Visio-CR-3 FINAL 11 1 09 Hodgkiss

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TotalTotalACTIVENum.Num.SCHOOL ZONE UnitsPrsns.Texas Peace Officer’s Crash Report (Form CR-3 1/1/2010)Mail to: Texas Department of Transportation, Crash Records, P.O. Box 149349, Austin, TX 78714. Questions? Call (512) 486-5780Refer to Attached Code Sheet for Numbered Fields These fields are required on all additional sheets submitted for this crash (ex.: additional vehicles, occupants, injured, etc.).Law Enforcement and TxDOT Use ONLYFATALCMVSCHOOL BUS/MABCaseIDCrash Time(24HRMM)/TxDOTCrash IDSUPPLEMENTOutsideCity LimitCityNameIn your opinion, did this crash result in at least 1,000 damage to any one person’s property?ROAD ON WHICH CRASH OCCURRED1 Rdwy.Hwy.Sys.Num.Crash Occurred on a Private Drive orRoad/Private Property/Parking LotYes LatitudeNo (decimal degrees)2 Rdwy.PartLongitude(decimal degrees).3 StreetPrefixBlockNum.Toll Road/ SpeedToll Lane Limit.4 StreetSuffixStreetNameYes WorkersNo PresentConst.ZoneYes StreetNo Desc.INTERSECTING ROAD, OR IF CRASH NOT AT INTERSECTION, NEAREST INTERSECTING ROAD OR REFERENCE MARKER2 Rdwy.3 StreetYes 1 Rdwy.AtHwy.BlockStreetPartPrefixInt.Num.Num.NameNo Sys.Fin. Resp.NameTowedByAlc.Result22 Alc.Spec.21 Sol./Fin. Resp.Num.TowedToLPNum.-YesNo11 DLRest.Name: Last, First, MiddleEnter Driver or Primary Person for this Unit on first lineDOB(MM/DD/YYYY)//23 DrugSpec.24 DrugResult25 DrugCategory10 CDLEnd.22 Alc.Spec.9 DLClassPol., Fire, EMS onEmergency (Explain inNarrative if checked)7 BodyStyleAlc.ResultVeh.Model21 g20Helmet6 Veh.ColorHit and LPRunState27 VehicleDamage Rating 2-18 Restr.ParkedVehicle5 UnitDesc.-17 Eject.Expired 26 Fin.Exempt Resp. Type27 VehicleDamage Rating 1VEHICLE, DRIVER, & PERSONSPersonNum.12 Prsn.Type13 SeatPositionFin. Resp.Phone Num./Not Applicable – Alcohol andDrug Results are only reportedfor Driver/Primary Person foreach Unit.16 SexYesNo8 DL/IDDL/IDTypeStateAddress (Street,City, State, ZIP)Proof ofFin. Resp.DOB(MM/DD/YYYY)Owner/LesseeName & AddressVeh.YearOwnerLessee11 DLRest.18 Restr.Name: Last, First, MiddleEnter Driver or Primary Person for this Unit on first lineFin. Resp.Phone Num.TowedByUnitNum.10 CDLEnd.17 Eject.9 DLClassPol., Fire, EMS onEmergency (Explain inNarrative if checked)7 BodyStyle15EthnicityProof ofFin. LE, DRIVER, & PERSONSPersonNum.12 Prsn.Type13 SeatPosition8 DL/IDDL/IDTypeStateAddress (Street,City, State, ZIP)VIN16 Sex6 Veh.ColorLPNum.15EthnicityVeh.YearHit and LPRunStateAgeParkedVehicle5 UnitDesc.RRXNum.StreetDesc.14 InjurySeverityUnitNum.ReferenceMarker4 StreetSuffix19Airbag20HelmetFT 3 Dir. from Int.MI or Ref. MarkerDistance from Int.or Ref. Markerof23 DrugSpec.24 DrugResult25 DrugCategoryCountyNamePageLocalUse14 InjurySeverityIDENTIFICATION & LOCATIONCrash Date(MM/DD/YYYY)RAILROADNot Applicable – Alcohol andDrug Results are only reportedfor Driver/Primary Person foreach Unit.Owner/LesseeName & AddressYesNoExpired 26 Fin.Exempt Resp. TypeFin. Resp.NameFin. Resp.Num.27 VehicleDamage Rating 1TowedTo--27 VehicleDamage Rating 2--VehicleInventoriedYesNo

Law Enforcement and TxDOT Use ONLY.Case IDForm CR-3 1/1/2010Unit Prsn.Taken ToNum. Num.TxDOT Crash IDDISPOSITION OFINJURED/ e Num.CHARGESUnitNum.PageofTime of Death(24HRMM)Date of Death(MM/DD/YYYY)Taken ByDAMAGEDamaged Property Other Than VehiclesUnitNum.Owner’s Name28 Veh.9 CAPACITY Oper.TRANSPORTINGHAZARDOUS MATERIAL10,001 LBS.CMVCarrier’sCorp. Name30 Rdwy.AccessTrailer ce35 Seq. 1Of EventsFACTORS &CONDITIONS29 CarrierID TypeCarrierID Num.Carrier’sPrimary Addr.31 Veh.Type33 CargoBody StyleOwner’s Address35 Seq. 236 Contributing Factors (Investigator’s Opinion)May Have Contrib.Unit Num.Contributing32 HazMatClass Num.34 Trlr.Type35 Seq. 3HazMatID Num.Trailer 2UnitNum.HazMatID Num.RGVWGVWR34 Trlr.TypeTotalNum. Axles35 Seq. 437 Vehicle Defects (Investigator’s Opinion)ContributingMay Have Contrib.38WeatherCond.TotalNum. TiresEnvironmental and Roadway Conditions394041424344Light Entering Roadway Roadway Surface TrafficCond. RoadsType Alignment Condition ControlField Diagram – Not to ScaleIndicateNorthINVESTIGATORNARRATIVE AND DIAGRAMInvestigator’s Narrative Opinion of What Happened(Attach Additional Sheets If Necessary)32 HazMatClass Num.Time Notified(24HRMM)Invest.Comp.ORINum.HowNotifiedTime Arrived(24HR:MM)Yes InvestigatorNo Name (Printed)Report Date(MM/DD/YYYY)/IDNum.AgencyDistrict/Area/

Page 1 of 2Law Enforcement and TxDOT Use ONLY.Form CR-3CS 1/1/2010IDENTIFICATION AND LOCATIONTexas Peace Officer’s Crash Report – Code SheetNumbered Fields on the CR-3 Refer to the Numbered Lists on this Code Sheet. Each list includes the codes that may be entered onthe form and the description of each code.1. Roadway System2. Roadway PartAL AlternateSP SpurCR County RoadPR Park RoadPV Private RoadRC Recreational RoadLR Local Road/Street (Street, Road, Ave.,Blvd., Pl., Trl., Beach, Alley, Boat Ramp, etc.)IH InterstateUS US HighwaySH State HighwayFM Farm to MarketRR Ranch RoadRM Ranch to MarketBI Business InterstateBU Business USBS Business StateBF Business FMSL State LoopTL Toll Road5. Unit Description 6. Vehicle ColorVEHICLE, DRIVER, AND PERSONS1 Motor Vehicle2 Train3 Pedalcyclist4 Pedestrian5 MotorizedConveyance6 Towed/Trailer7 Non-Contact98 Other (Explain inNarrative)BGE BeigeBLK BlackBLU BlueBRZ BronzeBRO BrownCAM CamouflageCPR CopperGLD GoldGRY GrayGRN GreenMAR MaroonMUL Multicolored1 Main/Proper Lane2 Service/Frontage Road3 Entrance/On Ramp4 Exit/Off Ramp5 Connector/Flyover98 Other (Explain in Narrative)P2 Passenger Car, 2-DoorP4 Passenger Car, 4-DoorPK PickupAM AmbulanceBU BusSB Yellow School BusFE Farm EquipmentFT Fire TruckMC MotorcycleSV Sport Utility Vehicle10. Commercial Driver 11. Driver License RestrictionsLicense Endorsements A With Corrective LensesA Class AAM Class A and MB Class BBM Class B and MC Class CCM Class C and MM Class M5 Unlicensed98 Other/Out of State99 UnknownH Hazardous MaterialsN Tank VehiclesP PassengersS School BusT Double/Triple TrailerX Tank Vehicle withHazMat5 Unlicensed96 None98 Other/Out of State99 UnknownB LOFS Age 21 or OverC Daytime OnlyD Not to Exceed 45 MPHE No Expressway DrivingF Must Hold Valid Learner Lic. to MM/DD/YYG TRC 545.424 Applies until MM/DD/YYH Vehicle Not to Exceed 26,000 lbs GVWRI Motorcycle Not to Exceed 250 CCJ Licensed Motorcycle Operator Age 21or Over in SightK Moped12. Person Type13. Seat Position1 Driver2 Passenger/Occupant3 Pedalcyclist4 Pedestrian5 Driver of Motorcycle Type Vehicle6 Passenger/Occupant on Motorcycle TypeVehicle98 Other (Explain in Narrative)99 Unknown1 Front Left2 Front Center3 Front Right4 Second Seat Left5 Second Seat Center6 Second Seat Right7 Third Seat Left8 Third Seat Center9 Third Seat Right18. Restraint Used7 Child Booster Seat96 None97 Not Applicable98 Other (Explain inNarrative)99 Unknown1 Not Deployed2 Deployed, Front3 Deployed, Side4 Deployed, Rear5 Deployed, Multiple97 Not Applicable99 Unknown20. Helmet Use21. Solicitation 22. Alcohol Specimen Type1 Not Worn2 Worn, Damaged3 Worn, Not Damaged4 Worn, Unk. Damage97 Not Applicable99 Unknown if WornY SolicitN No Solicit1 Breath2 Blood3 Urine4 Refused96 None98 Other (Explain in Narrative)23. Drug Specimen Type25. Drug Category2 Blood3 Urine4 Refused96 None98 Other (Explain in Narrative)2 CNS Depressants3 CNS Stimulants4 Hallucinogens6 Narcotic Analgesics7 Inhalants8 Cannabis10 Disassociative Anesthetics11 Multiple Drugs (Explain in Narrative)97 Not Applicable98 Other Drugs (Explain in Narrative)99 Unknown1 Positive2 Negative97 Not Applicable99 Unknown26. Financial Responsibility Type1 Liability Insurance Policy2 Proof of Liability Insurance3 Insurance Binder4 Surety BondRD RoadST StreetDR DriveAVE AvenueBLVD BoulevardPKWY ParkwayLN LaneFWY FreewayHWY HighwayWAY WayTRL TrailLOOP Loop5 Certificate of Deposit with Comptroller6 Certificate of Deposit with County Judge7 Certificate of Self-InsurancePC Police Car/TruckPM Police MotorcycleTL Trailer, Semi-Trailer, or Pole TrailerTR TruckTT Truck TractorVN Van98 Other (Explain in Narrative)99 UnknownL Vehicle w/o Air Brakes – Applies toVehicles Requiring CDLM CDL Intrastate Commerce OnlyN Ignition Interlock RequiredO Occ./Essent. Need DL-No CMVSee Court OrderP Stated on LicenseQ LOFS 21 or Over Vehicle AboveClass BR LOFS 21 or Over Vehicle AboveClass CS Outside Rear View Mirror orHearing Aid10 Cargo Area11 Outside Vehicle13 Other in Vehicle14 Passenger in Bus16 Pedestrian, Pedalcyclist,or Motorized Conveyance98 Other (Explain inNarrative)99 Unknown19. Airbag24. Drug Test ResultN NorthNE NortheastE EastSE SoutheastS SouthSW SouthwestW WestNW Northwest4. Street Suffix7. Body StyleONG OrangePNK PinkPLE PurpleRED RedSIL SilverTAN TanTEA Teal (green)TRQ Turquoise (blue)WHI WhiteYEL Yellow98 Other (Explain inNarrative)99 Unknown9. Driver LicenseClass1 Shoulder and Lap Belt2 Shoulder Belt Only3 Lap Belt Only4 Child Seat, Facing Forward5 Child Seat, Facing Rear6 Child Seat, Unknown3. Street Prefix,Direction from Int. orRef. MarkerEXPY ExpresswayCT CourtCIR CirclePL PlacePARK ParkCV Cove8. Driver License/IDType1 Driver License2 Commercial Driver Lic.3 Occupational4 ID Card5 Unlicensed98 Other99 UnknownT Automatic TransmissionU Applicable Prosthetic DevicesV Applicable Vehicle DevicesW Power SteeringX Vehicle Not to Exceed Class CY Valid TX Vision or Limb WaiverReq’d.Z Valid Fed. Vision or Limb WaiverReq’d.5 Unlicensed96 None98 Other/Out of State99 Unknown14. Injury Severity15. Ethnicity 16. SexA Incapacitating InjuryB Non-IncapacitatingInjuryC Possible InjuryK KilledN Not Injured99 UnknownW White1 Male1 NoB Black2 Female2 YesH Hispanic99 Unknown 3 Yes, PartialA Asian97 NotI Amer. Indian/ApplicableAlaskan Native99 Unknown98 Other99 Unknown27. Vehicle Damage RatingIn most cases, enter in the formatXX-ABC-Y, whereXX is the Direction of Force (1-12),ABC is the Damage Description 2- or 3letter code),and Y is the Damage Severity (0-7).17. EjectedFD1112 1102FL1112 1102FR1112 1102FC121110LFQ 9In special cases, use:8VB-1 vehicle burned, NOT due to7collision11VB-7 vehicle catches fire due to the LD7collisionTP-0 top damage only11VX-0 undercarriage damage only10MC-1 motorcycle, moped, scooter, LP 98etc.7NA Not Applicable (Farm Tractor,etc.)L&T 911110LBQ 9871523 RFQ41RD51523 RP435876 5BL486BC8765BD4765BR4R&T23 RBQ4

COMMERCIAL MOTOR VEHICLETexas Peace Officer’s Crash Report – Code SheetNumbered Fields on the CR-3 Refer to the Numbered Lists on this Code Sheet. Each list includes the codes that may be entered onthe form and the description of each code.Page 2 of 2Law Enforcement and TxDOT Use ONLY.Form CR-3CS 1/1/201028. Vehicle Operation29. Carrier ID Type30. Roadway Access31. Vehicle Type32. Hazardous Material Class Number1 Interstate Commerce2 Intrastate Commerce3 Not in Commerce4 Government5 Personal1 US DOT2 TxDOT3 ICC/MC96 None98 Other (Explain in Narrative)1 Full Access Control2 Partial Access Control3 No Access Control1 Passenger Car2 Light Truck3 Bus (9-15)4 Bus ( 15)5 Single Unit Truck 2 Axles 6 Tires6 Single Unit Truck 3 or More Axles7 Truck Trailer8 Truck Tractor (Bobtail)9 Tractor/Semi Trailer10 Tractor/Double Trailer11 Tractor/Triple Trailer98 Other (Explain in Narrative)99 Unknown Heavy Truck1 Explosives2 Gases3 Flammable Liquids4 Flammable Solids5 Oxidizers and Organic Peroxides6 Toxic Materials and Infectious Substances7 Radioactive Materials8 Corrosive Materials9 Miscellaneous Dangerous Goods33. Cargo Body Style1 Bus (9-15)2 Bus ( 15)3 Van/Enclosed Box4 Cargo Tank5 Flatbed6 Dump7 Concrete Mixer34. Trailer Type8 Auto Transporter9 Garbage Refuse10 Grain Chips Gravel11 Pole13 Intermodal14 Logging15 Vehicle Towing AnotherVehicle97 Not Applicable98 Other (Explain in Narrative)1 Full Trailer2 Semi-Trailer3 Pole Trailer35. Sequence of Events1 Non-Collision:2 Non-Collision:3 Non-Collision:4 Non-Collision:5 Non-Collision:6 Non-Collision:7 Non-Collision:8 Non-Collision:Ran Off RoadJackknifeOverturn RolloverDownhill RunawayCargo Loss Or ShiftExplosion Or FireSeparation of UnitsCross Median/Centerline9 Non-Collision: Equipment Failure10 Non-Collision: Other11 Non-Collision: Unknown12 Collision Involving Pedestrian13 Collision Involving Motor Vehicle in Transport14 Collision Involving Parked Motor Vehicle15 Collision Involving Train16 Collision Involving Pedalcycle17 Collision Involving Animal18 Collision Involving Fixed Object19 Collision With Work Zone Maintenance Equipment20 Collision With Other Movable Object21 Collision With Unknown Movable Object98 Other (Explain in Narrative)FACTORS AND CONDITIONS36. Factors and Conditions1 Animal on Road - Domestic2 Animal on Road - Wild3 Backed without Safety4 Changed Lane when Unsafe14 Disabled in Traffic Lane15 Disregard Stop and Go Signal16 Disregard Stop Sign or Light17 Disregard Turn Marks at Intersection18 Disregard Warning Sign at Construction19 Distraction in Vehicle20 Driver Inattention21 Drove Without Headlights22 Failed to Control Speed23 Failed to Drive in Single Lane24 Failed to Give Half of Roadway25 Failed to Heed Warning Sign26 Failed to Pass to Left Safely27 Failed to Pass to Right Safely28 Failed to Signal or Gave Wrong Signal29 Failed to Stop at Proper Place30 Failed to Stop for School Bus31 Failed to Stop for Train32 Failed to Yield ROW – Emergency Vehicle33 Failed to Yield ROW – Open Intersection34 Failed to Yield ROW – Private Drive35 Failed to Yield ROW – Stop Sign36 Failed to Yield ROW – To Pedestrian37 Failed to Yield ROW – Turning Left38 Failed to Yield ROW – Turn on Red39 Failed to Yield ROW – Yield Sign40 Fatigued or Asleep41 Faulty Evasive Action42 Fire in Vehicle43 Fleeing or Evading Police44 Followed Too Closely45 Had Been Drinking46 Handicapped Driver (Explain in Narrative)47 Ill (Explain in Narrative)48 Impaired Visibility (Explain in Narrative)49 Improper Start from Parked Position50 Load Not Secured51 Opened Door Into Traffic Lane52 Oversized Vehicle or Load53 Overtake and Pass Insufficient Clearance54 Parked and Failed to Set Brakes55 Parked in Traffic Lane56 Parked without Lights57 Passed in No Passing Lane58 Passed on Right Shoulder59 Pedestrian FTYROW to Vehicle60 Unsafe Speed61 Speeding – (Over Limit)62 Taking Medication (Explain in Narrative)63 Turned Improperly – Cut Corner on Left64 Turned Improperly – Wide Right65 Turned Improperly – Wrong Lane66 Turned when Unsafe67 Under Influence – Alcohol68 Under Influence – Drug69 Wrong Side – Approach or Intersection70 Wrong Side – Not Passing71 Wrong Way – One Way Road72 Cell/Mobile Phone Use73 Road Rage98 Other (Explain in Narrative)37. Vehicle Defects38. Weather Condition39. Light Condition40. Entering Roads5 Defective or No Headlamps6 Defective or No Stop Lamps7 Defective or No Tail Lamps8 Defective or No Turn Signal Lamps9 Defective or No Trailer Brakes10 Defective or No Vehicle Brakes11 Defective Steering Mechanism12 Defective or Slick Tires13 Defective Trailer Hitch98 Other (Explain in Narrative)1 Clear2 Cloudy3 Rain4 Sleet/Hail5 Snow6 Fog7 Blowing Sand/Snow8 Severe Crosswinds98 Other (Explain in Narrative)99 Unknown1 Daylight2 Dark, Not Lighted3 Dark, Lighted4 Dark, Unknown Lighting5 Dawn6 Dusk98 Other (Explain in Narrative)99 Unknown2 Three Entering Roads – T3 Three Entering Roads – Y4 Four Entering Roads5 Five Entering Roads6 Six Entering Roads7 Traffic Circle8 Cloverleaf97 Not Applicable98 Other (Explain in Narrative)41. Roadway Type42. Roadway Alignment43. Surface Condition44. Traffic Control1 Two-Way, Not Divided2 Two-Way, Divided, UnprotectedMedian3 Two-Way, Divided, ProtectedMedian4 One-Way98 Other (Explain in Narrative)1 Straight, Level2 Straight, Grade3 Straight, Hillcrest4 Curve, Level5 Curve, Grade6 Curve, Hillcrest98 Other (Explain in Narrative)99 Unknown1 Dry2 Wet3 Standing Water4 Snow5 Slush6 Ice7 Sand, Mud, Dirt98 Other (Explain in Narrative)99 Unknown2 Inoperative (Explain in Narrative)3 Officer4 Flagman5 Signal Light6 Flashing Red Light7 Flashing Yellow Light8 Stop Sign9 Yield Sign10 Warning Sign11 Center Stripe/Divider12 No Passing Zone13 RR Gate/Signal15 Crosswalk16 Bike Lane17 Marked Lanes18 Signal Light With Red LightRunning Camera96 None98 Other (Explain in Narrative)

Law Enforcement and TxDOT Use ONLY.Form CR-3 1/1/2010Crash Date(MM/DD/YYYY)/Case IDTxDOT Crash IDCrash Time(24HRMM)/CityNamePageofCountyName1 Rdwy.Sys.Hwy.Num.StreetNameADDITIONAL PERSONS21 Sol.19Airbag20Helmet18 Restr.17 Eject.16 SexAge14 InjurySeverityName: Last, First, Middle15EthnicityDistrict/AreaAgencyPersonNum.12 PersonType13 SeatPositionUnit Num.ORINum.

Law Enforcement and TxDOT Use ONLY.Form CR-3 1/1/2010Crash Date(MM/DD/YYYY)/Case IDTxDOT Crash IDCrash Time(24HRMM)/CityNamePageofCountyName1 Rdwy.Sys.Hwy.Num.StreetNameORINum.DISPOSITION OF ADDITIONAL INJURED/ KILLEDUnitNum.District/AreaAgencyPersonNum.Taken ToDate of Death(MM/DD/YYYY)Taken //////////////////////Time of Death(24HRMM)

Model 6 Veh. Color LP Num. LP State Owner/Lessee Name & Address Proof of Fin. Resp. Fin. Resp. Name Pol., Fire, EMS on Emergency (Explain in Narrative if checked) 27 Vehicle Damage Rating 1 Towed By Towed To Parked Vehicle 23 Drug Spec. Fin. Resp. Num. Vehicle Inventoried Hit and Run No

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