Loading...
HomeMy WebLinkAbout2025-00001457 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 6 Sheets 01111101111 IIIIII 00 III 1100 IIIIIIIII 11011111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X0036508.02` u, 1 U21 1 1 1 U199 U2 1 u, 1 1_12 1 u, 1 U2 1 1 10 u, 2 u2 3 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ElB Injury and f or Tow Due To Crash YR 202512025-00001457 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n CHIPPEWA DR Elgin02:50 ® ❑ RELATED ❑Y ®N 01 07 2025 ❑AM ❑YES El NO U1 —< _ _ g PRIVATE mo !day/yr ®PM FLOW CONDITION m FT N E S W PATRICIADR COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 6 cn ❑ Cook HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 —I CO AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 NIA/ 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 C) 1 201 3 FOR DAMAGEDAREA(S) FROM 0 TOWED U1 O NAME(LAST,FIRST,M) Hauschild. Donna. L. mo / 13-UNDER CARRIAGE ) FIRE 0IE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 0 DISTRACTED 0 0 U2 0 m F 2 SYTHER 4 ❑Y ON E DUNK VEH. 0 AT CRASH M IN ENGAGED 0 99-UNKNOWN 9 16-TOP 3 `Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 ;i� 6 �i 4 COM VEH 0 0 1 0 ~ ELGIN IL 60120 0 1 0 FIRST CONTACT 2 7 : __5 *IIYes.See Sidebar U1 Z FA96523 IL 2024 TELEPHONE IL 5J6RM4H70DL010756 American Alliance ❑Y ®N U2 m IS EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same I LAA 0905941 01 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused El ® N 2 c p; DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES ❑MAv 0 KCv ❑DV !1 9 yf 6 Chevrolet Silverado 2020' 00-NONE O 2 1.-_, DUE TO CRASH ❑ 2 x ... 13-UNDER CARRIAGE I ©). 2 FIRE 0 ® U2 C c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOP 3 X ❑Y i N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6-it 6 11:, 4 COM VEH ❑ ® U1 CO FIRST CONTACT 10 7�� _.5 •If Yes.See Sidebar F= ELGIN IL 60120 0 1 0 2852993B IL 2024 I 0 C IL D 3GCUYEED6LG202702 State Farm ❑Y ®N RDEF 73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Corral.Jocylin 3343518-SFP-13 BAG E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP 996 < Refused RESPONDER U1 = KNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) U2 996 r m #occs y / U1 1 D 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 4 01 ,07 /2025 02 50 ®PM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 � 2 0 04 18 N 3 0 0 CITATIONS ISSUED ID PENDING + / 0 PM- ❑Construction SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 1 —a, ARREST NAME / / 0 PM o N ® 11 1 0 • CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility SLMT t 2 ❑ 35 ARREST NAMEAM x- T , / ❑❑PM 0 Unknown work zone type U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 475-Williarhs. Brianna 201 334-Fries , / D PM Workers present? ®N U2 35 REMEMBER TO USE BLACK INK,PRESS HARD,PRINT LEGIBLY AND COMPLETE ALL REQUIRED FIELDS! A Diagram and Narrative are required on all Type B crashes, LARGE TRUCK, BUS, OR HM VEHICLE even if units have been moved prior to officer's arrival. IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A ADDITIONAL UNITS FORMS. r ----r••--, , ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< i- }---.r----; ' combination):or —I INDICATE NORTH p1 I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C 0 - --J. j r r (example:shuttle or charter bus):or X I- I- -I. A. I 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O I N - } } } transporting employees in the course of their employment(example:employee transporter-usually a van type vehicle or passenger car):or c0 I. 4. Is used or designated to transport between 9 and 15 passengers,including C}--- ----+ - } } } g po passen rs,includi the driver, met for direct compensation(example:large van used for specific purpose):or O L L____a____.I _ _ _ a ..,I �i — _ — i i L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m i ` •Oplacarding(example:placards will be displayed on the vehicle). XI _ CARRIER NAME Z ADDRESS 0aboewtw D Not To Scale I I i. C) CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ----------1 - USDOT NO. ILCC NO. m Xl Source of above z IDOT PERMIT NO. WIDELOAD� El Yes0 No TRAILER VIM 1 m co LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' -n TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Brown Black u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT' 2 TOWED BY/TO: _ SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE