HomeMy WebLinkAbout2026-00036851 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 1 li III 11 1111111
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004295739-
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INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW
Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 3
VEHICLE/PROPERTY ®OVER 91,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
0 AMENDED YR 202612026-00036851 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn
N STATE ST Elgin 09:
® ❑ RELATED ❑Y ®N 06 24 2026 DAM El YES ®NO U1 -<
19
_ _ PRIVATE mo /day/yr ®PM FLOW CONDITION M
FT N E S W DAVIS RD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW Cl)❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 --I
® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 0
1 2 /
yr 13-UNDER CARRIAGE D( i 2 FIRE 0 ® C
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL O4-TOTAL(ALL) O DISTRACTED 0 ]$I U2 M
M 2 8 SY M IN ENGAGED 15-
❑Y ®N SE❑UNK VEH. 0 AT CRASH 0 99-UUNKNOWN OCI.TOPO `DistractionValue ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF D i 6 'I COM VEH 0 j$J 1 0
" �- ELGIN IL 60123 B 1 4 FIRST CONTACT 1 0L®-® *I(Yes.See Sidebar U1 0
Z MARLAA IL 2026 REAR
TELEPHONE
IL D 0 3CZRU6H34JG706750 nla l v ❑N U2 m
5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Elgin Fire Same nla 2 r
`o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Sherman ❑Y ® N 2
0 DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0
yr 12 _ X1
o 13-UNDER CARRIAGE 10 I c. 2 FIRE 0 ❑ U2 C
c SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED
a SYSTEM IN ENGAGED 15-OTHER 9,16-TOP3 ❑ ❑ SPDR 0
❑Y 0 N 0 UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value U1 0 -
POINT OF s-.;, 4
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRSTO CONTACT Y 6 Ij,_5 CIO Ms See SidebarEH
❑ C
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M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 O
❑Y ❑N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 10 =
BAC
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
RESPNDER❑YD❑N U1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI :(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(A.DDRESS)((TELEPHONE) (EMS) (HOSPITAL) 0
1 3 02 / F 2 8 A 4 4
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/ / #OCCS >
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EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z
N 1 ® 2 4 06,24 /2026 09 19 ®AM in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 .,
v t 2 0 11 15 06,24 ,2026 09 20 RI 0 Construction
R 3 0 ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME
" ❑AM 0 Maintenance U2
-a, ARREST NAME Altschul. Kenneth. P. 3-707 1556-000198 06/24/2026 08 23 ®pM SLMT
o u 1 0 0 CITATIONS ISSUED PENDING Utility
o N 0 AM SECTION CITATION NO. ROAD CLEARANCE TIME 0
t 2 El ARREST NAME 06/24 /2026 10 13 ®PM El Unknown work zone type U1 40
n 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y
1556-Sanchez.Jimena 501 371-Arnold 07 ,07,2026 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
1.-4-
i ADDITIONAL UNITS FORMS.
A CMV is defined as any motor vehicle used to transport passengers or property and: Z
L. .
r r 1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -<
c --I I. INDICATE NORTH combination):or —I
oavia ntd
_ _ _ _ _ BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver 0
- } (example:shuttle or charter bus):or
Ar 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier O
- I. } } transporting employees in the course of their employment(example:employee
transporter-usually a van type vehicle or passenger car):or C
L }-----}----; - } } } 4. Is used or designated to transport between 9 and 15 passengers,including the driver,
for direct compensation(example:large van used fors specific purose):or
Not To Scale 'OD
l. i } } 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires
c placarding(example:placards will be displayed on the vehicle). XI
D
CARRIER NAME —I
unit 1 I - Z
ADDRESS 0
T.
t CITY/STATE/ZIP g
i. i. i. 4. MOTOR CARR.ID 0 Interstate 0 Intrastate
' ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00
--- --4. I 't USDOT NO. ILCC NO. C
m
XI
Source of above z
. 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
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_COLOR TRAILER LENGTH(S)1 ft. 2 ft. w
Black
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