HomeMy WebLinkAbout2026-00008474 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0 III 100
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XO04138064
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INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW
Elgin Police Department ONE PERSON'S ❑$501-S1,500 ®ON SCENE 3
VEHICLE/PROPERTY ®OVER 61,500 El NOT ON SCENE(DESK REPORT) El B Injury and f or Tow Due To Crash
El AMENDED
YR 202612026-00008474 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 m® ❑ RELATED ®Y 0 N 02 13 2026 ®AM ❑YES ®
PRIVATENO U1
N RANDALL RD Elgin mo /day/yr 10:44 ❑PM FLOW CONDITION Ill
®20�F !MI O E S W Holmes Rd COUNTY PROPERTY 0 Y ® N DOORING ❑y #OF MOTOR ❑SLOW 3 Cl)
Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ® STOPPED U2 —I
❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ❑ FREE FLOW # LNS O
Hi DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 0
FOR DAMAGEDAREA(S) FRO NT�TOWED EN
U1 0Weisenseo. Donna. K. 0 2 /
yr 13-UNDER CARRIAGE 10.I 2 FIRE 0
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 4 <<Tl
F 2 SY is-OTHER
4 ❑Y ONM❑UNK VEH. O AT CRASH IN D O 99-UNKNOWN 9 16•TOP 3 *Distraction Value ALGN =
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S, i�S 4 COM VEH 0 Ea 1 0
~ MchenryIL 60050 0 1 0 FIRST CONTACT 12 7 ; _5 *lIVes.SeeSidebar U1
ZBCALM-PF IL 2026 REAR
TELEPHONE
IL D 0 JTJ BC1 BA2A2028722 Progressive ❑Y ®N U2 93 , m
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Same 957945241 1 r
o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused ❑Y El 2 0
p; DRIVER ❑ PARKED 0 DRIVERLESS ❑ FED ❑PEDAL ❑EWES ❑iiuv 0 NOV ❑DV
!1 9 6 8 Honda Odyssey 2013 00-NONE 'o,1 t2 c,�2 DUE O CRASH 0 ® U2 2 C
o _ 13-UNDER CARRIAGE
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F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9..16-TOP 3 X
❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraclion Value 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S 1 S t 4 COM VEH ❑ ® Ut W
F,,, FIRST CONTACT 6 O7 ,�_Q,OS C.If Yes,See Sidebar C
60110 C 1 0 G DAN ES IL 2026 'PEAR 0 Si)
M
IL D 0 SFNRL5H46DB051318 State Farm ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X
Elgin Fire 99 9 Same 2610407-SFP-13 BAC
E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Sherman RESPONDER El N u1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME),(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL)
1 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 ® 11 1 21 ,31 ,026 10 44 ®❑pM in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1 C)
453. 2 28 18 21 ,31 ,026 11 02 ❑PM ❑Construction *
R 3 0 ]$I CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME 5
z J ®AM ❑Maintenance U2
a1 ® 11 1 ARREST NAME Weisenseo. Donna. K. 11-601-Ax 1560000384 21 ,31 r026 11 15 ❑PM El Utility SLMT
o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME
AM 55
t 2 El ARREST NAME 21 r 31 ,026 11 02 MPM 0 Unknown work zone type U1
2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 55
1560-Jones. Bennett 901 337-Thompson 31 , 12 ,26 09 00 ❑PM ®N U2
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.
, , , L11.9.4319ArIA CMV is defined as any motor vehicle used to transport passengers or property and: Zua« I II1. Has a weight rating more than 10,000 pounds(example:truck or truckrtraileri- ,.-� III - } combination):or -I
rr o Scale INDICATE NORTHr ' III BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver CL (example:shuttle or charter bus):orX
I=iI I I 3. Is designed to car 15 or fewer ssen ers and o rated a contract carrier O
} -A-.•-� } } } transporting employees In the course�of their empbyment(example:employeetransporter-usually a van Type vehicle or passenger car):or
11Y1''I I I } 4. Is used or desi nated to trans rt between 9 and 15 ge ng cC/t
-- } for direct com nation exam I lar a van used for s �cifice ur o ):or [he driver,Pe ( P 9 Pe p pose):or O
I IIi t 5. Is any vehicle used to transport an hazardous material(HAZMAT)that requires
placarding(example:placards will be displayed on the vehicle). m
y D
CARRIER NAME Z
Z
— — — — ADDRESS 0
W
CITY/STATE/ZIP n
r . . . . ,. MOTOR CARR.ID 0 Interstate 0 Intrastate
I I I I 0 Not in Comm./Govt. Not in Comm./Other
;____Y_._. USDOT NO. ILCC NO. m
XI
Source of above z
. —I
Were HAZMAT placards on vehicle? 0 Yes 0 No =
If Yes,Name on placard O
4 digit UN NO. 1 digit Hazard class No. XI
XI
Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's z
own tank)? 0 Yes 0 No 0 Unknown
Did HAZMAT Regulations violation contribute to the crash? r
❑ Yes ❑ No 0 Unknown g
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 0 No 2
TRAILER VIN 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
Gray Gray
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