~ -6-/b

TRAFFIC CRASH REPORT LOCAL REPORT NUMBER' CRASH SeVERITY HIT/SKIP @] I.FATAl ~',SOLveD ILOCAl iNfORMATION 16 MPD 1307 3 ,.iNJURV 2 2. UNSOLVED 16MPD1307 3·POO

• PHOTOS TA"N I D~~A~UNoeR 10 PRIVATE 'I~EPOAlING AGENCV NCIC'I ~EPORTlNQ AGENCY NAME' NUMBER Of D OH ~2 DOH -lP REPORTABlE PROPERTY UNITS II UN~ IN rii~ ••••o OH·3 OOTHER DOLLARA~OUNT 03801 Millersburg Police Department 1m COUNTY • DeiTY" CITY, VillAGE, TOWNSHIP' CRASH DATE' TIME Of CRASH DAYOr WeEK • VILLAGE" Holmes Millersburg OTOWNSHIP' 08/04/2016 0930 Thu

DEaREESJM1NU1~S/SJ::tONDS I DeCIMAL DEGREES LAnTUOE LONGITUDE • LATITUDE LONGITUDE 40:33:04.02 81:55:07.03 i N DIVIDED lANE DtRECT10NOF TRAVEL NUMBER Of THRU lANES ROAD TvpeSOR M1LEPOST .. 0 DIVIDED AL·Au.ev ·CR • C,RCLE HE· HEIGHTS MP • MilePoST 'PL PlACE· ST· STR'" WA,WAV.. DN - NORTHBOUND E - EAsTSOUND UNDIVIDED AV -.AVEHUE CT • CouRT HW·HIGHWAY PK· PARKWAV ·RD • ROAD S ~ SOUTH80UND W -WESTBOUND 2 ' TE .... TERRA~~ • BL ­ BOULEVARD. , DR • DRIVE LA'LANE PI P,,, . .SQ-Sou'R' TL.· TRAlL·

LOCATION ROUTE NUMBER Loc PREFIX LoCAnON ROAD NAME ' Route TwEs . .. . DLOCAT1ON [§JjLOCATiON dR".. INTERSTATe ROUTEONC:TURNPlKE):-­ . ROUTE ~ N,S. ST ROAD us' US ROUTE CR· NUMBERED CouNTY RouTe TVPE E.W Washington St. TYPE , 'SR·· ,$rAVE ROUTE TR.•NuMBERED TOWNSHlP ROUTI!

DISTANCE FROM RefERENCE IDIRF.OMREF REFERENCE ROUTE NUMBER REF PR.,.'" REFERENCE NAME (ROAD, Mll.EPOST, HOUse.'l REFERENCE o MILES N S I [§] ON.S. 1ST IROAD 40 •OYAR FE:':'. S E'W• ID~~~~' E.W Smith St. TVPE

REFERENCE PO;NT USED CRASH LOCATION OF FIRST HARMFUL EVENT NOT AN INTERSECTION FtVE-POINT.ORMORE LOCATION 01 - 06 - 11 - RAilWAY GRADE CROSStNG 1 ~ ON: RoADWAY [TI 1·INTERSECTION D IHTERSEcnON S·ONGoRE 07. ON RAMP 12 ~ SHARfD.Use PATHS OR TRAilS [Q1J 02 ­ FOUR. WAY iNTERSECTION 2 . ON SHOULDE OuTSIDE TRAFFICWAY 1 2·MIlE POST RELATED [TI 6 - 01 03 ­T-INTERSECTION 08 • Off RAMP 99· UNKNOWN 3 ~HOUSE NUMBER 3·iN MEDIAN 9- UN1

MANNER OF ClASH CoLUSIONi!MPACT WEATHER

[TI 1 M NOT COlliSION BETWEEN 2 - REAR.END 5 - BACKING 8 - SIDESWIPE. OPPOSITE 1· CLF"R 4· RAIN 7 SEVERE CROSSWINDS TWOMOlORVEH1ClES 3 _ HEAD.ON 6 • ANGLE DIRE:CTION [TI 2 -CLOUDY 5 - SLEET,HAlL 8 - BLOWING SAND.SOIl. DIAT.SNOW IN 4 ~ REAR.TO.REAR 7 ~ SIDESWIPE, .SAME DIRECTION 9 - UNKNOWN :3 - FOO.SMOG, SMOKE 6· SNOW 9 - OfHEruUNKNQWN

ROAD SURF ACE LIGHT CONDiTiONS ScHOOl Bus RELATED SECONDAR 1 ~ DAYLIGHT 5 - DARK> ROADWAY NOT UGHTEO 9- UNKNOWN 0 ScHOOl. o YES. ScHOOl Bus 1 - CONCRETE 4 - SLAG. GRAVEL BJ PRIMARV D 6 ~ DARK. UNKNOWN ROADWAY UGHTING ZooE DIFlECTlY INVOlVED 2 .. Bf ACKTOP. STONE 2· DAwN ~ 7 • RELATEO 8nUMIf.lOUS, AsPHALT S·DIR' 3 - DUSK GUIRE' o YES. ScHOOl Bus 4 - DARK·LIGHTED ROADWAV B- 3 BRICKrBlOCK 6·0T",R OrHER ·s€~CJ:»"p:ncHO...Y INDIREcnY IN\I01. 'lEO

o WORKERS PRESENT TVP£ 0' WORK ZoNE LOCATIONOf' CRASH IN WORt< ZONE o LAw ENFORCEMEN f PRESENT D1-LANE ClOSURE 4 ~ INTEAt,(ITTENl OA MOVING WORK 1 - BEFORE THE FIRST WORK Zorn: 4 - ACTIVITY AREA (O,ncnu'V£t

NARRAilYE Unit 02 was parked in a parking space along S. Washington St. in front of /---', 310 S. Washington St. Unit 01, and unknown vehicle, struck Unit 02 / + \ causing damage on the left side of the vehicle. The driver of Unit 01 did \ N I not leave any identifying information on Unit 02 and did not contact law enforcement. "--'-/)

Smith st. 1Downhill Grade

u5 -­ .~- :=. ~- i ! u) 310 S. Washington St

, o SWPlEMENT lCa:!Rr;cllCflM Al,'QnON IQ~ R'PO~T::;;!:NCY o MOTORIST E);I$lIJ,G Rcl'\(lA1' SEIn TO OOPS) I DATE CRASHRfPORT£:.D ID,SPATCH TIME ARRiVAL TIME TIME CLEARED 10T"ER INVESTIGATIONTIME TOTAL MINUTES 08/04/2016 1~209 1209 1215 1224 10 25 OFfICER'S NAME" OFFICER'S BAOGE NUMBER CHECKED Bv Brown. Kevin 108 uNIT ILOCAL REPORT NUMBER t ,"­ .... ,&....,...... ,...... I 16 MPD 1307 UNIT NUMBER IOwNER NAME' LAST. F,RST. MIDDLE ( 0 SAME As DRIVER) I OWNER PHONE NUMBER DAMAGE SCALE DAMAGE AREA FRONT 1 ' , OwNER AODRESS: CiTY, STATE. Zip OSAME As DRIVER) ~ D~;-D- 1 - NONE _ J...---.. ,OH -~ 2 - MINOR ,,~ LPSTATE ILICENSE PLATE NUMBER VEHICLE IOENTIFICAnON NUMBER rOCCUPANT~ [ 0 3 - FUNCTIONAL I I P VEHICLE YEAR IVEHICLE MAKE VEHICLE MODEL IVEHICLE COLOR 4 - DISABLING 0 Unknown I o PROOFOF rNSURANCE CoMPANY POLICY NUMBER I TOWED By 9 - UNKNOWN INSURANCE I ccFc1~ Stl0WN CARRIER NAME. ADDRESS. CITY, STATE. ZIp ICARRIER PHONE

USDOT VEHICLE WEIGHT GVWRIGCWR CARGO BODY Twe TRAFFICWAY DeSCRIPTION 001 - No CARGO BODVTvPEINoT ApPUCABl 09 - POLE D1 - Less THAN OR EOUAL 10 10K Las [1] 1 - TWO.WAY, NOT DIVIDED 2 -10.001 TO 26,000K LBS 02 - BUS/VAN (9-15 SEATS, INC DRIVER) 10 - CARGO TANK 1 2 - TWO-WAY. NOT DIVIDED. CoNTINUOUS LEFT TURN lANe HM PLACARD 10 NO. 03-Bus(16+SEATs.INcDRIVER) l1-FlATBED 3 - MORE THAN 26,000K LBS 3 - T WO.WAY, DIVIDED. UNPROTECTED/PAINTED OR GRASS .. 4FT.) MEDIA 04 ­ VEHICLE TOWING ANOTHER VEHICLE 12 - DUMP 4 - Two.WAY, DIVIDED, POSITIVE MEDIAN BARRIER 05 ­ LOGGING 13 ­ CONCRETE MIXER 5 - ONE.WAyTRAFFICWAY HAZARDOUS MATERIAL 06 -INTERMODAL CONTAINER CHASIS 14 - AUTO TRANSPORTER HM CLASS RELATED 07 ­ CARGO VAN/ENCLOSED Box 0 15 - GARBAGE/REFUSE HIT / SKIP UNIT NUMBER 08 ­ GRAIN. CHIPS. GRAVEL 99 - OTHER/UNKNowN •

NON.MOTORIST LOCATION PRIOR TO IMPACT TYPE OF USE UNIT TYPE 01 - INTERSECTION. MARKED CROSSWAL PASSEHGER VEHICLES (LESS 11iAH 9 PA88EHIl8IS MEDiHEAVY TRUCKS OR CoMBO UNTTB> 10K lBB BuaNANli.JMo(9 OR MORE INa.UD1N. DRIVER) 02 ­ INTERSECTION. No CROSSWALK D 01 - SUB·COMPACT 13 ­ SINGLE UNITTRUCK OR VAN 2AKLE, 6 TIRES 21 - BusNAN (9-15 SE.ATS I~ DRMP) 0 03 ­ INTERSECTION OTHER 1 - PERSONAL ~ 02 ­ COMPACT 14 ­ SINGLE UNITTRUCK: 3+ AXLES 22 - Bus (16+ SE.ATs.l~ ORNEP) 04 - MIDBLOCK . MARKED CROSSWAlK 99 ­ UNKNOWN 03 ­ MID SIZE 2 - COMMERCIAL 15 ­ SINGLE UNITTRUCKITRA1LER NON-MOTORIST as ­ TRAVEL LANE .OTHER LOCATION OR HiT/SKIP 04 ­ FULL SIZE 23 ­ ANIMAL WITH RIDER 06 ­ BICYCLE LANE 16 ­ TRUCK/TRACTOR (BOBTAIL) 3 - GoVERNMENT 05 ­ MINIVAN 24 - ANIMAL WITH BUGGY. WAGON. SURREY 07 - SHOULDERfRoADSIDE 17 - TRACTOR/SEMI.TRAILER 06 ­ SPORT UTILITY VEHICLE 08 ­ SIDEWALK 18 - TRACTOR/DoUBLE 25 - BICYCLEiPEDACYCLIST 07 ­ PICKUP 19 - TRACTORtTRIPLES 26 ­ PEDESTRIANISKATER 09 ­ MEDLAN,cROSSING ISLAND o IN EMERGENCY 08 - VAN 20 ­ OTHER MEo/HEAVY VEHICLE 27 - OTHER NON.MoTORIST 10 - DRIVE WAY ACCESS RESPONSE 09 - MOTORCYCLE 11 - SHARED·USE PATH OR TRAIL 10 - MOTORIZED BICYCLE 12 ­ NON.TRAFF1CWAYAREA 11 - SNOWMOBILEIATV HAS HM PLACARD 99 ­ OTHER/UNKNOWN 12 - OTHER PASSENGER VEHICLE 10 1 SPECIAL FUNCTIONal - NONE 09 ­ AMBULANCE 17 ­ FARM VEHICLE MOST DAMAGED AREA AcTION 02 ­ TAXI 10 - FIRE 18 ­ FARM EOUIPMENT 08 ­ LEFT SIDE 99 ­ UNKNOWN 01- NONE ~ '-NON.CONTACT 03 ­ RENTAL TRUCK (OVER 10K LSS) 19 - MOTORHOME 11 - HiGHWAy/MAINTENANCE 02 ­ CENTER FRONT 09 - LEFT FRONT 9 2 - NON.COLLISION 0 04 - Bus. SCHOOL (PUBLIC OR PRNATE) 12 ­ MILITARY 20 ­ GOLF CART ~ 03 ­ RIGHT FRONT 10 ­ Top AND WINDOWS 3 - STRIKING 05 ­ Bus. TRANSIT 21 - TRAIN IMPACT ARE 13 ­ POLICE 04 - RIGHT SIDE 11 - UNDERCARRIAGE 4 - STRUCK 06 ­ Bus. CHARTER 22 ­ OTHER (E ....p\..,l.IN~ N..RlUlIV£) 14 ­ PUBLIC UTILITY as - RIGHT REAR 12 - LOAD/TRAILER 5 - SmlKINGlSTRUCK 07 - Bus. SHUTTlE 06 ­ REAR CENTER 15 ­ OTHER GoVERNMENT 13 - TOTAL (ALL AREAS) 9 - UNKNOWN 08 ­ Bus. OTHER 16 ­ CONSTRUCTION EOIP. ~ 07 ­ LEFT REAR 14 - OTHER

PRE. CRASH Ac nONS

MOTORIST NON-MOTORIST ~ 01 - STRAIGHT AHEAD 07 ­ MAKING U-TURN 13 ­ NEGOTIATING A CURVE 15 ­ ENTERING OR CROSSING SPECIFIED LOCATIO 21 - OTHER NON.MoTORIST ACTION 02 - BACKING 08 - ENTERING TRAFFIC LANE 14 ­ OTHER MOTORIST ACTIO 16 - WALKING.RuNNING. JOGGING. PLAVING. CYCLING 03 ­ CHANGING LANES 09 ­ LEAVING TRAFFIC LANE 17 -WORKING 99 ­ UNKNOWN 04 - OVERTAKINGiPASSING 10 ­ PARKED 18 ­ PUSHING VEHICLE 05· MAKING RIGHT TURN l' - SLOWING OR STOPPED IN TRAFFIC 19 - ApPROACllING OR LEAVING VEHICLE 06 ­ MAKING LEFT TURN 12 - DRIVERl ESS 20 - STANDING

CONTRIBUTING CIRCUMSTANCE VEHICLE DEFECTS PRIMARY MOTORIST NON-MOlORIS1 o 01 - TURN SIGNALS 01 - NONE 11 - IMPROPER BACKING 22 - NONE 02 ­ HEAD LAMPS 02 - FAILURE TO YielD 12 -IMPROPER START FROM PARKED POSITION 23 ­ IMPROPER CROSSING 03 ­ TAIL LAMPS ~ 03 ­ RAN RED LIGHT 13 ­ STOPPED OR PARKED ILLEGALLY 24 - DARTING 04 - BRAKES 04 - RAN 14 ­ OPERATING VEHICLE IN NEGLIGENT MANNER 25 ­ LVINGAND.QR ILLEGAlLY IN ROADWAY 05 ­ STEERING SECONDARY 05 - EXCEEDED 15 ­ SWERING 10 AVOID (DUE TO EXTEHNAL CONDITIONS) 26 ­ FALURE TO YIELD RIGHT OF WAY 06 ­ TIRE BLOWOUT 06 - UNSAFE SPEED 16 - WRONGSIDElWRONGWAY 27 ­ NOT VISIBLE (DARK CLOTHING) 07 - WORN OR SLICK TIRES 07 -IMPROPER TURN 17 - FALURE TO CONTROL 28 ­ INATTENTIVE 08 ­ TRAILER EOUIPMENT DEFECTIVE 0 08 - LI:FT OF CENTER 18 ­ VISION OSSTRUCTION 29 ­ FAILURE TO OBEY TRAFFIC SIGNS 09 ­ MOTOR TROUBLE 09 - FOLLOWEDTooCLOSEly/ACDA 19 ­ OPERATING DEFECTIVE EOUIPMENT ISIGNALS/OFFICER 10 ­ DISABLED FROM PRIOR ACCIDENT 99 - UNKNOWN 10 ­ IMPROPER LANE CHANGE 20 ­ LOAD SHIFTING/FALLING/SPILLING 30 ­ WRONG SIDE OF THE ROAD 11 - OTHER DEFECTS ,PASSINGtOFF ROAD 21 - OTHER IMPROPER ACTION 31 - OTHER NON-MOTORIST ACTION

SEQUENCE OF EVENTS ~!2~·!:!2III!.1IQ~ E~f~Hi 1 01 - OVERTURN/ROLLOVER 06 ­ EOUIPMENT FAILURE 10 ­ CROSS MEDIAN [IT] 20 30 40 50 60 tBLOWHTIIIE,BIW".E F,I,/\.~E,ETC) 02 ­ FIRE!ExPLOSION 11 - CROSS CENTER LINE 03 :- IMMERSION 07 ­ SEPARATION OF UNITS OPPOSITE DIRECTION OF TRAVel FIRST [I] M"'[I] HARMFUL 1 HARMFUL 1 99 ­ UNKNOWN 04 ­ JACKKNIFE 08 ­ RAN OFF ROAD RIGHT 12 ­ DOWNHILL RUNAWAY EVENT EVENT as ­ CARGO..eaUiPMENT Loss OR SHIFT 09 ­ RAN OFF ROAD LEFT 13 ­ OTHER NON.COlllSION

COIII§IQt:! :tiIIH EIXf.O: QIlJ!;;!;;:I COLLI§IQ~ WITJj E:EBSO~ ~EHICLf OB QI!JE,CI ~QT J:IXt~ 25 ­ IMPACT ATTENUATOR,cRASH CUSHIOIB3 - MEDIAN CABLE BARRIER 41 - OTHER POST, POlE 48 - TREE

14 w PEDESTRIAN 21 - PARKED MOTOR VEHICLE 26 ­ BRIDGE OVERHEAD STRUCTURE 34 - MEDIAN GUARDRAIL BARRIER OR SUPPORT 49 ­ FIRE HYDRANT 15 ­ PEDALCYCLE 22 ­ WORK ZONE MAINTENANCE EOUIPMENT 27 ~ BRIDGE PIER OR ABUTMENT 35 ­ MEDIAN CONCRETE BARRIER 42 ­ CULVERT 50 ­ WORK ZONE MAINTENANCE 16 ~ RAILWAY VEHICLE (T

UNIT SPEED POSTED SPEED TRAFFIC CoNTROL UNIT DIRECTION 1 - NORTH 5 - NORTHEAST 9 - UNKNOWN 01 - No CONTROLS 07 ­ RAILROAD 13 ­ CROSSWALK LINES FROM To 2 - SOUTH 6 - NORTHWEST 14 -WAu

( 0 SAME As DRIVER) DAMAGE SCAlE DAMAGE AREA FRONT

l-N"", B. Millersburg. OH. 44654 ..:...-..;..----=-~--r.:---:-----:-:------...,.#'::'O=-CC-U-PAN-TS-i 2 - M,NOR

_-::-______..J..::..=:.:;=.:..::..:.::.:.:.:.::.::..:.::=.:..::..:...:.______,-:-:-_-::-....L____0:..t 3 - FUNCTIONAL

4 ~ D1SABUNG

9· UNKNOWN

CARRIER NAME. AooREss.Crrv.SrATE.2jp

US DOT "tlCLE WEIGHT GVWRJGC::WR CARGO BoDY Tvpe TRAFFICWAY DESCRIPTION 1______-1 D1 - LESS THAN OR EOUAl TO 10K LB. f'{)"1l 01 - No CARGO BODV TYPE/NoT ApPl1CABl 09 - POLE 1:11. Two.W.., NOT DIVIDED 2 L2..:!..J 02 - BusNAN (9·15SEA,., INC DRIVER) 10· CARGO TANK W2 - T WO.WAY. NOT 0I1110EO. CoNTINUOUS LEFT TURN lANE HM PLACARD ID NO. • 10,001 T026,OOOK LB. 03 - Bus (16+ SEATS, INC DRIVER) 11 • FLAT BED 3 MORE THAN 26.000K LB., 3 .. TWO.WAY, DMDEO, UNPROTECTEDIPAINTEDOR GRASS >4FT.l MEDIA 04 - VEHICLE TOWINGANOTHER VEHICLE 12 - DUMP 4 .. T WO.WAY, DIVIDED, POSIHVE MEDIANBAAR!ER 05 - lOGGING 13 - CONCRETE MIXER 5 ~ ONE·WAY TRAFRCWAY HAZARDOUS MATERIAL 06 ¥ INTERMOOAl CO~TAINER CHASIS 14 - AUTO TRANSPORTER HM CLASS o RELA1ED 07 - CARGO VAN/ENCl.OSEOBol( 15 - GARBAOE IREFUSE o HIT I SKIP UNIT NUMBER 08 - GRAIN. CHIPS. GRAVEl 99 _OTHER/UNKNOWN

Nm:.MoTORIST LOCATION PRIOfl TO IMPACT TVPE OF USE UNIT TypE. 01 • INTERSECTION. MARKEO CROSSWAI I()7l PASSENGER VEHIC"'S (t£8S TlWi 9 PASSEN.... MEOiHEAVY TR"""" OR Co,..o UNITS. 10KLBII BuoNAHII.JMO(9 OR Mooe INCUlDlNG DR"""') 02 • INTERSECTION. No CROSSWALK OJ ~ 01· SuS·COMPACT 13 ~SINGlE UNIT TRUCK OR VAN2AxlE, 6 TlRES 21 BusNAN (9·15SEAt.I II.COOlt.'fP) 03 ~ INTERSECTION OTHER 1 PERSONAL 02 ~ COMPACl 14 ~ SINGLE UNlTTRUC~: 3+ AXLES 22 ~ 8u5(16+ SEAt$ II.C ORl'o'U<) 04 MIOBLOCK. MARKED CROSSWALt{ 99 ­ UNt{NOWN 03 ­ MID SIZE 15. SINGLE NoH-MOTOruST 05 TRAVFl LANE. OTHER LOCATION 2 - COMMERCIAL UNlTTRUC~tTRAllER OR HIT/SKIP 04 - FUll SIZl~ 23 _ ANIMAL WITH RIDER 06 B,CYCLE LANE 3· GovERNMENT 05· MiNIVAN 24 _ ANIMAL WITH BUGGY. WAGON. SURREY 07 .. SHOULDER/RoAOSIOf ~~: i:~~~~~~~:ll) 06 - SPORl UUlITYVEHIClE 18 TRACTORtDouslE BICYClEJPEDACYCUST 08· SIDEWALK 07 - PIcKUP 19 _ TRACTOR/TRtplES PEDESTRlAAiSKATER 09 ­ MEDIANICROSSING ISLAND D IN EMERGENCY 08 ­ VAN 20 _ OTHER MEDtHEAvyVEHlClE - OTHER NON.MoTORIST 10 DRIVE WA' ACCESS RESPONSE 09 ­ MOTORCYCLE 11 • SHAREO,USE PATH OR TRAlL 10 ­ MOTORIZED BICYCLE 12" NON.TRAFFICWAY AREA ,11-&'owMOBIlEIATV D HASHIM !PLA( 99 - OTHER/UNKNOWN 12 ­ OTHER PASSENGER VEHICLE

SPECIAL FUNCTlON01 .. NONE 09 ­ AMBULANCE 17 ­ FARM VEHICLE MOST D,MMGEDAREA ACTION 02· TAXI 10 - FIRE 18 ­ FARM EOUIPMENT If\Ol 01· NONE 08· LEFT SlOe 99· UNKNOWN r::il 1 - NON. CONTACT [ill0·' 03 ~ RENTAL TRUCK (OveR 101<.1.SS) 11 - HIGHWAYIMAINTENANCE 19 ~ MOTORHOME ~ 02 - CENTER FRONT 09 • LEFT FRONT ~ 2· NON·COUISION Bus. SCHOOL (PUBLIC OR PRIVATE) 12· M'UTAR' 20-GoLfCART 04 03 • RIGHT FRONT 10 ~ Top AND WINDOWS . 3 ~ STRll<.lNG 21- TRAIN 05 - Bus • TRANSIT 13 • POl'CE IMPACT ARE 04 ~ RIGHT SIDE 11 - UNDERCARRIAGE 4-SffWCt: 22 ~ OTHER (E;rp,....lI'.mN,t,lutuM:) 06 - Bu•• CHARTER 14 - PUBtiC UnuTY If\-7l 05· R,GHT REAR 12· LOAD/TRAIlER 5 - STRIKING/STRUCK 07 ~ Bus. SHUTTLE 15 _OTHER G.:weRNMENT t..,QZj 06· REAR CeNTER 13 - TOTAl (ALL ARE..) 9-UNI

PRE. CRASH AcTIONS [J]J MOTORIST NON-MOTORIST 01 - STRAIGHT MEAD 07 - MAttiNG U~TURH 13- NEOOTIATINGACURVE 15 ­ ENTERING OR CROSSING SPECIFIED LOCATIO 21 ~ OTHER NoN.MoTORlST ACTlON 02 - BAcKING 08 - ENTERING TRAfFIC LANE 14 ­ OTHER MOTORIST AcTIO , 16 ~ WAlKING-RUNNING. JOOGlNG, PlAYING. CVCtlNG 03 - CHANG.NG lANES 09 ­ LEAVING TRAFFIC LANE 17 ­ WoRJ

CONTRIBUTING ClftCUMSTANCE VEHICLE DEFECTS PRIMMV MOTORIST NON-MOTORIST 01 • TURN SIGNALS 01 NoNE 11 .. IMPROPER BACKtHG 22-NoNE 02 • HEAD lAMPs 02 - FAlLURE 10 -IMPROPER START FROM PARI<.ED POSlTlON 23 .. IMPROPER CROSSING D []j]01 YieLD 12 03 .. TA1l LAMPS 03 - RAN REO L.GHT '3 - STOPPED OR PARJ

NON.ern IISION EvENTS 01 .. OvE"'-TU~N/RollOVER 06 - EaUlPMENT FAILURE 10 ­ CROSS MEDIAN 02 FIREIE;W:PlQSION 11 - CROSS CENTER LINE 03 .. IMMfRSION 07 ­ SEPARATION OF UNITS OPPOSITE DiRECTION OF TRAVEL 99· UNKNOWN 04 - JACKKNlff: 08 ­ RAN OFr ROAD RIGHT 12 .. DOWNHilL RUNAWAY OS .. CARGO/EoUiPMENT Loss OR Slilf T 09 ~ RAN Orr ROAD LEFT '3 .. OTHER NOU.cOLUSION

CO! IISlaN Wlut FIXEP OBJECT

ColllSIONWIIH PERSON Yf;litCU; OR OeJECI NOJ F!:I(ED 25 .. IMPACT AnENUAIORICRASti CUSHlOta3 - MEDIAN CASlE BARRIER 4' .. OTHER POST, POLE 48- TR .. 14 .. PEOESTRlAN 21 ~ PARKED MOTOR VEHICLE 26 .. BRIDGE OVERHEAD STRUCTURE 34 ­ MEOIAN GUARDRAil BARJUER OR SUPPORT 49 - FIRE HVORANT 15 " PEOAlCVCLE 22 ­ WORK ZONE MAINTENANCE EOUIPMENT 27 " BRIDGE PIER OR ABUTMENT 35 ~ MEDIAN CONCRETE BARRlER 42 -CULVERT 50 - WORt< 20NE MNNTENANCE 16 .. RAlLWAV VEHIC~E (lA.M., E~t<€; 23 ­ STRUCK BY FALLING. SIiIFTING CARGO 28 .. BRIDGE PARAPH 36 ­ MEDIAN OTHER BARRIER 43 -CURB EQUIPMENT 17 .. ANIMAL, FARM OR AN'ftHING SET IN MOllON fly A 29 ­ BRIDGE RAIL 37 ­ POST 44 .. D~TCH 51 - WAll. BUiLDING, TUNNEL 1 B .. ANIMAL. DEER MoTOR VEHICLE 30 GUARDRAIL FACE 38 - OvERHEAD SIGN POST 45 ­ EMBANKMENT 52 ­ OTHER FIXED OaJECT 19 .. ANIMAl.OTHER 24 .. OTHER MOVABLE OBJECT 31 - GUARDRM.ENO 39 .. LIGHT/LUMINARIES SUPPORT 46 - FENCE 20 .. MOTOR VEHICLE IN TRANSPORT 32 .. PORTABLE BARRIER 40 - UTIUTV POLE 47 - MAILBOX

UNIT SPEeD POSTEO SPEED TRAFFIC CONTROL UNIT DIRECTiON 1- NORTH 5 - NoRTKEAST 9· UNKNOwN 01 - No CoNmoLS 07 ­ RAILROAD CAosseucKS 13 .. CROSSWALK LINES FROM [I] To 2 -SOUtH 6 - NOATHWEST 25 08 ­ RAILROAD FLASHERS 14 -WALKlDOJI'TWAlK a 02 - S TOP S,GN 3-EAS' 7 - SoUTHEAST 09 .. RAILROAD GATES 15-0THER ~ 03· YIELD SIGN 4-WfS' 8 - SouUiWEST • STATED 04 ­ TRAFFIC SIGNAL '0 - COSTRucnON BAHRICAOE 16 ~ NOT REPORTED 05 ~ TRAFFIC FLASHERS 11 - PERSON (FLAGGER. OFFICER D ESTIMATED 06 • SCHOOL ZONE , 2 - PAVEMENT MARt{INGS fI).J'L!E:!J.\l;' MOTORIST I NON-MoTORIST I OCCUPANT "...... ------1 16 MPD 1307 Urm NUMBfR NAMS> LAST. FIRST. MIDDLE F • FEMALE Unknown, M-MALf AnDRESS. CITY, STATE. ZIp

~ ,OH ~ INJURIES EMS AOENCY MEDICAl FACIUN INJURED TAKEN To iliJ ~ ~ OL STATF. ::; OffeNSE CHARGED (CLOCAlCOOE) o UNIT NUMBER NAME F - FEMALE M-MAlE

ADDRESS. CITY. STATE. Zip

o INJURJES INJURED TAK£N By SAFETY EotJIPMENT USED 99 .. UNKNOWN SAFElY EOUlPM~NT

1 - No INJURY I NONE REPORTE 1 • NOT TRANSPORTED I MOTORIST 2 .. POSSiBlE TREATED AT SCENE 3 .. NON.INCAPACHAllNG 2·EMS 01 .. NONE USED· VEHICLE OCCUPANT '05 .. CHILO ResTRAltff SYSTEM.FoRWARD FACING 09 ' NONE USED 12 ' REFtECTIVE CoATINO 4 .. INCAPACITATlNG 3 ,POWCE 02 ~ SHOUlDER BELT ONLV USED 06 .. CHILD ReSTRAINT SysTEM.ReM FACING 10·HWlETUSEIl .. 13·l.JatlUNG 5 - FATAl 4 -OlltER 03 - l»BELT ONLY USED . 07 • ElooSTER SEAT ' 11 ' PROTECTIVE PADS USED 14·0lltER g·.. ·UNKNOWN 04 ' SHOUlDER A.D LAp BELT ONlVUSED 08 ' HELMET USED (EI.lIOoV$.!Q.us,E~)

SEATlNO P,oSlTlON AlR BAll u..a. 01 .. FRONT.·LEFTS!DE(M()~D~) 07 ~ THIRD. LEFT SlOE (f'oI~S~CN'l) :12'~ P~EHGER~IN UHENCl()SEOCAfmOAAeA'" 1-NoTDE";'OYei, 02 ' FRONT - M'OOlE 08 - THIRD. M.OOLf ,13 - T.... uNG UNiT • 2 - DEl'toYEO FRONT 03 - FRONT. R,GHT Sill. • 09, THIRD- RIGHT SIDE • '; 14 '" RIDtNG ON VEHiCLE exTERIOR (fi?,,"TolWlIt«'l UN'l1 3 • DEI'lOVl!D SIDE, , 04, SECOND. LEFTSIDE(Mo' __P~ 10 "SLEEPER SecnONOfCIIll(T,...;.q· . ,,15:....ION-MoTORlST ~" • 4 • D£PI.o'vEoBOTH FRONTISIDE 05 .. SecoND • MIDDLE ' 11 .. P,ASllEHOER IN OllteR E~CtOSED CARGO AA&;. 16-0lltER ,5 - NOT APPUcA8t.s 06 '. SECOND • RIGHt S,DE ,.iNotwT/lAlUN3UmSul:;k4S,.BIID.~V!1~~) ~9:- U;'~NOWN_ • 9 - DePLOYMENT UNKIIOWN

TRAPPED 'ALcOHOLlDRUQ SUSPECTED EJECTION , OPERATOR LlCEN5E a.­ 'CoNDITION , ". < • 1 - NOT EJecTED 1- NeTTA_Eo l-Clf,ssA 1 ~ APPAREHTlV NORMAL 5 , FEll ASLEEP. FAlNTsD.,FATiGUe 1 NONE • 2 - TOTAltvEJECTEO 2 - EXTRICATED BY . 2-CLASSB 2 ~ PHYSICAL IMPAIRMENT 6·-UtWERTHEJNFtUENOSOf ", 2· YES.!ltCOHOLSUSPECTED 3 ~ PARTIAlJ.VEJECTED MECHANICAL MeANs 3,CLASS

ALCOHOl TEST STATUS AlCOHOL TSST,T""E DRUG TEsTSmus ORUG TeST TYPE DRIVER DlsTRACTED By 1 ,'NONE GiVEN 1.NON' l,NONeGIVEN l·NoNE ",1, No DlsTRACTION R'~RTEO 6 ' en;eR·1.slDE THE VEH<:Lf 2 - TeST RERJSEO 2,'BLooo 2 - TEST REFUSED 2 - BLOOD 2· PHONE • 7 .. EXTERNAl DISTRACTION 3 - TEST GIVEN. CONTAMtHATED SAMPL.E!UNUSABt 3· URINe 3 - TesT GIVEN. CONTAMINATED S...... LElUNU"".' . 3- URINE .... 4, TEST GlVEN, ResuusKHowH 4 - BREAm 4 - TesrGIVEN, ReSULTS KNOWN 4, OlltSR ~ : ~~:~~~·t~~~N;~Ano~ DE~'c€ 5· TeST GIvEN. RESUlTSUHKNOWN 5 • OTHER 5, TEST GIVEN. ReSULTS UNKNOWN 5 ' OlltER EleCTRO.'C DEVlCE (NA~llONO~. A#tbiO: °XO) ,

.... ADDRESS, OTV. STATe. ZIP ! g INJuRIES INJUREDTAKENBv EMSAnENCY MEDICAL FACrUTY INJURED TAKEN To SA.FETY EQUIPMENT USED o 0

o 0