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HomeMy WebLinkAbout2026-00029578 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 10110 II llllllll� 11111 1111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV XO0424368.3 u, 1 U21 1 1 1 U1 2 U2 1 U, 1 U2 1 U1 1 U2 1 1 10 u1 3 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash ID AMENDED YR 2026I 2026-00029578 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn ® ❑ RELATED ' V 0 N 05 24 202612,— ❑YES ®NO U1 ROYAL BLVD Elgin PRIVATE mo /day/yr 12:12 ®PM FLOW CONDITION ITT 00 1C.'J/MI NOS W RANDALL Rd COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 -I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 tg:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NW 0!Cu 0 DJ DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n Ii80P,r TOWED U1 Q CHWALISZ.CAROLINE. E. mo Forrester 2025 00-NONE ©, O , DUE TO CRASH ❑ EN O NAME(LAST,FIRST,M) yr 13-UNDER CARRIAGE I FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 2 DISTRACTED 0 0U2 2 rn F 2 SYTM IN ENGAGE4 ❑Y ®SNE❑UNK VEH. 0 AT CRASHO 0 99-UNKNOWN 9 76•TOP 3 `Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, i�a �i 4 COM VEH 0 j$J 1 0 ELGIN I L 60123 0 1 0 FIRST CONTACT 11 7_: __5 *Ilyes.See Sidebar U1 Z MJ5267 IL 2025 REAR TELEPHONE IL D 0 JF2SLDDCOSH603600 ALLSTATE ❑v ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 Same 811001868 1 1— "6 HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER 711 D Refused ❑Y ElN 2 0 m g DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL 0 EWES 0 ivy 0 KCV 0 Dv /1 9 8 6 Toyota Corolla 2005 00-NONE 0 Qj O DUE TO CRASH ❑ 2 .io13-UNDER CARRIAGE I FIRE ❑ ® U2 c M 2 8 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,19-TOP 3 X ❑Y NJ N ❑UNK VEH. AT CRASH 99-UNKNOWN •0istractlon Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s-il��:- C.OM VEH ❑ ® U1 CO FIRST CONTACT 12 Y _, .5 •(ryes,See Sidebar H ELGIN IL 60123 B 1 0 BR90805 IL 2025 0 M IL D 0 1 NXBR32E45Z561077 STATE FARM ❑y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Elgin Fire 99 9 Same 3036748-SFP-13 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Sherman RESPOND ID N U1 = (UNIT) (SEAT) (DOBi (SEX) {SAFT) (AIR) (INJI (EJCT( (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(A.DDRESS)1(TELEPHONEI (EMS) (HOSPITAL) 1 3 03 / LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur IDY U2 N 1 ® 11 1 05,24 ,2026 12 12 ®pm in a Work Zone? ®N DIRP co 1 r PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 v 2 0 06 18 05,24 /2026 12 12 0 pM ❑Construction >F " ❑ xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 3 ❑AM 0 Maintenance U2 -a, ARREST NAME CHWALISZ.CAROLINE. E. 11-801-A S1570-000086 05,24/2026 12 16 ®pM SLMT ❑CITATIONS ISSUED PENDING 1 ® 11 1 Utility o N SECTION CITATION NO. ROAD CLEARANCE TIME ❑ r 2 El ARREST NAME 05/24 /2026 12 50 0 PM 0 Unknown work zone type U1 0 AM 30 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑y 30 1570-Tomlin. Eli 500 331-Ziegler 06 ,09,2026 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. r ----r••--, , ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z A 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< } } ' ' N f INDICATE NORTH combination):or -I Not TO Scale J 1111 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driverC (example shuttle or charter bus)or n r r ` ` A 3. Is desgnetl to carry 15 or fewer passengers and operated by a contract carrier O } } } transporting employees in the course of their employment(example:employee transporter-usually a van type vehicle or passenger car):or w < <. a I 111 I 4. Is used or desi nated to trans rt between 9 and 15 ssen rs,including[he driver, } } } for direct compensation(example:large van used for specific purpose):or . m AA .. 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires a arlt Yob_kip* placarding(example:placards will be isplayed on the vehicle). Xl D _ CARRIER NAME Z - - - — _ ADDRESS w CITY/STATE/ZIP 0 MOTOR CARR.ID 0 Interstate ❑ Intrastate I I . I ❑ Not in Comm./Govt. 0 Not in Comm./Other -"---- --1 - USDOT NO. ILCC NO. rn 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. Xl Xl 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 v TRAILER WIDTH(S) 0-96" 97-102" >102' m TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 ❑ O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Silver Red 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 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO:DUE TO ® DISABLING DAMAGE Redmons VEHICLE CONFIG._CARGO BODY TYPE LOAD TYPE