Loading...
HomeMy WebLinkAbout2026-00049033 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets _ 1111 III 11 Milli Mil 01111DM 11 IflIl II ll� inn it DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004340630 u, 1 U21 2 4 8 U, 9 U2 1 U, 1 U2 1 U, 1 U2 1 1 11 Ul 23 U211 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) El AMENDED ElB Injury and for Tow Due To Crash YR 202612026-00049033 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n CAPITAL ST Elgin ® ❑ RELATED ®Y 0 N 08 14 2026DAM ❑YES El NO U1 -< PRIVATE mo /day/yr 04:22 ®PM FLOW CONDITION Ill _ �5 ® © COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n !MI N E S Alft Ln WITH VEHICLES INVLD ❑ STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) Kane HIT&RUN ❑Y ® N PEDALCYCLIST®N ® FREE FLOW # LNS 0 18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NIAV 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 1 n 0Tischauser. Mark. D. 1 1 / yr 13-UNDER CARRIAGE IE fal !�. 2 FIRE 0 EN STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 1 r<I1 M 2 SY4 ❑Y ®SNE❑UNK VEH. O AT CRASH M IN D 0 99-UNKNOWN 9 76•TOP 3 *Distraction Value 9 ALGN 2 r POINT OF iII COM VEH 0 El 1 CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR F. 8 a i_i,4 0 FIRST CONTACT 6 7_;L-Q, _5 *IIYes.SeeSidebar U1 Z Schaumburg IL 60194 0 1 0 E344998 IL 2026 I TELEPHONE IL D 0 4T1 BF1 FK7DU665087 State Farm ❑Y Igl N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 0297727-SFP-13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER > Refused ❑Y ® N 2 0 x DRIVER 0 PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 NMV 0 NCv 0 DV 1 9 9 5 Toyota Corolla 2013 00-NONE 0. Qi'-_, DUE TO CRASH ❑ 2 x Yr 0 13-UNDER CARRIAGE 10( I E FIRE 0 ® U2 C M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X ❑Y i N DUNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 POINT OF 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 12 8i1 II 4 COM VEH ❑ ® U1 to 7 B .5 •IfYes,See Sidebar — Lake Barrington IL 60010 0 1 0 EE38236 IL 2027 I 0 IL D 0 5YFS4MCE2PP166208 State Farm El ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same 1768542-SFP-13 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 1 0 E/ MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 08,14 /2026 09 00 ®❑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 � 0 2 0 28 30 + / ❑PM ❑Construction * R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM 0 Maintenance U2 o1 ® 11 1 ARREST NAME Tischauser. Mark. D. 11-601 S1542-000991 / ! El PM SLMT o N ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME El Utility 0 AM r 2 0 ARREST NAME 081 14 12026 04 25 ®PM El Unknown work zone type U1 3O 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1542 Chafe. Ethan sot 09 , 15,2026 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. .--1-- . 0 A CMV is defined as any motor vehicle used to transport passengers or property and: Z r r 1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< i- -- -r- -1 . 0 combination):or —I INDICATE NORTH r• i w BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C rg I g L Not To Scale 1 _ } (example:shuttle or charter bus):or J r 3. Is designed to carry15 or fewer passengers and operated a contract carrier O I- I- -A----J. ` } } } transporting employee In the course�of their empbym�ent(example:employee � X +g�Itransporter-usually a van type vehicle or passenger car):or wL ---+ 5 - } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver, C __ 1 for direct compensation(example:large van used for specific purpose):or O } } } t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m placarding(example:placards will be displayed on the vehicle). ;p —1 CARRIER NAME Z ADDRESS 0 w C) w.�T.' CITY/STATEJZIP _ MOTOR CARR.ID 0 Interstate ❑ Intrastate 1 I r ❑ Not in Comm./Govt. Not in Comm./Other0 � "Y""1 USDOT NO. ILCC NO. m XI Source of above z ' . 0 Yes 0 No ❑ Unknown A 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 Red Silver u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 1 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