLE NON-COLLISION - DOWNHILL RUNAWAY 9 - ANIMAL -OTHER - OTHER NON-COLLISION 0 - MOTOR IN - PEDESTRIAN TRANSPORT - PARKED MOTOR - WORK ZONE COLLISION WITH FIXED - STRUCK - GUARDRAIL END - PORTABLE 8 - OVERHEAD SIGN POST 9 - LIGHT / LUMINARIES - EMBANKMENT 6 - FENCE - MEDIAN CABLE SUPPORT 7 - MAILBOX - MEDIAN GUARDRAIL 0 - UTILITY POLE 8 - TREE - OTHER POST, POLE 9 - FIRE HYDRANT OR SUPPORT - CULVERT - CURB - DITCH OWNER PHONE:INCLUDE AREA CODE ( COMMERCIAL CARRIER PHONE: INCLUDE AREA CODE 0 - WORK ZONE - WALL YEAR 0 TOWED : COMPANY NAME - CONDITIONAL AUTOMATION - HIGH AUTOMATION - FULL AUTOMATION MODEL COROLLA 9 OR HIT/SKIP - MAIL CARRIER - DUMP - CONCRETE MIXER - AUTO TRANSPORTER - GARBAGE/REFUSE STANDING OUTSIDE DISABLED - OPENING DOOR INTO ROADWAY 99 - OTHER IMPROPER - STRUCK FALLING, SHIFTING CARGO OR ANYTHING SET IN MOTION A MOTOR - OTHER MOVABLE - BUILDING - TUNNEL - OTHER FIXED - NONE - MINOR DAMAGE FROM DAMAGE SCALE DAMAGED AREA(S) INDICATE ALL THAT APPLY - NO DAMAGE [ 0 ] - TOP [ ] TRAFFICWAY FLOW - ONE-WAY - TWO-WAY # OF THROUGH S ON ROAD UNIT SPEED 0 - FUNCTIONAL DAMAGE - DISABLING DAMAGE - UNIT NOT AT SCENE [ 6 ] - UNDERCARRIAGE [ ] - ALL AREAS [ ] TRAFFIC CONTROL - ROUNDABOUT - SIGNAL - FLASHER UNIT / NON-MOTORIST DIRECTION TO POSTED SPEED D A M A G E INITIAL POINT OF CONTACT 0 - NO DAMAGE - - REFER TO UNIT DIAGRAM - TOP T R A F F I C - NORTH - EAST - WEST - UNDERCARRIAGE - NOT AT SCENE 9 DETECTED SPEED - STATED / ESTIMATED SPEED - CALCULATED / EDR - UNDETERMINED - STOP SIGN - YIELD SIGN RAIL GRADE CROSSING - NOT INVLOVED 6 - NO CONTROL - INVOLVED-ACTIVE CROSSING - INVOLVED-PASSIVE CROSSING - NORTHEAST 6 - NORTHWEST 7 - SOUTHEAST 8 - SOUTHWEST PAGE OF

3 O W N E R V E H I C L E E V E N T S (s) UNIT # OWNER ( ADAM G. COMBS INC., OWNER ( LP STATE INSURANCE X VERIFIED COMMERCIAL UNIT SPECIAL FUNCTION DEFECTS NON-MOTORIST LOCATION AT IMPACT LICENSE PLATE # HGU TURN SIGNALS - HEAD LAMPS - TAIL LAMPS OF USE GOVERNMENT - PASSENGER CAR - PASSENGER VAN (MINIVAN) - SPORT UTILITY - PICK UP - INTERSECTION - - INTERSECTION - UN - INTERSECTION - OTHER IN EMERGENCY RESPONSE - BRAKES - STEERING # S - CARGO VAN - ALL TERRAIN (ATV/UTV) # OF TRAILING UNITS - NONE - TAXI - ELECTRONIC RIDE SHARING - SCHOOL TRANSPORT - BUS - TRANSIT/COMMUTER - NON-CONTACT - NON-COLLISION - STRIKING - STRUCK - BOTH STRIKING & STRUCK - NONE - FAILURE TO YIELD - RAN RED LIGHT - RAN STOP SIGN - UNSAFE SPEED CONTRIBUTING 6 - IMPROPER TURN CIRCUMSTANCES 7 - LEFT OF CENTER SEQUENCE OF EVENTS VAN (9- SEATS) 7 - MOTORCYCLE -WHEELED 8 - MOTORCYCLE -WHEELED 9 - AUTOCYCLE 0 - MOPED OR MOTORIZED BICYCLE - OVERTURN/ROLLOVER - FIRE/EXPLOSION - IMMERSION - JACKKNIFE - CARGO / LOSS OR SHIFT 6 - FAILURE - IMPACT ATTENUATOR / CRASH CUSHION 6 - BRIDGE OVERHEAD STRUCTURE 7 - BRIDGE PIER OR ABUTMENT 8 - BRIDGE PARAPET 9 - BRIDGE RAIL 0 - GUARDRAIL FACE 96 FALCON PT, MAINEVILLE,, 09 COMMERCIAL CARRIER: NAME, ADDRESS, CITY, STATE, ZIP INTERLOCK DEVICE EQUIPPED CARGO BODY UNIT INSURANCE COMPANY PRIVILEGE UNDERWRITERS HIT/SKIP UNIT WAS OPERATING IN AUTONOMOUS MODE WHEN CRASH OCCURRED? - YES - NO - NO CARGO BODY / NOT APPLICABLE - BUS - TOWING ANOTHER MOTOR 6 - BUS - CHARTER/TOUR 7 - BUS - INTERCITY 8 - BUS - SHUTTLE 9 - BUS - OTHER 0 - AMBULANCE - LOGGING 6 - TIRE BLOWOUT - MIDBLOCK - - TRAVEL - OTHER LOCATION 6 - BICYCLE - STRAIGHT AHEAD - BACKING - CHANGING S - OVERTAKING/PASSING PRE-CRASH - MAKING RIGHT TURN S 6 - MAKING LEFT TURN 7 - MAKING U-TURN 8 - ENTERING TRAFFIC 8 - FOLLOWING TOO CLOSE /ACDA 9 - IMPROPER CHANGE 0 - IMPROPER PASSING - DROVE OFF ROAD - IMPROPER BACKING FIRST HARMFUL EVENT IDENTIFICATION # LMJJJT7GEL0978 INSURANCE POLICY # US DOT # WEIGHT GVWR/GCWR - 0K LBS. - 0,00-6K LBS. - > 6K LBS. 0 AUTONOMOUS MODE LEVEL - INTERMODAL CONTAINER CHASSIS 6 - CARGOVAN /ENCLOSED BOX 7 - SEPARATION OF UNITS 8 - RAN OFF ROAD RIGHT 9 - RAN OFF ROAD LEFT 0 - CROSS MEDIAN - CROSS CENTERLINE - OPPOSITE DIRECTION OF TRAVEL - MEDIAN CONCRETE 6 - MEDIAN OTHER 7 - TRAFFIC SIGN POST PA GOLF CART - SNOWMOBILE - SINGLE UNIT TRUCK - SEMI-TRACTOR 6 - FARM 7 - MOTORHOME 0 - NO AUTOMATION - DRIVER ASSISTANCE - PARTIAL AUTOMATION - FIRE - MILITARY - POLICE - PUBLIC UTILITY - CONSTRUCTION EQUIP. 7 - GRAIN/CHIPS/GRAVEL 8 - POLE 9 - CARGO TANK 0 - FLAT BED 7 - WORN OR SLICK TIRES 9 - MOTOR TROUBLE 8 - TRAILER DEFECTIVE 7 - SHOULDER/ROADSIDE 8 - SIDEWALK 9 - MEDIAN/CROSSING ISLAND 9 - LEAVING TRAFFIC 0 - PARKED - SLOWING OR STOPPED IN TRAFFIC - DRIVERLESS - NEGOTIATING A CURVE - ENTERING OR CROSSING SPECIFIED LOCATION - IMPROPER START FROM A PARKED - STOPPED OR PARKED ILLEGALLY - SWERVING TO AVOID 6 - WRONG WAY 7 - VISION OBSTRUCTION - PEDALCYCLE 6 - RAILWAY 7 - ANIMAL - FARM 8 - ANIMAL - DEER MOST HARMFUL EVENT COLOR GRY 0 - DISABLED FROM PRIOR ACCIDENT MAKE LINCOLN HAZARDOUS MATERIAL MATERIAL RELEASED PLACARD CLASS # PLACARD ID # 8 - LIMO (LIVERY ) 9 - BUS (6+ PASSENGERS) 0 - OTHER - HEAVY - ANIMAL WITH RIDER OR ANIMAL-DRAWN 6 - FARM 7 - MOWING 8 - SNOW REMOVAL 9 - TOWING 0 - SAFETY SERVICE PATROL 0 - DRIVEWAY ACCESS - SHARED USE PATHS OR TRAILS - FIRST RESPONDER AT INCIDENT SCENE - WALKING, RUNNING, JOGGING, PLAYING 6 - WORKING 7 - PUSHING 8 - APPROACHING OR LEAVING - PEDESTRIAN/SKATER - WHEELCHAIR (ANY ) - OTHER NON-MOTORIST 6 - BICYCLE 7 - TRAIN 9 - STANDING 0 - OTHER NON-MOTORIST 8 - OPERATING DEFECTIVE 9 - LOAD SHIFTING /FALLING/SPILLING 0 - IMPROPER CROSSING - LYING IN ROADWAY - NOT DISCERNIBLE NON-COLLISION - DOWNHILL RUNAWAY 9 - ANIMAL -OTHER - OTHER NON-COLLISION 0 - MOTOR IN - PEDESTRIAN TRANSPORT - PARKED MOTOR - WORK ZONE COLLISION WITH FIXED - STRUCK - GUARDRAIL END - PORTABLE 8 - OVERHEAD SIGN POST 9 - LIGHT / LUMINARIES - EMBANKMENT 6 - FENCE - MEDIAN CABLE SUPPORT 7 - MAILBOX - MEDIAN GUARDRAIL 0 - UTILITY POLE 8 - TREE - OTHER POST, POLE 9 - FIRE HYDRANT OR SUPPORT - CULVERT - CURB - DITCH OWNER PHONE:INCLUDE AREA CODE ( COMMERCIAL CARRIER PHONE: INCLUDE AREA CODE 0 - WORK ZONE - WALL YEAR 06 TOWED : COMPANY NAME - CONDITIONAL AUTOMATION - HIGH AUTOMATION - FULL AUTOMATION MODEL NAVIGATOR 9 OR HIT/SKIP - MAIL CARRIER - DUMP - CONCRETE MIXER - AUTO TRANSPORTER - GARBAGE/REFUSE STANDING OUTSIDE DISABLED - OPENING DOOR INTO ROADWAY 99 - OTHER IMPROPER - STRUCK FALLING, SHIFTING CARGO OR ANYTHING SET IN MOTION A MOTOR - OTHER MOVABLE - BUILDING - TUNNEL - OTHER FIXED - NONE - MINOR DAMAGE FROM DAMAGE SCALE DAMAGED AREA(S) INDICATE ALL THAT APPLY - NO DAMAGE [ 0 ] - TOP [ ] TRAFFICWAY FLOW - ONE-WAY 6 - TWO-WAY # OF THROUGH S ON ROAD UNIT SPEED 0 - FUNCTIONAL DAMAGE - DISABLING DAMAGE - UNIT NOT AT SCENE [ 6 ] - UNDERCARRIAGE [ ] - ALL AREAS [ ] TRAFFIC CONTROL - ROUNDABOUT - SIGNAL - FLASHER UNIT / NON-MOTORIST DIRECTION TO POSTED SPEED D A M A G E INITIAL POINT OF CONTACT 0 - NO DAMAGE - - REFER TO UNIT DIAGRAM - TOP T R A F F I C - NORTH - EAST - WEST - UNDERCARRIAGE - NOT AT SCENE 9 DETECTED SPEED - STATED / ESTIMATED SPEED - CALCULATED / EDR - UNDETERMINED - STOP SIGN - YIELD SIGN RAIL GRADE CROSSING - NOT INVLOVED 6 - NO CONTROL - INVOLVED-ACTIVE CROSSING - INVOLVED-PASSIVE CROSSING - NORTHEAST 6 - NORTHWEST 7 - SOUTHEAST 8 - SOUTHWEST PAGE OF

4 UNIT # DATE OF BIRTH AGE 7 INDIAN LAKE DRIVE, MAINEVILLE,, 09 MORGAN, WILLIS INJURED OL STATE OPERATOR LICENSE NUMBER UNIT # RR8 ENDORSEMENT M INJURED EMS AGENCY (NAME) INJURED TO: MEDICAL FACILITY (NAME, CITY) SAFETY COMBS, ADAM, GRANT RESTRICTION SELECT UP TO 96 FALCON PT, MAINEVILLE,, 09 OL STATE OPERATOR LICENSE NUMBER RF7 OFFENSE CHARGED.A DRIVER DISTRACTED LOCAL CODE ALCOL / DRUG SUSPECTED ALCOL OTHER DRUG MARIJUANA OFFENSE DESCRIPTION 07/8/ NO PERSON SHALL OPERATE A MOTO CONDITION EMS AGENCY (NAME) INJURED TO: MEDICAL FACILITY (NAME, CITY) SAFETY ENDORSEMENT RESTRICTION SELECT UP TO DRIVER DISTRACTED OFFENSE CHARGED LOCAL CODE ALCOL / DRUG SUSPECTED ALCOL OTHER DRUG MARIJUANA OFFENSE DESCRIPTION CONDITION ALCOL TEST. VALUE DATE OF BIRTH 07/0/978 AIR BAG USAGE 70 CITATION NUMBER 09 DRUG TEST(S) ALCOL TEST. VALUE AIR BAG USAGE M RESULTS SELECT UP TO AGE 0 CITATION NUMBER DRUG TEST(S) M RESULTS SELECT UP TO UNIT # DATE OF BIRTH AGE INJURED OL STATE - FATAL - SUSPECTED SERIOUS INJURY - SUSPECTED MINOR INJURY - POSSIBLE INJURY - NO APPARENT INJURY - NOT TRANSPORTED /TREATED AT SCENE - EMS - POLICE - NONE - SHOULDER BELT ONLY - LAP BELT ONLY - SHOULDER & LAP BELT - CHILD RESTRAINT SYSTEM - FORWARD FACING 6 - CHILD RESTRAINT SYSTEM - REAR FACING 7 - BOOSTER SEAT 8 - HELMET 9 - PROTECTIVE PADS (ELBOWS, KNEES, ETC) 0 - REFLECTIVE CLOTHING - LIGHTING - PEDESTRIAN / BICYCLE ONLY EMS AGENCY (NAME) INJURED TO: MEDICAL FACILITY (NAME, CITY) SAFETY OPERATOR LICENSE NUMBER OFFENSE CHARGED LOCAL CODE SAFETY ENDORSEMENT RESTRICTION SELECT UP TO DRIVER DISTRACTED - FRONT - LEFT SIDE (MOTORCYCLE DRIVER) - FRONT - MIDDLE - FRONT - RIGHT SIDE - SECOND - LEFT SIDE (MOTORCYCLE PASSENGER) - SECOND - MIDDLE 6 - SECOND - RIGHT SIDE 7 - THIRD - LEFT SIDE (MOTORCYCLE SIDE CAR) 8 - THIRD - MIDDLE 9 - THIRD - RIGHT SIDE 0 - SLEEPER SECTION OF TRUCK CAB - PASSENGER IN OTHER ENCLOSED CARGO AREA (NON-TRAILING UNIT, BUS, PICK-UP WITH CAP) - PASSENGER IN UNENCLOSED CARGO AREA - TRAILING UNIT - RIDING ON EXTERIOR (NON-TRAILING UNIT) - NON-MOTORIST AIR BAG ALCOL / DRUG SUSPECTED ALCOL - NOT DEPLOYED - DEPLOYED FRONT - DEPLOYED SIDE - DEPLOYED BOTH FRONT/SIDE - NOT APPLICABLE 9 - DEPLOYMENT UNKNOWN - NOT EJECTED - PARTIALLY EJECTED - TOTALLY EJECTED - NOT APPLICABLE - NOT - EXTRICATED MECHANICAL MEANS - FREED NON-MECHANICAL MEANS OTHER DRUG MARIJUANA OFFENSE DESCRIPTION AIR BAG USAGE CITATION NUMBER CONDITION ALCOL TEST DRUG TEST(S) OL RESTRICTION(S) VALUE. DRIVER DISTR - CLASS A - ALCOL INTERLOCK - NOT DISTRACTED DEVICE - MANUALLY OPERATING AN - CLASS B - CDL INTRASTATE ONLY ELECTRONIC - CLASS C - CORRECTIVE LENSES COMMUNICATION DEVICE - FARM WAIVER (TEXTING, TYPING, - REGULAR CLASS - EXCEPT CLASS A BUS DIALING) (IO = D) 6 - EXCEPT CLASS A - TALKING ON HANDS-FREE & CLASS B BUS COMMUNICATION DEVICE - M/C MOPED ONLY 7 - EXCEPT TRACTOR-TRAILER - TALKING ON HAND-HELD 6 - NO VALID OL 8 - INTERMEDIATE LICENSE COMMUNICATION DEVICE RESTRICTIONS - OTHER ACTIVITY WITH AN 9 - LEARNER'S PERMIT ELECTRONIC DEVICE OL ENDORSEMENT RESTRICTIONS 6 - PASSENGER 0 - LIMITED TO DAYLIGHT 7 - OTHER DISTR H - HAZMAT ONLY INSIDE THE M - MOTORCYCLE - LIMITED TO EMPLOYMENT 8 - OTHER DISTR P - PASSENGER - LIMITED - OTHER OUTSIDE THE - MECHANICAL DEVICES N - TANKER (SPECIAL BRAKES, HAND CONDITION Q - MOTOR SCOOTER CONTROLS, OR OTHER ADAPTIVE DEVICES) - APPARENTLY NORMAL R - THREE-WHEEL - MILITARY S ONLY - PHYSICAL IMPAIRMENT MOTORCYCLE - MOTOR S - EMOTIONAL (E.G., S - SCHOOL BUS WITHOUT AIR BRAKES DEPRESSED, ANGRY, 6 - OUTSIDE MIRROR DISTURBED) T - DOUBLE & TRIPLE 7 - PROSTHETIC AID TRAILERS - ILLNESS 8 - OTHER - FELL ASLEEP, FAINTED, X - TANKER / HAZMAT FATIGUED, ETC. 6 - UNDER THE INFLUENCE OF MEDICATIONS / DRUGS / ALCOL F - FEMALE M - MALE U - OTHER / UNKNOWN RESULTS SELECT UP TO TEST - NONE GIVEN - TEST REF - TEST GIVEN, CONTAMINATED SAMPLE / UNUSABLE - TEST GIVEN, RESULTS KNOWN - TEST GIVEN, RESULTS UNKNOWN ALCOL TEST - NONE - BLOOD - URINE - BREATH - OTHER DRUG TEST - NONE - BLOOD - URINE - OTHER DRUG TEST RESULT(S) - AMPHETAMINES - BARBITURATES - BENZODIAZEPINES - CANNABINOIDS - COCAINE 6 - OPIATES / OPIOIDS 7 - OTHER 8 - NEGATIVE RESULTS PAGE OF

5 / WITNESS ADDENDUM UNIT # DATE OF BIRTH AGE 96 FALCON PT, MAINEVILLE,, 09 COMBS, KAITLYN INJURED EMS AGENCY (NAME) INJURED TO: MEDICAL FACILITY (NAME, CITY) SAFETY 09// AIR BAG USAGE UNIT # DATE OF BIRTH AGE 6 F INJURED EMS AGENCY (NAME) INJURED TO: MEDICAL FACILITY (NAME, CITY) SAFETY AIR BAG USAGE UNIT # DATE OF BIRTH AGE INJURED EMS AGENCY (NAME) INJURED TO: MEDICAL FACILITY (NAME, CITY) SAFETY AIR BAG USAGE UNIT # DATE OF BIRTH AGE INJURED EMS AGENCY (NAME) INJURED TO: MEDICAL FACILITY (NAME, CITY) SAFETY AIR BAG USAGE - FATAL - SUSPECTED SERIOUS INJURY - SUSPECTED MINOR INJURY - POSSIBLE INJURY - NO APPARENT INJURY INJURED - NOT TRANSPORTED / TREATED AT SCENE - EMS - POLICE SAFETY AIR BAG USAGE - NONE - - SHOULDER BELT ONLY - LAP BELT ONLY - SHOULDER & LAP BELT - CHILD RESTRAINT SYSTEM - FORWARD FACING 6 - CHILD RESTRAINT SYSTEM - REAR FACING 7 - BOOSTER SEAT 8 - HELMET 9 - PROTECTIVE PADS (ELBOWS, KNEES, ETC) 0 - REFLECTIVE CLOTHING - LIGHTING - PEDESTRIAN / BICYCLE ONLY - FRONT - LEFT SIDE (MOTORCYCLE DRIVER) - FRONT - MIDDLE - FRONT - RIGHT SIDE - SECOND - LEFT SIDE (MOTORCYCLE PASSENGER) - SECOND - MIDDLE 6 - SECOND - RIGHT SIDE 7 - THIRD - LEFT SIDE (MOTORCYCLE SIDE CAR) 8 - THIRD - MIDDLE 9 - THIRD - RIGHT SIDE 0 - SLEEPER SECTION OF TRUCK CAB - 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 EXTERIOR (NON-TRAILING UNIT) - NON-MOTORIST - NOT DEPLOYED - DEPLOYED FRONT - DEPLOYED SIDE - DEPLOYED BOTH FRONT/SIDE - NOT APPLICABLE 9 - DEPLOYMENT UNKNOWN - NOT EJECTED - PARTIALLY EJECTED - TOTALLY EJECTED - NOT APPLICABLE - NOT - EXTRICATED MECHANICAL MEANS - FREED NON-MECHANICAL MEANS DATE OF BIRTH AGE WITNESS DATE OF BIRTH AGE WITNESS DATE OF BIRTH AGE WITNESS PAGE OF

6 IO TRAFFIC ACCIDENT - NARRATIVE IN COUNTY OF Warren County REPORTING AGENCY Hamilton Township ACCIDENT LOCATION 8 DATE OF CRASH 0/09/09 OFFICERS SIGNATURE BADGE NO.

7 IO TRAFFIC ACCIDENT - DIAGRAM IN COUNTY OF Warren County REPORTING AGENCY Hamilton Township ACCIDENT LOCATION 8 Date Of Crash 0/09/09 OFFICERS SIGNATURE BADGE NO.