Local Report Number * Crash Severity Hit/Skip 0 GARFIELD HEIGHTS. Road Types or Milepost AL - Alley AV - Avenue BL - Boulevard
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- Avice Allen
- 5 years ago
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1 Photos Taken OH- OH-P OH- Other County * HSY700 (Rev 0/) Traffic Crash Report Local Information SIEMENS BUILDING TECHNOLOGIES PDO Under Private Reporting Agency NCIC * State Property Reportable 8 0 Dollar Amount þ City * Village * Township * O F Crash Severity Hit/Skip Reporting Agency Name * - Fatal - Injury - PDO Number Units Unit in error - Solved - Unsolved 98 - Animal City, Village, Township * Crash Date * Time Crash Day Week Degrees / Minutes / Seconds Decimal Degrees Latitude Longitude O Latitude Longitude o / // o / // - R Roadway Division þ Divided Undivided Location Route Type Distance From Reference Miles Feet Yards Reference Point Used - Intersection - Mile Post - House Number Road Contour - Straight Level - Straight Grade - Curve Level Manner Crash Collision/Impact Road Surface 8 S R Narrative - Not Collision Between Two Motor Vehicles In Transport - Concrete - Blacktop, Bituminous, Asphalt - Brick/Block Work Zone Related Report Taken By þ Police Agency Date Crash Reported.. Divided Lane Direction Travel N - Northbound S - Southbound Location Route Number Dir From Ref Crash Location - Curve Grade N,S, E,W - Rear-End - Head-On - Rear-to-Rear - Slag, Gravel, Stone 5 - Dirt 6 - Other Workers Present Law Enforcement Present (Officer/Vehicle Law Enforcement Present (Vehicle Only) GARFIELD HTS E - Eastbound W - Westbound Loc. Prefix N,S, E,W Number Thru Lanes Location Road name Reference Route Type 0 - Not an intersection 0 - Four-way Intersection 0 - T-Intersection 0 - Y-Intersection 05 - Traffic Circle/Roundabout Road Conditions 5 - Backing 6 - Angle 7 - Sideswipe, Same Direction Light conditions Type Work Zone Time Crash Reported Reference Route Number 06 - 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 Ref Prefix - Daylight - Dawn - Dusk - Dark - Lighted Roadway - Lane Closure - Lane Shift/Crossover - Work on Shoulder or Median Supplement (Correction or Addition to an Existing Report Sent to ODPS) Dispatch Time CR - Circle CT- Court DR - Drive N,S, E,W - Railway Grade Crossing - Shared-Use Paths or Trails HE - Heights HW - Highway LA - Lane Location Road Type MP - Milepost PK - Parkway PI - Pike Route Types IR - Interstate Route (inc. turnpike) US - US Route SR - State Route Reference Name (Road, Milepost, House #) þ Intersection Related 05 - Sand, Mud, Dirt, Oil, gravel 06 - Water (Standing, Moving) 07 - Slush 08 - Debris* Weather - Intermittent or Moving Work 5 - Other Arrival Time - Clear - Cloudy - Fog, Smog, Smoke Location First Harmful - On Roadway - On Shoulder - In Median - On Roadside ST - Street TE - Terrace TL - Trail WA - Way CR - Numbered County Route TR - Numbered Township Route Reference Road Type 5 - On Gore 6 - Outside Trafficway 09 - Rut, Holes, Bumps, Uneven Pavement* 0 - Other * Condition Only - Rain 5 - Sleet, Hail 6 - Snow 5 - Dark - Roadway Not Lighted 6 - 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 Time Cleared Officer's Name * Officer's Badge Number Checked By T. Baon W GARFIELD HEIGHTS 0 5 UNIT WAS STOPPED FOR THE RED LIGHT IN THE CENTER LEFT TURN LANE OF W/B S.R. 7 AT TRANSPORTATION. DUE TO A SUDDEN MEDICAL EVENT THE OPERATOR OF UNIT SUDDENLY ACCELERATED TO AN ESTIMATED SPEED OF 5 MPH THROUGH THE RED LIGHT TRAVELING SOUTHWEST THROUGH THE INTERSECTION. UNIT TRAVELED UP OVER THE SOUTHWEST CURB OF THE INTERSECTION CONTINUING FORWARD THROUGH AN ALUMINUM FENCE. UNIT THEN WENT AIRBORNE DOWN AN EMBANKMENT INTO THE LOT OF 550 TRANSPORTATION WHERE UNIT STRUCK THE ROOF OF UNIT. UNIT THEN ROLLED TO THE LEFT AND 00 TRANSPORTATION PL - Place RD - Road SQ - Square Other Investigation Time 7 - Severe Crosswinds 8 - Blowing Sand, Soil, Dirt, Snow 9 - Other/Unknown School Zone Related 0 B L School Bus Related Yes, School Bus Directly Involved Yes, School Bus Indirectly Involved - Activity Area 5 - Termination Area Total Minutes L09 T. Murphy W E D
2 Unit Owner LP State Owner Name: Last, First, Middle License Plate Number ( ü Same As Driver) ( Same As Driver) Vehicle Identification Number Owner Phone Number - inc. area code Vehicle Year Vehicle Make Vehicle Model Vehicle Color Pro Insurance Shown BROWN AISHA LERONA FXJ85 Insurance Company Policy Number Towed By Carrier Name, KIA Kia Motors Corpora OTH Other BLK Black PROGRESSIVE K N A F K A 6 6 G A & H TOWING ( Same As Driver) 790 WATERBURY AVE MAPLE HTS OH 7 # s 0 Damage Scale - None - Minor - Functional - Disabling Carrier Phone - include area code 0 US DOT HM Placard ID No. HM Class Number Non- Location Prior to Impact 0 - Intersection - Marked Crosswalk 0 - Intersection - No Crosswalk 0 - Intersection - Other 0 - Midblock - Marked Crosswalk 05 - Travel Lane - Other Location 06 - Bicycle Lane 07 - Shoulder/Roadside 08 - Sidewalk 09 - Median/Crossing Island 0 - Driveway Access - Shared-Use Path or Trail - Non-Trafficway Area Special Function HSY80 OHU (Rev 0/) Vehicle Weight GVWR/GCWR - Less Than or Equal to 0k Lbs. - 0,00 to 6,000 Lbs - More Than 6,000 Lbs. Hazardous Material Released 0 - None 0 - Taxi 0 - Rental Truck (Over 0K Lbs) 0 - Bus - School (Public or Private) 05 - Bus - Transit 06 - Bus - Charter 07 - Bus - Shuttle 08 - Bus - Other Type Use - Personal - Commercial - Government In Emergency Response Cargo Body Type 0 - No Cargo Body Type/Not Applicable 0 - Bus/Van(9-5 Seats, Inc.Driver) Bus(6+ Seats, Inc Driver) 0 - Vehicle Towing Another Vehicle 05 - Logging 06 - Intermodal Container Chassis 07 - Cargo Van/Enclosed Box 08 - Grain, Chips, Gravel Unit Type or Hit/Skip 09 - Ambulance 0 - Fire - Highway/Maintenance - Military - Police - Public Utility 5 - Other Government 6 - Construction Equip. Passenger Vehicle (less than 9 passengers) 0 - Sub-Compact 0 - Compact 0 - Mid Size 0 - Full Size 05 - Minivan 06 - Sports Utility Vehicle 07 - Pickup 08 - Van Motorized Bicycle - Snowmobile/ATV - Other Passenger Vehicle 7 - Farm Vehicle 8 - Farm Equipment 9 - Motorhome 0 - Golf Cart - Train - Other (Explain in Narrative) 09 - Pole 0 - Cargo Tank - Flat Bed - Dump - Concrete Mixer - Auto Transporter 5 - Garbage/Refuse Trafficway Description - 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 5 - One-Way Trafficway Hit / Skip Unit Med/Heavy Trucks or Combo Units>0k lbs - 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 Most Damaged Area 0 - None 0 - Center Front Right Front Impact Area 0 - Right Side 05 - Right Rear 06 - Rear Center Left Rear Pre-Crash Actions Non- 0 - Straight Ahead 0 - Backing 0 - Changing Lanes 0 - Overtaking/Passing 05 - Making Right Turn 06 - Making Left Turn Contributing Circumstances 0 - None 0 - Failure to Yield Ran Red Light 0 - Ran Stop Sign 05 - Exceeded Speed Limit 06 - Unsafe Speed 07 - Improper Turn 08 - Left Center 09 - Followed Too Closely/ACDA 0 - Improper Lane Change /Passing/Off Road Sequence s Traffic Control 07 - Making U-Turn 08 - Entering Traffic Lane 09 - Leaving Traffic Lane 0 - Parked - Slowing or Stopped in Traffic - Driverless First Most Harmful Harmful 5 Collision with Person, Vehicle or Object Not Fixed - Pedestrian - Parked Motor Vehicle 5 - Pedalcycle - Work Zone Maintenance Equipment 6 - Railway Vehicle (Train,Engine) - Struck by Falling, Shifting Cargo 7 - Animal - Farm or Anything Set in Motion by a 8 - Animal - Deer Motor Vehicle 9 - Animal - Other - Other Movable Object 0 - Motor Vehicle in Transport Unit Speed þ 6 0 Posted Speed Stated Estimated No Controls 0 - Stop Sign 0 - Yield Sign 0 - Traffic Signal 05 - Traffic Flashers 06 - School Zone - Negotiating a Curve - Other Action - Improper Backing - Improper Start From Parked Position - Stopped or Parked Illegally - Operating Vehicle in Negligent Manner 5 - Swerving to Avoid (Due to External Conditions) 6 - Wrong Side/Wrong Way 7 - Failure to Control 8 - Vision Obstruction 9 - Operating Defective Equipment 0 - Load Shifing/Falling/Spilling - Other Improper Action 6 0 Non-Collision s 0 - Overturn/Rollover 0 - Fire/Explosion 0 - Immersion 0 - Jackknife 05- Cargo/Equipment Loss or Shift Collision With Fixed Object 5 - Impact Attenuator/Crash Cushion 6 - Bridge Overhead Structure 7 - Bridge Pier or Abutment 8 - Bridge Parapet 9 - Bridge Rail 0 - Guardrail Face - Guardrail End - Portable Barrier 07 - Railroad Crossbucks 08 - Railroad Flashers 09 - Railroad Gates 0 - Construction Barricade - Person (Flagger, Officer) - Pavement Markings Non Left Side 09 - Left Front 0 - Top and Windows - Undercarriage - Load/Trailer - Total (All Areas) - Other 5 - Entering or Crossing Specified Location 6 - Walking, Running, Jogging, Playing, Cycling 7 - Working 8 - Pushing Vehicle 9 - Approaching or Leaving Vehicle 0 - Standing - None - Improper Crossing - Darting 5 - Lying and/or Illegally in Roadway 6 - Failure to Yield Right Way 7 - Not Visible (Dark Clothing) 8 - Inattentive 9 - Failure to Obey Traffic Signs /Signals/Officer 0 - Wrong Side the Road - Other Non- Action 06 - Equipment Failure (Blown Tire, Brake Failure, etc) 07 - Separation Units 08 - Ran Off Road Right 09 - Ran Off Road Left - Median Cable Barrier - Median Guardrail Barrier 5 - Median Concrete Barrier 6 - Median Other Barrier 7 - Traffic Sign Post 8 - Overhead Sign Post 9 - Light/Luminaries Support 0 - Utility Pole - Crosswalk Lines - Walk/Don't Walk 5 - Other 6 - Not Reported Unit Direction From To Bus/Van/Limo (9 or More Including Driver) - Bus/Van (9-5 Seats, Inc Driver) - Bus(6+ Seats, Inc Driver) Non- - Animal with Rider - Animal with Buggy, Wagon, Surrey 5 - Bicycle/Pedacyclist 6 - Pedestrian/Skater 7 - Other Non- Vehicle Defects 0 - Cross Median - Cross Center Line Opposite Direction Travel - Downhill Runaway - Other Non-Collision - Other Post, Pole or Support - Culvert - Curb - Ditch 5 - Enbankment 6 - Fence 7 Mailbox 8 - North - South - East - West Action - Non-Contact - Non-Collision - Striking - Struck 5 - Striking/Struck - Other Non- Action 0 - Turn Signals 0 - Head Lamps 0 - Tail Lamps 0 - Brakes 05 - Steering 06 - Tire Blowout 07 - Worn or Slick tires 08 - Trailer Equipment Defective 09 - Motor Trouble 0 - Disabled From Prior Accident - Other Defects 8 - Tree 9 - Fire Hydrant 50 - Work Zone Maintenance Equipment 5 - Wall, Building, Tunnel 5 - Other Fixed Object 5 - Northeast 6 - Northwest 7 - Southeast 8 - Southwest
3 Unit Owner LP State Owner Name: Last, First, Middle License Plate Number ( Same As Driver) ( Same As Driver) Vehicle Identification Number Owner Phone Number - inc. area code Vehicle Year Vehicle Make Vehicle Model Vehicle Color Pro Insurance Shown ROSCA JEAN MARIUS HKR860 Insurance Company Policy Number Towed By Carrier Name, BMW BMW X X BLK Black STATE FARM INS W B X P A 9 8 W A A75C ( Same As Driver) 90 SAINT ANDREWS WESTLAKE OH # s 0 0 Damage Scale - None - Minor 0 - Functional - Disabling Carrier Phone - include area code US DOT HM Placard ID No. HM Class Number Non- Location Prior to Impact 0 - Intersection - Marked Crosswalk 0 - Intersection - No Crosswalk 0 - Intersection - Other 0 - Midblock - Marked Crosswalk 05 - Travel Lane - Other Location 06 - Bicycle Lane 07 - Shoulder/Roadside 08 - Sidewalk 09 - Median/Crossing Island 0 - Driveway Access - Shared-Use Path or Trail - Non-Trafficway Area Special Function HSY80 OHU (Rev 0/) Vehicle Weight GVWR/GCWR - Less Than or Equal to 0k Lbs. - 0,00 to 6,000 Lbs - More Than 6,000 Lbs. Hazardous Material Released 0 - None 0 - Taxi 0 - Rental Truck (Over 0K Lbs) 0 - Bus - School (Public or Private) 05 - Bus - Transit 06 - Bus - Charter 07 - Bus - Shuttle 08 - Bus - Other Type Use - Personal - Commercial - Government In Emergency Response Cargo Body Type 0 - No Cargo Body Type/Not Applicable 0 - Bus/Van(9-5 Seats, Inc.Driver) Bus(6+ Seats, Inc Driver) 0 - Vehicle Towing Another Vehicle 05 - Logging 06 - Intermodal Container Chassis 07 - Cargo Van/Enclosed Box 08 - Grain, Chips, Gravel Unit Type or Hit/Skip 09 - Ambulance 0 - Fire - Highway/Maintenance - Military - Police - Public Utility 5 - Other Government 6 - Construction Equip. Passenger Vehicle (less than 9 passengers) 0 - Sub-Compact 0 - Compact 0 - Mid Size 0 - Full Size 05 - Minivan 06 - Sports Utility Vehicle 07 - Pickup 08 - Van Motorized Bicycle - Snowmobile/ATV - Other Passenger Vehicle 7 - Farm Vehicle 8 - Farm Equipment 9 - Motorhome 0 - Golf Cart - Train - Other (Explain in Narrative) 09 - Pole 0 - Cargo Tank - Flat Bed - Dump - Concrete Mixer - Auto Transporter 5 - Garbage/Refuse Trafficway Description - 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 5 - One-Way Trafficway Hit / Skip Unit Med/Heavy Trucks or Combo Units>0k lbs - 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 Most Damaged Area 0 - None 0 - Center Front Right Front Impact Area 0 - Right Side 05 - Right Rear 06 - Rear Center Left Rear Pre-Crash Actions Non- 0 - Straight Ahead 0 - Backing 0 - Changing Lanes 0 - Overtaking/Passing 05 - Making Right Turn 06 - Making Left Turn Contributing Circumstances 0 - None 0 - Failure to Yield Ran Red Light 0 - Ran Stop Sign 05 - Exceeded Speed Limit 06 - Unsafe Speed 07 - Improper Turn 08 - Left Center 09 - Followed Too Closely/ACDA 0 - Improper Lane Change /Passing/Off Road Sequence s 0 0 Traffic Control 07 - Making U-Turn 08 - Entering Traffic Lane 09 - Leaving Traffic Lane 0 - Parked - Slowing or Stopped in Traffic - Driverless First Most Harmful Harmful Collision with Person, Vehicle or Object Not Fixed - Pedestrian - Parked Motor Vehicle 5 - Pedalcycle - Work Zone Maintenance Equipment 6 - Railway Vehicle (Train,Engine) - Struck by Falling, Shifting Cargo 7 - Animal - Farm or Anything Set in Motion by a 8 - Animal - Deer Motor Vehicle 9 - Animal - Other - Other Movable Object 0 - Motor Vehicle in Transport Unit Speed 0 Stated Estimated Posted Speed No Controls 0 - Stop Sign 0 - Yield Sign 0 - Traffic Signal 05 - Traffic Flashers 06 - School Zone - Negotiating a Curve - Other Action - Improper Backing - Improper Start From Parked Position - Stopped or Parked Illegally - Operating Vehicle in Negligent Manner 5 - Swerving to Avoid (Due to External Conditions) 6 - Wrong Side/Wrong Way 7 - Failure to Control 8 - Vision Obstruction 9 - Operating Defective Equipment 0 - Load Shifing/Falling/Spilling - Other Improper Action Non-Collision s 0 - Overturn/Rollover 0 - Fire/Explosion 0 - Immersion 0 - Jackknife 05- Cargo/Equipment Loss or Shift Collision With Fixed Object 5 - Impact Attenuator/Crash Cushion 6 - Bridge Overhead Structure 7 - Bridge Pier or Abutment 8 - Bridge Parapet 9 - Bridge Rail 0 - Guardrail Face - Guardrail End - Portable Barrier 07 - Railroad Crossbucks 08 - Railroad Flashers 09 - Railroad Gates 0 - Construction Barricade - Person (Flagger, Officer) - Pavement Markings Non Left Side 09 - Left Front 0 - Top and Windows - Undercarriage - Load/Trailer - Total (All Areas) - Other 5 - Entering or Crossing Specified Location 6 - Walking, Running, Jogging, Playing, Cycling 7 - Working 8 - Pushing Vehicle 9 - Approaching or Leaving Vehicle 0 - Standing - None - Improper Crossing - Darting 5 - Lying and/or Illegally in Roadway 6 - Failure to Yield Right Way 7 - Not Visible (Dark Clothing) 8 - Inattentive 9 - Failure to Obey Traffic Signs /Signals/Officer 0 - Wrong Side the Road - Other Non- Action 06 - Equipment Failure (Blown Tire, Brake Failure, etc) 07 - Separation Units 08 - Ran Off Road Right 09 - Ran Off Road Left - Median Cable Barrier - Median Guardrail Barrier 5 - Median Concrete Barrier 6 - Median Other Barrier 7 - Traffic Sign Post 8 - Overhead Sign Post 9 - Light/Luminaries Support 0 - Utility Pole - Crosswalk Lines - Walk/Don't Walk 5 - Other 6 - Not Reported Unit Direction From To Bus/Van/Limo (9 or More Including Driver) - Bus/Van (9-5 Seats, Inc Driver) - Bus(6+ Seats, Inc Driver) Non- - Animal with Rider - Animal with Buggy, Wagon, Surrey 5 - Bicycle/Pedacyclist 6 - Pedestrian/Skater 7 - Other Non- Vehicle Defects 0 - Cross Median - Cross Center Line Opposite Direction Travel - Downhill Runaway - Other Non-Collision - Other Post, Pole or Support - Culvert - Curb - Ditch 5 - Enbankment 6 - Fence 7 Mailbox North - South - East - West Action - Non-Contact - Non-Collision - Striking - Struck 5 - Striking/Struck - Other Non- Action 0 - Turn Signals 0 - Head Lamps 0 - Tail Lamps 0 - Brakes 05 - Steering 06 - Tire Blowout 07 - Worn or Slick tires 08 - Trailer Equipment Defective 09 - Motor Trouble 0 - Disabled From Prior Accident - Other Defects 8 - Tree 9 - Fire Hydrant 50 - Work Zone Maintenance Equipment 5 - Wall, Building, Tunnel 5 - Other Fixed Object 5 - Northeast 6 - Northwest 7 - Southeast 8 - Southwest
4 Unit Owner LP State Owner Name: Last, First, Middle License Plate Number ( Same As Driver) ( Same As Driver) Vehicle Identification Number Owner Phone Number - inc. area code Vehicle Year Vehicle Make Vehicle Model Vehicle Color Pro Insurance Shown FEAR CASSANDRA M GKD6590 Insurance Company Policy Number Towed By Carrier Name, FORD Ford FUS Fusion BLK Black GRANGE INS F A H P 0 J A A R PA ( Same As Driver) 550 WILLMAN AVE CLEVELAND OH 5 58 # s 0 0 Damage Scale - None - Minor - Functional - Disabling Carrier Phone - include area code US DOT HM Placard ID No. HM Class Number Non- Location Prior to Impact 0 - Intersection - Marked Crosswalk 0 - Intersection - No Crosswalk 0 - Intersection - Other 0 - Midblock - Marked Crosswalk 05 - Travel Lane - Other Location 06 - Bicycle Lane 07 - Shoulder/Roadside 08 - Sidewalk 09 - Median/Crossing Island 0 - Driveway Access - Shared-Use Path or Trail - Non-Trafficway Area Special Function HSY80 OHU (Rev 0/) Vehicle Weight GVWR/GCWR - Less Than or Equal to 0k Lbs. - 0,00 to 6,000 Lbs - More Than 6,000 Lbs. Hazardous Material Released 0 - None 0 - Taxi 0 - Rental Truck (Over 0K Lbs) 0 - Bus - School (Public or Private) 05 - Bus - Transit 06 - Bus - Charter 07 - Bus - Shuttle 08 - Bus - Other Type Use - Personal - Commercial - Government In Emergency Response Cargo Body Type 0 - No Cargo Body Type/Not Applicable 0 - Bus/Van(9-5 Seats, Inc.Driver) Bus(6+ Seats, Inc Driver) 0 - Vehicle Towing Another Vehicle 05 - Logging 06 - Intermodal Container Chassis 07 - Cargo Van/Enclosed Box 08 - Grain, Chips, Gravel Unit Type or Hit/Skip 09 - Ambulance 0 - Fire - Highway/Maintenance - Military - Police - Public Utility 5 - Other Government 6 - Construction Equip. Passenger Vehicle (less than 9 passengers) 0 - Sub-Compact 0 - Compact 0 - Mid Size 0 - Full Size 05 - Minivan 06 - Sports Utility Vehicle 07 - Pickup 08 - Van Motorized Bicycle - Snowmobile/ATV - Other Passenger Vehicle 7 - Farm Vehicle 8 - Farm Equipment 9 - Motorhome 0 - Golf Cart - Train - Other (Explain in Narrative) 09 - Pole 0 - Cargo Tank - Flat Bed - Dump - Concrete Mixer - Auto Transporter 5 - Garbage/Refuse Trafficway Description - 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 5 - One-Way Trafficway Hit / Skip Unit Med/Heavy Trucks or Combo Units>0k lbs - 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 Most Damaged Area 0 - None 0 - Center Front Right Front Impact Area 0 - Right Side 05 - Right Rear 06 - Rear Center Left Rear Pre-Crash Actions Non- 0 - Straight Ahead 0 - Backing 0 - Changing Lanes 0 - Overtaking/Passing 05 - Making Right Turn 06 - Making Left Turn Contributing Circumstances 0 - None 0 - Failure to Yield Ran Red Light 0 - Ran Stop Sign 05 - Exceeded Speed Limit 06 - Unsafe Speed 07 - Improper Turn 08 - Left Center 09 - Followed Too Closely/ACDA 0 - Improper Lane Change /Passing/Off Road Sequence s 0 0 Traffic Control 07 - Making U-Turn 08 - Entering Traffic Lane 09 - Leaving Traffic Lane 0 - Parked - Slowing or Stopped in Traffic - Driverless First Most Harmful Harmful Collision with Person, Vehicle or Object Not Fixed - Pedestrian - Parked Motor Vehicle 5 - Pedalcycle - Work Zone Maintenance Equipment 6 - Railway Vehicle (Train,Engine) - Struck by Falling, Shifting Cargo 7 - Animal - Farm or Anything Set in Motion by a 8 - Animal - Deer Motor Vehicle 9 - Animal - Other - Other Movable Object 0 - Motor Vehicle in Transport Unit Speed 0 Stated Estimated Posted Speed No Controls 0 - Stop Sign 0 - Yield Sign 0 - Traffic Signal 05 - Traffic Flashers 06 - School Zone - Negotiating a Curve - Other Action - Improper Backing - Improper Start From Parked Position - Stopped or Parked Illegally - Operating Vehicle in Negligent Manner 5 - Swerving to Avoid (Due to External Conditions) 6 - Wrong Side/Wrong Way 7 - Failure to Control 8 - Vision Obstruction 9 - Operating Defective Equipment 0 - Load Shifing/Falling/Spilling - Other Improper Action 6 0 Non-Collision s 0 - Overturn/Rollover 0 - Fire/Explosion 0 - Immersion 0 - Jackknife 05- Cargo/Equipment Loss or Shift Collision With Fixed Object 5 - Impact Attenuator/Crash Cushion 6 - Bridge Overhead Structure 7 - Bridge Pier or Abutment 8 - Bridge Parapet 9 - Bridge Rail 0 - Guardrail Face - Guardrail End - Portable Barrier 07 - Railroad Crossbucks 08 - Railroad Flashers 09 - Railroad Gates 0 - Construction Barricade - Person (Flagger, Officer) - Pavement Markings Non Left Side 09 - Left Front 0 - Top and Windows - Undercarriage - Load/Trailer - Total (All Areas) - Other 5 - Entering or Crossing Specified Location 6 - Walking, Running, Jogging, Playing, Cycling 7 - Working 8 - Pushing Vehicle 9 - Approaching or Leaving Vehicle 0 - Standing - None - Improper Crossing - Darting 5 - Lying and/or Illegally in Roadway 6 - Failure to Yield Right Way 7 - Not Visible (Dark Clothing) 8 - Inattentive 9 - Failure to Obey Traffic Signs /Signals/Officer 0 - Wrong Side the Road - Other Non- Action 06 - Equipment Failure (Blown Tire, Brake Failure, etc) 07 - Separation Units 08 - Ran Off Road Right 09 - Ran Off Road Left - Median Cable Barrier - Median Guardrail Barrier 5 - Median Concrete Barrier 6 - Median Other Barrier 7 - Traffic Sign Post 8 - Overhead Sign Post 9 - Light/Luminaries Support 0 - Utility Pole - Crosswalk Lines - Walk/Don't Walk 5 - Other 6 - Not Reported Unit Direction From To Bus/Van/Limo (9 or More Including Driver) - Bus/Van (9-5 Seats, Inc Driver) - Bus(6+ Seats, Inc Driver) Non- - Animal with Rider - Animal with Buggy, Wagon, Surrey 5 - Bicycle/Pedacyclist 6 - Pedestrian/Skater 7 - Other Non- Vehicle Defects 0 - Cross Median - Cross Center Line Opposite Direction Travel - Downhill Runaway - Other Non-Collision - Other Post, Pole or Support - Culvert - Curb - Ditch 5 - Enbankment 6 - Fence 7 Mailbox North - South - East - West Action - Non-Contact - Non-Collision - Striking - Struck 5 - Striking/Struck - Other Non- Action 0 - Turn Signals 0 - Head Lamps 0 - Tail Lamps 0 - Brakes 05 - Steering 06 - Tire Blowout 07 - Worn or Slick tires 08 - Trailer Equipment Defective 09 - Motor Trouble 0 - Disabled From Prior Accident - Other Defects 8 - Tree 9 - Fire Hydrant 50 - Work Zone Maintenance Equipment 5 - Wall, Building, Tunnel 5 - Other Fixed Object 5 - Northeast 6 - Northwest 7 - Southeast 8 - Southwest
5 / Non- / /Non- Name: Last, First, Middle Date Birth 0 BROWN AISHA LE OL State Operator License Number OL Class No Valid OL M/C End 790 WATERBURY AVE MAPLE HTS OH GARFIELD HTS FIRE METROHEALTH Condition Alcohol/Drug Suspected Alcohol Test Status Alcohol Test Type Alcohol Test Value Drug Test Status Drug Test Type SS877 Offense Charged Offense Description Citation Number ( Local Code ) Hands-Free Device Used Driver Distracted By F /Non- Name: Last, First, Middle Date Birth OL State Operator License Number OL Class No Valid OL M/C End Condition Alcohol/Drug Suspected Alcohol Test Status Alcohol Test Type Alcohol Test Value Drug Test Status Drug Test Type Offense Charged ( Local Code ) Offense Description Citation Number Hands-Free Device Used. Driver Distracted By Injuries - No Injury/None Reported - Possible - Non-Incapacitating - Incapacitating 5 - Fatal Seating Position Injured Taken By 0 - Front - Left Side ( Driver) 0 - Front - Middle 0 - Front - Right Side 0 - Second - Left Side ( Passenger) 05 - Second - Middle 06 - Second - Right Side - Not Transported / Treated at Scene - EMS - Police - Other Safety Equipment Used 0 - None Used - Vehicle 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 Equipment 05 - Child Restraint System-Forward Facing 06 - Child Restraint System-Rear Facing 07 - Booster Seat 08 - Used - Passenger in Unenclosed Cargo Area - Trailing Unit - Riding on Vehicle Exterior (Non-Trailing Unit) 5 - Non- 6 - Other Non 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 5 - Not Applicable 9 - Deployment Unknown Ejection Trapped Operator License Class Condition Alcohol/Drug Suspected - Not Ejected - Totally 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") 5 - MC/Moped Only - Apparently Normal - Physical Impairment - Emotional (Depressed, Angry, Disturbed) - Illness 5 - Fell Asleep, Fainted, Fatigued 6 - Under The Influence Medications, Drugs, Alcohol 7 - Other - None - Yes - Alcohol Suspected - Yes - HBD Not Impaired - Yes - Drugs Suspected 5 - Yes - Alcohol and Drugs Suspected Alcohol Test Status - None Given - Test Refused - Test Given, Contaminated Sample/Unusable - Test Given, Results Known 5 - Test Given, Results Unknown Alcohol Test Type - None - Blood - Urine - Breath 5 - Other Drug Test Status - None Given - Test Refused - Test Given, Contaminated Sample/Unusable - Test Given, Results Known 5 - Test Given, Results Unknown Drug Test Type - None - Blood - Urine - Other Driver Distracted By - No Distraction Reported - Phone - Texting/ ing - Electronic Communication Device 5 - Other Electronic Device (Navigation Device, Radio, DVD) 6 - Other Inside the Vehicle 7 - External Distraction Name: Last, First, Middle Date Birth 0 BRITTON SHYONNA WATERBURY MAPLE HTS OH CUYAHOGA HTS FIRE METROHEALTH 0 F 0 IMKA ROBERT GRANGER RD GARFIELD HTS OH Injuries Name: Last, First, Middle Injured Taken By EMS Agency Medical Facility Injured Taken To Safety Equipment Used Date Birth Seating Position Age 6 F Air Bag Usage Gender Ejection Trapped HSY806 (Rev 0/)
6 / Witness Addendum Name: Last, First, Middle Date Birth PRESSON THOMAS A LARCHMONT UP LAKEWOOD OH M Name: Last, First, Middle Date Birth Name: Last, First, Middle Date Birth Name: Last, First, Middle Date Birth Name: Last, First, Middle Date Birth Name: Last, First, Middle Date Birth Injuries - No Injury/None Reported - Possible - Non-Incapacitating - Incapacitating 5 - Fatal Injured Taken By - Not Transported / Treated at Scene - EMS - Police - Other Safety Equipment Used 0 - None Used - Vehicle 0 - Shoulder Belt Only Used 0 - Lap Belt Only Used 0 - Shoulder Belt and Lap Belt Used Safety Equipment 05 - Child Restraint System-Forward Facing 06 - Child Restraint System-Rear Facing 07 - Booster Seat 08 - Used Non None Used 0 - Used - Protective Pads Used (Elbows, Knees, Etc) - Reflective Clothing - Lighting - Other Seating Position Air Bag Usage Ejection Trapped 0 - Front - Left Side ( Driver) 0 - Front - Middle 0 - Front - Right Side 0 - Second - Left Side ( Passenger) 05 - Second - Middle 06 - Second - Right Side 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) - Passenger in Unenclosed Cargo Area - Trailing Unit - Riding on Vehicle Exterior (Non-Trailing Unit) 5 - Non- 6 - Other - Not Deployed - Deployed Front - Deployed Side - Deployed Both Front/Side 5 - Not Applicable 9 - Deployment Unknown - Not Ejected - Totally Ejected - Partially Ejected - Not Applicable - Not Trapped - Extricated by Mechanical Means - Extricated by Non-Mechanical Means HSY855 OHP (Rev 0/)
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