HomeMy WebLinkAbout2026-00024618 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets DII 111011 II
I0110
111111111111010100 0
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004222720
u, 1 U2 1 1 1 U116 U2 U, 1 u2 U, 1 U2 1 7 U1 1 U2 *P 0119*
INVESTIGATING AGENCY DAMAGE TO ANY El g500 OR LESS TYPE OF REPORT 0 A No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW
Elgin Police Department ONE PERSON'S ❑sso,-g1.500 ®ON SCENE 2
VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 23 B Injury and/or Tow Due To Crash
0 AMENDED YR 202612026-00024618 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 10 �I
NATIONAL ST Elgin
® ❑ RELATED ❑Y ®N 05 01 2026 ❑AM ❑YES ®NO U1 -<
PRIVATE mo /day/yr 01:00 ®PM FLOW CONDITION m
_
Oq0(y� COUNTY PROPERTY ❑Y ® N DOORING El #OF MOTOR 0 SLOW Cl)
O/MI N CI S W State St WITH VEHICLES INVLD 0 STOPPED U2 --I
0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) Kane HIT&RUN ❑V ® N PEDALCYCLIST®N ® FREE FLOW # LNS 0
Ig: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 01 FOR DAMAGEDAREA(S) FROf T TOWED U1 Q
Po ovich. Eric.J. 1 0 /
yr
13-UNDER CARRIAGE 161 O 2 FIRE ❑ NI
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 Ea U2 m
M 17 SYTM IN ENGAGETHER
3 ❑Y ®S NE El UNK VEH. 0 AT CRASH 0 99-Uis-UNKNOWN 9 16-TOPO ,Distraction Value 9 ALGN =
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6• iI 6 it COM VEH 0 Ea 5 C)
F. FIRST CONTACT 3 7 _L--_;_OS .irYes.See Sidebar U1 0
II'. WHEATON IL 60189 B 2 8 MCGA6253 IL 2026 REAR
TELEPHONE
IL M 0 JS1 DM11 H8P7100682 DAIRYLAND ❑Y ®N U2 ni
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
co
Elgin Fire 99 9 Same 11409442830 6 r
o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Provena St.Joseph ❑Y ® N 2 0
rg-
❑ DRIVER 0 PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NOV 0 NOV 0 DV
yr 12 _ 71
o 13-UNDER CARRIAGE 10 I 2 FIRE 0 ❑ U2 C
c SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED
a SYSTEM IN ENGAGED 15-OTHER 916-TOP 3 ❑ El SPDR n
❑Y 0 N ❑UNK VEH. AT CRASH 99-UNKNOWN POINT OF 8 `Oistrac) n Value 0 -
-.;, 4
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT TA—d:-5 CIO e1sVEH •Sidebar❑ El U1
• SeeCO
I.* ---,- co
M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 O
❑Y ❑N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 9 =
BAC
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
RESP❑YDNDER❑N U1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) n
/ / U2 r
m
Pj
LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z
N 1 ® 20 1 05,01 /2026 01 02 ®PM in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1
v t 2 0 28 12 05,01 /2026 01 03 ®PM ❑Construction
*
R O 0 ]$I CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME
3 ❑AM 0 Maintenance U2
-a, ARREST NAME Popovich. Eric.J. 11-601 W1565000030 05/01 /2026 01 07 ®PM SLMT
o u 1 ❑ Utility
CITATIONS ISSUED PENDING
o N SECTION CITATION NO. ROAD CLEARANCE TIME 0
t 2 El ARREST NAME 05/01 /2026 01 38 ®PM 0 Unknown work zone type U1 0 AM 25
-r
n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME Y
-2 3 ❑ ❑AM Workers present? ❑
1565-Harris.Jeffrey 701 , / ❑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.
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 INDICATE NORTH combination):or .Z-1
A0pA BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
_ (example:shuttle or charter bus):or
ii 3. Is designed tocarry 15 or fewer passengers and operated by a contract carrier I O
I- I: de in pa g pe
}.---a.. terra `
} } } transporting employees in the course of their employment(example:employee
transporter-usually a van type vehicle or passenger car):or 03
L 4. Is used or designated to transport between 9 and 15 passengers,including C}--- ----; - - } } g Po passen rs,includi the driver,
for direct compensation(example:large van used for specific purpose):or O
L i l. i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m
placarding(example:placards will be displayed on the vehicle). XI
I ?
..u.. + I: CARRIER NAME Z
anwar
ADDRESS
C)
_Not 7o Scale I CITY/STATE/ZIP g
MOTOR CARR.ID 0 Interstate 0 Intrastate
0
I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other
‘I. - --1 - USDOT NO. ILCC NO. m
XI
Source of above z
. • m
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 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
to
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_COLOR TRAILER LENGTH(S)1 ft. 2 ft. w
White
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO.
_Redmons/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET
U_DUE ETOO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: TOWED BY/TO:
DUE T VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE