Are you involved in a traffic crash that occurred in Ohio? If so, it’s important to understand the official process to report the incident. Oftentimes, this includes understanding and obtaining the appropriate form required by law - Ohio Traffic Crash Report (Form CR-3). This article provides information about what the Ohio Traffic Crash Report Form is used for and how it must be completed. In addition, we will provide details about where to obtain Form CR-3 reports for motor vehicle accidents that take place on highways/roads throughout the state of Ohio. Read on to learn more about your responsibilities when filing an Ohio Traffic Crash Report!
Question | Answer |
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Form Name | Ohio Traffic Crash Report Form |
Form Length | 3 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 45 sec |
Other names | ohio traffic crash report, oshp crash reports, ohio crash reports, crash reports ohio |
TRAFFIC CRASH REPORT
LOCAL REPORT # *
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PRIVATE |
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PHOTOS |
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CRASH SEVERITY |
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HIT/SKIP |
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PROPERTY |
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1 NOT HIT/SKIP |
TAKEN |
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1 FATAL |
3 PDO |
‘X’ |
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2 SOLVED |
‘X’ |
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2 INJURY |
4 UNKNOWN |
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IF YES |
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IF YES |
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3 UNSOLVED |
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N.C.I.C.# *
TIME OF CRASH |
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DAY OF WEEK |
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REPORTING AGENCY * |
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# UNITS |
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CITY * |
VILLAGE * |
TWP * |
NAME (OF CITY, VILLAGE OR TOWNSHIP) * |
UNIT ERROR |
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DATE OF CRASH * |
98= ANIMAL
99= UNKNOWN
COUNTY # * |
LATITUDE |
LONGITUDE |
CRASH OCCURRED ON |
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TYPE LOCATION POINT USED |
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PREFIX CRASH LOCATION |
TYPE LOC |
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1 NAMED STREET |
3 NUMBERED ROUTE |
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2 NUMBERED STREET |
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REFERENCEPOINTUSED |
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AT / REFERENCE |
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DIST REFERENCE |
DR |
PREFIX |
REFERENCE |
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REF POINT 01 |
STATE LINE |
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02 |
INTERSECTION 2 STREETS |
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03 |
COUNTY LINE |
LOCAL INFORMATION
04 |
HOUSE NUMBER |
08 |
PLACE NAME W/O REFERENCE |
05 |
TOWNSHIP BOUNDARY |
09 |
DRIVEWAY |
06 |
MILE POST |
10 |
STREET OR ROUTE W/O |
07 |
CORPORATION LIMIT |
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REFERENCE |
UNIT #
A
#OF OCC.
NAME (LAST, FIRST, MIDDLE)
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ADDRESS (STREET, CITY, STATE, ZIP CODE) |
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SOCIAL SECURITY NUMBER |
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DATE OF BIRTH |
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AGE |
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SEX |
HOME PHONE # |
WORK PHONE # |
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DL STATE |
DL # |
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LP STATE |
LP # |
INJURED |
1 NONE |
4 OTHER |
TRANSPORTED BY |
INJURED TAKEN TO |
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TAKEN BY |
2 EMS |
5 |
UNKNOWN |
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3 POLICE |
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OWNER NAME (IF SAME, WRITE “SAME”) |
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ADDRESS (STREET, CITY, STATE, ZIP CODE) |
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YEAR |
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MAKE |
MODEL |
COLOR |
INSURANCE COMPANY |
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TOWING SERVICE |
OWNER PHONE # |
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OFFENSE CHARGED |
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OFFENSE DESCRIPTION |
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CITATION # |
LOCAL |
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CODE? |
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‘X’ |
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IF YES |
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B |
UNIT # |
# OF OCC. |
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NAME |
(LAST, FIRST, MIDDLE) |
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ADDRESS (STREET, CITY, STATE, ZIP CODE) |
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SOCIAL SECURITY NUMBER |
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DATE OF BIRTH |
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AGE |
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SEX |
HOME PHONE # |
WORK PHONE # |
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DL STATE |
DL # |
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LP S |
LP # |
INJURED |
1 NONE |
4 OTHER |
TRANSPORTED BY |
INJURED TAKEN TO |
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TATE |
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TAKEN BY |
2 EMS |
5 |
UNKNOWN |
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3 POLICE |
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OWNER NAME (IF SAME, WRITE “SAME”) |
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ADDRESS (STREET, CITY, STATE, ZIP CODE) |
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YEAR |
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MAKE |
MODEL |
COLOR |
INSURANCE COMPANY |
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TOWING SERVICE |
OWNER PHONE # |
OFFENSE CHARGED |
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OFFENSE DESCRIPTION |
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CITATION # |
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LOCAL |
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CODE? |
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‘X’ |
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IF YES |
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C |
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UNIT # |
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DATE OF BIRTH |
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NAME (LAST, FIRST, MIDDLE) |
HOME PHONE # |
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Occupant |
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ADDRESS (STREET, CITY, STATE, ZIP CODE) |
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INJURED TAKEN BY |
TRANSPORTED BY |
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1 NONE |
4 OTHER |
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2 EMS |
5 UNKNOWN |
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3 POLICE |
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UNIT # |
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DATE |
OF BIRTH |
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D |
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NAME (LAST, FIRST, MIDDLE) |
HOME PHONE # |
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ADDRESS (STREET, CITY, STATE, ZIP CODE) |
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INJURED TAKEN BY |
TRANSPORTED BY |
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1 NONE |
4 OTHER |
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2 EMS |
5 UNKNOWN |
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3 POLICE |
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AGE |
SEX |
INJURED TAKEN TO
AGE |
SEX |
INJURED TAKEN TO
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SEATING POSITION |
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SAFETYEQUIPMENT |
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AIRBAG |
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AIRBAGSWITCH |
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EJECTION |
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01 |
FRONT – LEFT (MC DRIVER) |
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MOTORIST |
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1 |
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1 |
NOT PRESENT |
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1 |
NOT EJECTED |
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A |
02 |
FRONT – MIDDLE |
A |
01 |
NONE USED |
A |
2 |
A |
2 |
IN ON POSITION |
A |
2 |
TOTALLY EJECTED |
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03 |
FRONT |
– RIGHT |
02 |
SHOULDER BELT ONLY |
3 |
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3 |
IN OFF POSITION |
3 |
PARTIALLY EJECTED |
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04 |
SECOND – LEFT (MC PASS) |
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03 |
LAP BELT ONLY |
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4 |
DEPLOYED BOTH |
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4 |
UNKNOWN |
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4 |
NOT APPLICABLE |
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05 |
SECOND – MIDDLE |
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04 |
SHOULDER/LAP BELT |
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FRONT/SIDE |
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5 |
UNKNOWN |
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B |
06 SECOND – RIGHT |
B |
05 CHILD SAFETY SEAT |
B |
5 |
NOT APPLICABLE |
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B |
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B |
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07 |
THIRD – LEFT |
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06 |
MC HELMET USED |
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6 |
UNKNOWN |
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(MC PASSENGER/SIDE CAR) |
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07 |
USE UNKNOWN |
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08 |
THIRD |
– MIDDLE |
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C |
09 |
THIRD |
– RIGHT |
C |
08 |
NONE USED |
C |
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C |
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C |
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10 |
SLEEPER SECTION OF CAB |
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09 |
HELMET USED |
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11 |
ENCLOSED CARGO AREA |
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10 |
PROTECTIVE PADS |
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D |
12 |
UNENCLOSED CARGO AREA |
D |
11 |
REFLECTIVE CLOTHING |
D |
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D |
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D |
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13 |
TRAILING UNIT |
12 |
LIGHTING |
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BLANK FOR |
14 |
EXTERIOR |
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13 |
OTHER |
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15 |
OTHER |
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14 |
UNKNOWN |
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WITNESS |
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16 |
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17 |
UNKNOWN |
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HSY7001 |
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TOP COPY - ODPS |
BOTTOM COPY - AGENCY |
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TRAPPED
1NOT TRAPPED
A2 EXTRICATED BY MECHANICAL MEANS
3FREED BY
B
4UNKNOWN
C
D
INJURIES
1NO INJURY
A 2 POSSIBLE
3NON-
INCAPACITATING
4INCAPACITATING
B5 FATAL INJURY
6 UNKNOWN
C
D
SUPPLEMENT *
‘X” IF YES
UNITNUMBERS |
DAMAGEAREA |
SEQUENCE OF EVENTS |
POSTEDSPEED |
DRUGTEST STATUS |
A |
B |
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A |
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B |
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B |
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B |
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B |
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MOTORIST |
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1 |
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1 |
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1 |
NONE |
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01 MOVEMENTS ESSENTIALLY |
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2 |
EST |
R |
EFUSED |
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TRAFFICCONTROL |
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T |
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STRAIGHT AHEAD |
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3 |
TEST GIVEN, CONTAMINATED |
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02 BACKING |
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2 |
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2 |
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SAMPLE/UNUSABLE |
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4 TEST GIVEN, RESULTS KNOWN |
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A |
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B |
A |
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03 CHANGING LANES |
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04 OVERTAKING/PASSING |
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A |
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B |
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5 |
TEST GIVEN, RESULTS UNKNOWN |
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01 MARKED CROSSWALK AT |
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05 TURNING RIGHT |
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01 NO CONTROLS |
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6 |
UNKNOWN |
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INTERSECTION |
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06 TURNING LEFT |
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3 |
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3 |
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02 STOP SIGN |
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DRUGTESTTYPE |
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02 INTERSECTION/ NO CROSSWALK |
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07 MAKING |
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03 YIELD SIGN |
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03 |
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08 ENTERING TRAFFIC LANE |
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04 TRAFFIC SIGNAL |
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04 DRIVEWAY ACCESS CROSSWALK |
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09 LEAVING TRAFFIC LANE |
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4 |
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4 |
05 TRAFFIC FLASHERS |
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05 IN ROADWAY |
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10 PARKED |
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A |
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B |
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06 SCHOOL ZONE |
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06 NOT IN ROADWAY |
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11 SLOWING/STOPPED IN TRAFFIC |
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07 RAILROAD CROSSBUCKS |
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1 |
NONE |
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07 MEDIAN (BUT NOT SHOULDER) |
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12 DRIVERLESS |
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01 |
OVERTURN/ROLLOVER |
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08 RAILROAD FLASHERS |
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2 |
BLOOD |
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08 ISLAND |
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13 OTHER |
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02 |
FIRE/EXPLOSION |
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AILROAD |
G |
ATES |
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3 |
URINE |
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09 SHOULDER |
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B |
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14 UNKNOWN |
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09 R |
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03 |
IMMERSION |
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ONSTRUCTION |
B |
ARRICADE |
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4 |
OTHER |
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10 SIDEWALK |
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10 C |
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04 |
JACKKNIFE |
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11 POLICE OFFICER |
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11 WITHIN 10 FEET OF ROADWAY |
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15 ENTERING/CROSSING IN SPECIFIED |
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DRUGTEST1&2 RESULT |
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05 |
CARGO/EQUIPMENT LOSS/SHIFT |
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12 PAVEMENT MARKINGS |
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(NOT SHOULDER, MEDIAN, |
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LOCATION |
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06 |
EQUIPMENT FAILURE |
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13 |
CROSSWALK LINES |
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SIDEWALK, ISLAND) |
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16 |
WALKING, RUNNING, JOGGING, |
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A |
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B |
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07 |
SEPARATION OF UNITS |
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14 WALK/DON’T WALK SIGNAL |
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12 BEYOND 10 FEET OF ROADWAY |
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PLAYING, CYCLING |
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08 |
RAN OFF ROAD RIGHT |
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15 TRAFFIC CONTROL DEVICE INOPERATIVE, |
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(WITHIN TRAFFICWAY) |
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17 WORKING |
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09 |
RAN OFF ROAD LEFT |
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MISSING, OBSCURED |
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13 OUTSIDE TRAFFICWAY |
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18 PUSHING VEHICLE |
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1 |
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2 |
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1 |
2 |
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10 |
CROSS MEDIAN/CENTERLINE |
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16 OTHER |
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14 SHARED USE PATHS OR TRAILS |
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19 APPROACHING/LEAVING VEHICLE |
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11 |
DOWNHILL RUNAWAY |
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MOSTDAMAGEDAREA |
20 PLAYING/WORKING ON VEHICLE |
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15 UNKNOWN |
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12 |
OTHER |
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DIRECTION |
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1 |
NONE |
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21 STANDING |
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13 |
UNKNOWN |
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2 |
MARIJUANA |
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TYPEOFUNIT |
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FROM |
TO |
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FROM |
TO |
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22 OTHER |
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COLLISIONW/PERSON,VEHICLE, |
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3 |
COCAINE |
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23 UNKNOWN |
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OROBJECTNOTFIXED |
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4 |
OPIATES |
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A |
B |
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14 |
PEDESTRIAN |
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A |
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B |
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5 |
AMPHETAMINES |
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A |
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15 |
PEDALCYCLE |
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6 |
PCP |
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01 NONE |
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CONTRIBUTINGCIRCUMSTANCES |
16 |
RAILWAY VEHICLE |
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1 |
NORTH |
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7 |
OTHER |
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MOTORIST |
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02 CENTER FRONT |
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17 |
ANIMAL – FARM |
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8 UNKNOWN AT TIME OF REPORTING |
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2 |
SOUTH |
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01 |
03 RIGHT FRONT |
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18 |
ANIMAL – DEER |
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3 |
EAST |
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02 COMPACT |
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04 RIGHT SIDE |
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TYPE OF INTERSECTION |
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19 |
ANIMAL – OTHER |
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4 |
WEST |
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03 MID SIZE |
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05 RIGHT REAR |
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A |
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20 |
MOTOR VEHICLE IN TRANSPORT |
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5 |
NORTHEAST |
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04 FULL SIZE |
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06 REAR CENTER |
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21 |
PARKED MOTOR VEHICLE |
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MOTORIST |
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6 |
NORTHWEST |
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05 MINIVAN |
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07 LEFT REAR |
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22 |
WORK ZONE MAINTENANCE EQUIPMENT |
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01 NONE |
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7 |
SOUTHEAST |
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06 SPORT UTILITY VEHICLE |
08 LEFT SIDE |
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23 |
OTHER MOVABLE OBJECT |
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02 FAILURE TO YIELD |
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8 |
SOUTHWEST |
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07 PICKUP |
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09 LEFT FRONT |
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01 NOT AN INTERSECTION |
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24 |
UNKNOWN MOVABLE OBJECT |
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03 RAN RED LIGHT, OR STOP SIGN |
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9 |
UNKNOWN |
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08 PANEL/VAN |
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10 TOP AND WINDOWS |
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02 |
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COLLISIONWITHFIXEDOBJECT |
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04 EXCEEDED SPEED LIMIT |
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09 SINGLE UNIT TRUCK; |
11 UNDERCARRIAGE |
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03 |
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05 UNSAFE SPEED |
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25 |
IMPACT ATTENUATOR/CRASH CUSHION |
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|
2 AXLES, 6 TIRES |
12 |
LOAD/TRAILER |
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CONDITION |
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04 |
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26 |
BRIDGE OVERHEAD STRUCTURE |
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06 |
IMPROPER TURN |
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10 SINGLE UNIT TRUCK; 3+ AXLES |
13 TOTAL (ALL AREAS) |
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05 TRAFFIC CIRCLE/ROUNDABOUT |
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27 |
BRIDGE PIER OR ABUTMENT |
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07 LEFT OF CENTER |
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11 TRUCK/TRAILER |
14 OTHER |
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06 |
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08 FOLLOWED TOO CLOSELY/ACDA |
28 |
BRIDGE PARAPET |
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12 TRUCK TRACTOR (BOBTAIL) |
15 UNKNOWN |
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07 ON RAMP |
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29 |
BRIDGE RAIL |
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A |
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B |
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09 |
IMPROPER LANE CHANGE/ |
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13 |
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08 OFF RAMP |
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30 |
GUARDRAIL FACE |
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||||||||||||||||
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|
DROVE OFF ROAD/ |
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||||||||||||||
14 TRACTOR/DOUBLE SHORT |
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1 |
PPARENTLY |
N |
ORMAL |
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09 CROSSOVER |
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POINTOFIMPACT |
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IMPROPER PASSING |
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31 |
GUARDRAIL END |
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A |
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15 |
TRACTOR/DOUBLE LONG |
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2 |
PHYSICAL IMPAIRMENT |
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10 |
DRIVEWAY/ACCESS |
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10 IMPROPER BACKING |
32 |
MEDIAN BARRIER |
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16 FIFTH WHEEL OR |
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3 |
EMOTIONAL |
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11 RAILWAY GRADE CROSSING |
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33 |
HIGHWAY TRAFFIC SIGN POST |
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11 IMPROPER START FROM PARKED POSITION |
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CONVERTER DOLLY |
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4 |
ILLNESS |
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12 |
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34 |
OVERHEAD SIGN POST |
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12 STOPPED OR PARKED ILLEGALLY |
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17 |
TRACTOR/TRIPLES |
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A |
B |
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5 |
ELL |
A |
SLEEP |
, F |
AINTED |
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ATIGUED |
TC |
13 UNKNOWN |
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13 OPERATING VEHICLE IN ERRATIC, |
35 |
LIGHT/LUMINARIES SUPPORT |
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F |
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, E |
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18 MOTORCYCLE |
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6 |
UNDER THE INFLUENCE OF |
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36 |
UTILITY POLE |
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01 NONE |
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RECKLESS, CARELESS, NEGLIGENT OR |
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19 MOTORIZED BICYCLE |
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MEDICATIONS/DRUGS/ALCOHOL |
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OCCURRENCE |
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37 |
OTHER POST, POLE OR SUPPORT |
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02 CENTER FRONT |
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AGGRESSIVE MANNER |
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20 SCHOOL BUS |
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7 |
OTHER |
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03 RIGHT FRONT |
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38 CULVERT |
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14 SWERVING TO AVOID (DUE TO WIND, |
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21 CHURCH BUS |
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8 |
UNKNOWN |
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04 RIGHT SIDE |
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SLIPPERY SURFACE, VEHICLE, OBJECT, |
39 |
CURB |
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22 PUBLIC BUS |
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40 |
DITCH |
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05 RIGHT REAR |
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ALCOHOL/DRUG SUSPECTED |
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23 OTHER BUS |
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06 REAR CENTER |
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15 FAILURE TO CONTROL |
41 |
EMBANKMENT |
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24 POLICE VEHICLE |
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1 |
ON ROADWAY |
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07 LEFT REAR |
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16 VISION OBSTRUCTION |
42 |
FENCE |
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25 FIRE TRUCK |
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2 |
ON SHOULDER |
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08 LEFT SIDE |
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17 DRIVER INATTENTION |
43 |
MAILBOX |
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A |
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B |
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26 AMBULANCE/RESCUE |
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3 |
IN MEDIAN |
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09 LEFT FRONT |
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44 |
TREE |
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18 FATIGUE/ASLEEP |
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27 TAXI |
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4 |
ON ROADSIDE |
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45 |
OTHER FIXED OBJECT |
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10 TOP AND WINDOWS |
19 OPERATING DEFECTIVE EQUIPMENT |
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1 |
NONE |
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28 MOTOR HOME |
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5 |
ON GORE |
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11 UNDERCARRIAGE |
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20 LOAD SHIFTING/FALLING/SPILLING |
46 |
WORK ZONE MAINTENANCE EQUIPMENT |
2 |
YES – ALCOHOL SUSPECTED |
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29 TRAIN |
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6 |
OUTSIDE TRAFFICWAY |
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12 LOAD/TRAILER |
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21 OTHER IMPROPER ACTION |
47 |
UNKNOWN FIXED OBJECT |
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3 |
YES – HBD NOT IMPAIRED |
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30 FARM VEHICLE |
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7 |
UNKNOWN |
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13 TOTAL (ALL AREAS) |
22 UNKNOWN |
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48 |
OTHER |
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4 |
YES – DRUGS SUSPECTED |
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31 FARM EQUIPMENT |
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14 OTHER |
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49 |
UNKNOWN |
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5 |
YES – ALCOHOL / DRUGS SUSPECTED |
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32 SNOWMOBILE |
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ROADCONTOUR |
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15 UNKNOWN |
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23 NONE |
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6 |
UNKNOWN |
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33 CONSTRUCTION EQUIPMENT |
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FIRSTHARMFUL EVENT |
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24 IMPROPER CROSSING |
|
ALCOHOLTESTSTATUS |
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34 ALL OTHERS |
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ACTION |
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25 DARTING |
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26 LYING AND/OR ILLEGALLY IN ROADWAY |
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35 ANIMAL W/RIDER |
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A |
B |
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27 FAILURE TO YIELD RIGHT OF WAY |
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36 ANIMAL W/BUGGY |
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A |
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B |
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1 |
STRAIGHT LEVEL |
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A |
B |
28 NOT VISIBLE (DARK CLOTHING) |
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ICYCLE |
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OF THE SEQUENCE OF EVENTS – WHICH |
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2 |
STRAIGHT GRADE |
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37 B |
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29 INATTENTIVE |
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38 |
|
EDESTRIAN |
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ONE IS THE FIRST HARMFUL EVENT |
1 |
NONE |
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3 |
CURVE LEVEL |
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P |
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1 |
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30 FAILURE TO OBEY TRAFFIC SIGNS, |
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EDALCYCLIST |
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2 |
TEST REFUSED |
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4 |
CURVE GRADE |
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39 P |
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2 |
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SIGNALS, OR OFFICER |
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40 SKATER |
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MOSTHARMFUL EVENT |
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3 |
TEST GIVEN, CONTAMINATED |
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3 |
STRIKING |
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31 WRONG SIDE OF THE ROAD |
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M |
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SAMPLE/UNUSABLE |
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THER |
ON |
OTORIST |
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ROADCONDITIONS |
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41 O |
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4 |
STRUCK |
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32 OTHER |
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42 UNKNOWN |
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4 |
TEST GIVEN, RESULTS KNOWN |
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PRIMARY |
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SECONDARY |
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5 |
BOTH STRIKING AND STRUCK |
33 UNKNOWN |
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5 TEST GIVEN, RESULTS UNKNOWN |
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INEMERGENCYRESPONSE |
6 |
UNKNOWN |
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A |
B |
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6 |
UNKNOWN |
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VEHICLEDEFECT |
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OF THE SEQUENCE OF EVENTS – WHICH |
ALCOHOL |
TEST TYPE |
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CODEONLYIF‘19’ |
|
ONE IS THE MOST HARMFUL EVENT |
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A |
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B |
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SELECTEDABOVE |
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RY |
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01 D |
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STRIKINGVEHICLE: |
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02 WET |
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1 |
NO |
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SPEED DETECTED |
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A |
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B |
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03 SNOW |
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OVERRIDE/UNDERRIDE |
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2 |
YES |
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04 |
ICE |
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1 |
NONE |
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4 |
BREATH |
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3 |
UNKNOWN |
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A |
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B |
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05 SAND, MUD, DIRT, OIL, GRAVEL |
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2 |
BLOOD |
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5 |
OTHER |
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06 WATER (STANDING, MOVING) |
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A |
B |
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A |
B |
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3 |
URINE |
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DAMAGESCALE |
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01 T |
S |
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07 SLUSH |
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URN |
IGNALS |
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** |
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02 HEAD LAMPS |
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1 |
STATED |
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ALCOHOLTESTRESULT |
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08 D |
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1 NO UNDERRIDE OR OVERRIDE |
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EBRIS |
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03 |
TAIL LAMPS |
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2 |
ESTIMATED SPEED |
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09 |
UT |
, H |
OLES |
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UMPS |
NEVEN |
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2 |
UNDERRIDE, COMPARTMENT |
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. |
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R |
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, B |
, U |
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04 |
BRAKES |
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PAVEMENT ** |
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B |
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INTRUSION |
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05 STEERING |
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SPEED |
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A |
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10 OTHER |
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3 |
UNDERRIDE, NO COMPARTMENT |
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06 TIRE BLOWOUT |
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11 UNKNOWN |
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INTRUSION |
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1 |
NONE |
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07 WORN OR SLICK TIRES |
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* *SECONDARY ROAD CONDITIONS ONLY |
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4 |
UNDERRIDE, COMPARTMENT |
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. |
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2 |
08 TRAILER EQUIPMENT |
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INTRUSION UNKNOWN |
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A |
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B |
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3 |
FUNCTIONAL DAMAGE |
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DEFECTIVE |
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5 |
OVERRIDE, MOTOR VEHICLE IN |
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ISABLING |
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AMAGE |
09 MOTOR TROUBLE |
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LOCAL REPORT # * |
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4 |
D |
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D |
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TRANSPORT |
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ISABLED |
F |
ROM |
P |
RIOR |
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SUPPLEMENT |
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5 |
SEVERE |
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6 |
OVERRIDE, OTHER VEHICLE |
10 D |
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B |
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‘X” IF YES * |
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6 |
UNKNOWN |
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CRASH |
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7 |
UNKNOWN |
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11 OTHER DEFECTS |
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TOP COPY - ODPS BOTTOM COPY - AGENCY
Narrative
MANNEROFCOLLISIONORIMPACT |
SCHOOLBUSRELATED |
Diagram |
Writean“N” |
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onthecompass |
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diagramtoindicate |
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thedirectionof |
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1 |
NO |
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north. |
1 |
|
NOT COLLISION BETWEEN |
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TWO VEHICLES IN TRANSPORT |
2 |
YES, DIRECTLY INVOLVED |
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2 |
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3 |
YES, INDIRECTLY INVOLVED |
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3 |
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4 |
UNKNOWN |
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4 |
WORKZONERELATED |
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5 |
|
BACKING |
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6 |
|
ANGLE |
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7 SIDESWIPE, SAME DIRECTION |
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8 SIDESWIPE, OPPOSITE DIRECTION |
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9 |
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UNKNOWN |
1 |
NO |
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2 |
YES |
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WEATHER |
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3 |
UNKNOWN |
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TYPEOFWORKZONE |
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01 CLEAR |
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02 CLOUDY |
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1 |
LANE CLOSURE |
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03 |
FOG, SMOG, SMOKE |
2 |
LANE SHIFT/CROSSOVER |
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04 RAIN |
|
3 |
WORK ON SHOULDER OR MEDIAN |
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|
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05 |
SLEET, HAIL (FREEZING RAIN DRIZZLE) |
4 |
INTERMITTENT/ MOVING WORK |
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06 SNOW |
|
5 |
OTHER |
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||
07 SEVERE CROSSWINDS |
LOCATIONOFCRASH IN |
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|
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08 |
BLOWING SAND,SOIL, DIRT,SNOW |
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WORKZONE |
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09 OTHER |
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10 UNKNOWN |
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LIGHTCONDITIONS |
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PRIMARY |
SECONDARY |
1 |
BEFORE FIRST WORK ZONE |
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WARNING SIGN |
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2 |
ADVANCE WARNING AREA |
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1 |
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DAYLIGHT |
|
3 |
TRANSITION AREA |
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4 |
ACTIVITY AREA |
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2 |
|
DAWN |
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3 |
|
DUSK |
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WORKERSPRESENT |
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4 |
|
DARK – LIGHTED ROADWAY |
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5 |
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DARK |
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6 |
|
DARK – UNKNOWN LIGHTING |
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7 |
|
GLARE |
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8 |
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OTHER |
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1 |
NO |
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9 |
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UNKNOWN |
2 |
YES |
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3 |
UNKNOWN |
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Truck/Bus |
THE CRASH INVOLVED ONE OR MORE OF THE FOLLOWING: |
A THE CRASH RESULTED IN ONE OR MORE OF THE FOLLOWING: |
||||
|
|||||||
|
A TRUCK (MOTOR VEHICLE) WITH A GVWR MORE THAN 10,000 POUNDS; OR |
N |
A FATALITY; OR |
||||
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|
|
A TRUCK (MOTOR VEHICLE) WITH A HAZARDOUS MATERIALS PLACARD; OR |
AN INJURY REQUIRING TRANSPORTATION FOR IMMEDIATE MEDICAL TREATMENT; OR |
||
|
|
|
|
D |
|||
|
UNIT # |
A BUS DESIGNED FOR AT LEAST 8 PERSONS, INCLUDING DRIVER . |
AT LEAST ONE VEHICLE WAS TOWED DUE TO DISABLING DAMAGE OR REQUIRED INTERVENING ASSISTANCE BEFORE PROCEEDING UNDER ITS OWN POWER. |
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COMPANY (FROM SHIPPING PAPERS) |
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COMPANY PHONE |
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ADDRESS (STREET, CITY, ST, ZIP CODE) |
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US DOT |
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ICC MC |
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PUCO |
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TRAILER LP ST. |
TRAILER LP YEAR |
TRAILER LP # |
|
PLACARD # |
# DIA. |
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CARGOBODYTYPE01 |
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Weight (GVWR) |
CDLClass |
|
|
Hazardous |
|
Hazardous |
|
||
NOT APPLICABLE |
|
05 |
POLE |
09 |
CONCRETE MIXER |
|
1 |
CLASS A |
MaterialsPlacard |
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|||||||||||||
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|
MaterialReleased |
|||||||||||||||||||||
02 |
BUS |
06 |
CARGO TANK |
10 |
UTO |
T |
RANSPORTER |
1 |
LESS/EQUAL 10,000 |
2 |
LASS |
B |
1 |
NO |
1 |
NO |
|||||||
A |
|
2 |
10,001 - 26,000 |
C |
|||||||||||||||||||
03 |
V |
AN |
/E |
NCLOSED |
B |
OX |
07 |
LATBED |
11 |
ARBAGE EFUSE |
3 |
LASS |
C |
2 |
YES |
2 |
YES |
||||||
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F |
G |
|
/R |
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C |
||||||||||||
04 |
G |
RAIN |
/C |
HIPS RAVEL |
08 |
UMP |
12 |
THER |
|
3 |
MORE THAN 26,000 |
4 |
CLASS M |
3 |
UNKNOWN |
3 |
NOT APPLICABLE |
||||||
|
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/G |
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D |
O |
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13 |
UNKNOWN |
|
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5 |
CLASS D |
|
|
4 |
UNKNOWN |
Police Action
DATE CRASH REPORTED |
TIME REC CALL |
OFFICER’S NAME *
DISPATCH
BADGE # *
ARRIVEDCLEAREDOTHERTOTAL MINUTES
|
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CHECKED BY |
|
DATE REPORT FILED |
* |
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REPORTTAKENBY |
1 POLICE AGENCY |
REPORTTAKEN AT |
1 SCENE |
|
|
LOCAL REPORT # |
* |
SUPPLEMENT |
* |
|
|||||
|
2 MOTORIST |
|
|||||
|
|
2 STATION |
‘X” IF YES |
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||
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|||
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3 OTHER |
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TOP COPY - ODPS |
BOTTOM COPY - AGENCY |
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