HomeMy WebLinkAbout2026-00013006 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 0 fl fl 00 000
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XO0416O 4.$
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INVESTIGATING AGENCY DAMAGE TO ANY 0$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW '
Elgin Police Department ONE PERSON'S 0$501-$1.500 ®ON SCENE 14
VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
El AMENDED
YR 2026I 2026-00013006 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH I '1
® ❑ RELATED ®Y 0 N 03 08 2026 ®AM ❑YES ®NO U1
N SPRING ST Elgin 10:19
_ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION III
FT!MI N E S W E CH ICAGO ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ®SLOW 1 (n
❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I
® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0
Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EDUCE 0 NW 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 C)
FOR DAMAGEDAREA(S) mom TOWED U1 O
NAME(LAST,FIRST,M) mo
/1 9 8 1 Scion TC 2014 00-NONE ,, • 12 , DUE TO CRASH ® 0 E
13-UNDER CARRIAGE FIRE ❑ tz
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 h O DISTRACTED 0 0 U2 2 III
F 2 4 SYTM❑Y ®SNE❑UNK VEH. O ATCRASHH 0D 99-U 15-UNKNOWN THER 9 76•TOP4 `Distraction Value ALGN X.
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF $ iI 6 jl COM VEH 0 Ea 1 C)
I.• FIRST CONTACT 2 7 _ --_;__5 *lives.See Sidebar U1 0
Z ELGIN IL 60120 0 1 0 CV79143 IL 2026
TELEPHONE
IL D 0 JTKJ F5C70E3079502 no insurance ❑Y ❑N U2 m
B EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Elgin Fire 99 9 Same no insurance 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Sherman ❑Y El 2 eu
g DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED ❑PEDAL 0 EWES 0 N,Iv 0 NDV ❑DV
/2 0 0 9 Nissan Altima 2003 00-NONE O Qi-O DUE TO CRASH ❑ 2
0 13-UNDER CARRIAGE 10( I 2 FIRE 0 ® U2 C
M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X
❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *OistractIon Value 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 6 11:, 4 COM VEH ❑ ® U1 CO
FIRST CONTACT 2 7�. -5 •
11... 0
FIRST
IL 60123 0 1 0 Z150588 IL 2026 REAR If Yes.See Sidebar 0
M
IL D 0 1 N4BL11 E43C110560 Progressive ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER I X
Elgin Fire 99 9 Ortega. Miguel.A. 862240895 SAC E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP
U1 =
(UNIT) (SEAT) (DO81 (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL)
2 3 09 / M 2 4 C 1 0
m
/ / #OCCS D
/ / U1 1 D
/ / 2 O
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 ® 11 4 Henderson. Mike. R. Damaged wooden fence 31 ,12 /26 11 52 ®❑pM AM in a Work Zone? ®N DIRP co
1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1
2 ❑ 39 2 203 E CHICAGO ST ELGIN IL 60120 25 28 31 ,12 /26 10 20 pm
❑ • ❑Conslnlction >F
3 0 I!!I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3
®AM ❑Maintenance U2
-a, ARREST NAME Wisniewski.Christina.G. 3-707 1573-000013 3/ ,12 /26 10 23 ❑PM SLMT
o u ® 11 4 igiCITATIONS ISSUED 0 PENDING - 0 Utility
o N SECTION CITATION NO. ROAD CLEARANCE TIME AM 30
t 2 El ARREST NAME Wisniewski.Christina.G. 11-305-A 1573-000012 3/ //2 /26 11 20 0 PM 0 Unknown work zone type U1
n 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME
2 2 3 0 - ❑AM Workers present? 0 Y 30
1573-Bea�Iey. Martese 101 , / ❑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
Une 1 ADDITIONAL UNITS FORMS.
t5J L r ----r••--, , I ; 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 truckrtrailer -<
/- }---_r_ --; combination):or
. 0
INDICATE NORTH
Ili ARROW 2 Is used or designed to transport more than 15 passengers including the driver —I
} E?Chl ?3treet - (example:shuttle or charter bus):or 0
r rr
I I Unit 1 3. Is designed to carry 15 or fewer passengers and operated a contract carrier O
}----- ----; — - transporting employees In the course of their employment(example:employee X
1Jntt 2—i § — — — — transppoorterg-usuall a van type vehicle or passenger car): r c0
} } }
tl~ ) 'g 6> rt0M I.
} } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver, y
1 for direct compensation(example:large van used for specific purpose):or
203?E?ChlaVo?Street O
L L____a____. t i. i i t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)thatrequires
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a placarding(example:placards will be displayed on the vehicle). XI
m
r r -I- 1 1 OS I' :' r I-- --1-
CARRIER NAME Z
ADDRESS
& �
CITY/STATE/ZIP 00
A0
MOTOR CARR.ID 0 Interstate 0 Intrastate
-
I I I ❑ Not in Comm./Govt. Not in Comm./Other
I '
, _Y____ USDOT NO. ILCC NO. m
Not To Scale
Source of above z
. own tank)? 0 Yes 0 No 0 Unknown
Did HAZMAT Regulations violation contribute to the crash? r
❑ Yes 0 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
Blue Silver
u 1 TOWED •
TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO.
Arties/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO:
DUE TO ® DISABLING DAMAGE Arties/Impound.Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE