HomeMy WebLinkAbout2025-00024052 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 01101100 1001111IIII�I1111II
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INVESTIGATING AGENCY DAMAGE TO ANY 0 5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW '
Elgin Police Department ONE PERSON'S M$501-51,500 ®ON SCENE 14
VEHICLE/PROPERTY ❑OVER 51,500 ❑NOT ON SCENE(DESK REPORT)
El AMENDED ❑ B Injury and/or Tow Due To Crash YR 2025512025-00024052 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 5 -n
® ❑ RELATED ®Y 0 N 04 16 2025 12,— ❑YES
PRIVATE I NO U1
W HIGHLAND AVE Elgin mo /day/yr 03:40 MPM FLOW CONDITION M
00 0/MI NOS S W North McLean Blvd COUNTY PROPERTY 0 Y M N DOORING Ely #OF MOTOR 0 SLOW 5 Cl)
Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 -I
❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST M N M FREE FLOW # LNS 0
18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NOV 0 Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n
0 6 /
yr 13-UNDER CARRIAGE 10.I !�. 2 FIRE ❑ M
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 M U2 2 I'T1
M 2 4 ❑Y ®N
SYSTEM
❑UNK VEH. 0 AT CRASHD 0 99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 it �i 4 COM VEH M 0 1 n
I— FIRST CONTACT 11 7__)_—_-6_;__5 *IIYes.See Sidebar U1 0
Z ELGIN IL 60123 0 1 0 117818SB IL 2025 REAR
TELEPHONE
IL A 7 4DRBUC8N2GB165086 Illiinois Counties Risk M ❑Y IlN U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m
99 9 U46 School District P4-1001458-2425-01 1 I—
t HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER
7 0
m g DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑r My 0 Ncv ❑DV
/1 9 yf 2 International GtlaCE3 2019 00-NONE ,�_' t2 -_, DUE TO CRASH ❑ M 7 xi
0 13-UNDER CARRIAGE o I 2 FIRE ❑ M U2 C
F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 016•TOP 3 X
❑Y M N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR PFIRST CONTACT 1 O O`NT OF Ij 6 ',_5 CIO es SeeSidebaH ® ❑ U1 CO
m ELGIN IL 60123 0 1 0 99667SB IL 2025 • 0 Si)
Z
IL B 7 4DRBUC8NXKB046940 Illiinois Counties Risk M ❑Y 0 N RDEF XI
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 X
99 9 U46 P4-1001458-2425-01 BAG $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP
U1 =
KNIT) (SEAT) (DM (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)//TELEPHONE) (EMS) (HOSPITAL)
2 7 01 /
LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y
N 1 ® 11 1 04/16 /2025 03 40 ®pm in a Work Zone? M N DIRP co
1 r PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 2
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1
0
2 0 28 06 / / ❑PM ❑Construction *
R 3 0 M CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7
❑AM 0 Maintenance U2
a ® 11 1 ARREST NAME Switzer.Clifford. E. 11-601 W1542-000213 / / El PM SLMT
o N ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility
AM
r 2 ElARREST NAME 04/16 /2025 ❑❑pM ElUnknown work zone type U1 30
n 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME
2 2 3 ❑ 1542-Chase. Ethan 601 - / / ❑❑AM Workers present? ®N U2 30
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 INLVED,USE SR 1050A
ADDITIONAL UNITVOS FORMS.
r ----r••--, , I I
® - ; A CMV is defined as any motor vehicle used to transport passengers or property and:
01. Has a weigh t rating more than 10,000 pounds(example:truck or truck trailer
-<
} }-- --I-- --' I I • INDICATE NORTH combination):or -I
Not To Scale I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
} (example:shuttle or charter bus):or
L A } transportingI I 3. Is designed to carry 15 or fewer passengers and operated a contract carrier O
} } employees In the course of their employment(example:employee X
NaI transporter-usually a van type vehicle or passenger car):or CO
}.___a_ __1 la r/�` I. } } } 4. Is used or designated to transport between 9 and 15 passengers,indudingthe driver. C
rect
on(example:
e van
or specific
' 1 ___� ." _ i. < < L 5forsl any vehicenusedtotasportlanhazadousf material(HAZMAT))that requires
.' ..o placarding(example:placards will be any
on the vehicle).
D
CARRIER NAME Z
1 __ ADDRESS D
if I I C)
CITY/STATE/ZIP I 0
I II _ MOTOR CARR.ID 0 Interstate 0 Intrastate
I ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00
I C
i. i. USDOT NO. ILCC NO. m
XI
Source of above z
. If Yes,Name on placard 0
4 digit UN NO. 1 digit Hazard class No.
XI
Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's z
own tank)? 0 Yes ® No 0 Unknown
Did HAZMAT Regulations violation contribute to the crash? r
❑ Yes 0 No 0 Unknown M
D
Did Carrier Safety Regulations MCS)violation contribute to the crash? A
❑ Yes II El Unknown C
Was a driver/vehicle Examination Report Form completed? r
HAZMAT ❑Yes 0 No ❑Unknown Out of Service ❑Yes ®No 7
MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ®No C
Z
Form Number 0
m
Xl
IDOT PERMIT NO. WIDELOAD-; ❑Yes ®No 2
TRAILER VIN 1 m
to
LOCAL USE ONLY TRAILER VIN 2 m
0
TRAILER WIDTH(S) 0-96" 97-102" >102' -n
TRAILER 1 0 0 0 Z
TRAILER 2 ❑ 0 0 O
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w
Yellow Yellow
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO:
_ . SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO.
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE