TRAFFIC COLLISION REPORT - El Camino College交通事故报告-埃尔卡米诺学院.doc

Administration of JusticeEl Camino CollegeProfessor Ray LewisTRAFFIC COLLISION REPORTSPECIAL CONDITIONS:NUMBER INJURED:HIT & RUN FELONY:CITY:JUDICIAL DISTRICT:NUMBER:NUMBER KILLED:HIT & RUN MISDCOUNTY:REPORTING DISTRICT:SEAT:COLLISION OCCURRED ON:DATE:TIME: (24:00)NCIC #OFFICER ID:MILEPOST INFORMATION:DAY OF THE WEEK:TOW AWAY YES NOPHOTOGRAPHS BY: NONE AT INTERSECTION WITH OR OF STATE HWY REL YES NOPARTY 1DRIVERS LICENSE NO.STATE:CLASS:SAFETY EQUIPVEH YR.MAKE/MODEL/COLORLICENSE NO.STATEDRIVERNAME (First, Middle, Last)PED.STREET ADDRESS:OWNERS NAME: SAME AS DRIVERPARKED VEH CITY/STATE/ZIPOWNERS ADDRESS: SAME AS DRIVERBICYCL-IST SEXHAIREYESHEIGHTWEIGHTDOBRACEDISPOSITION OF VEHICLE ON ORDERS OF: OFFICER DRIVER OTHER OTHERHOME PHONE:BUSINESS PHONEPRIOR MECHANICAL DEFECT: NONE APPARENT REFER TO NARRATIVE CHP USE ONLYVEHICLE TYPEDESCRIBE VEHICLE DAMAGESHADE DAMAGED AREAINSURANCE CARRIER:POLICY NUMBER:DIR OF TRAVELON STREET OR HIGHWAYSPEED LIMITPCF ICC PUC CHPPARTY 2DRIVERS LICENSE NO.STATE:CLASS:SAFETY EQUIPVEH YR.MAKE/MODEL/COLORLICENSE NO.STATEDRIVERNAME (First, Middle, Last)PED.STREET ADDRESS:OWNERS NAME: SAME AS DRIVERPARKED VEH CITY/STATE/ZIPOWNERS ADDRESS: SAME AS DRIVERBICYCL-IST SEXHAIREYESHEIGHTWEIGHTDOBRACEDISPOSITION OF VEHICLE ON ORDERS OF: OFFICER DRIVER OTHER OTHERHOME PHONE:BUSINESS PHONEPRIOR MECHANICAL DEFECT: NONE APPARENT REFER TO NARRATIVE CHP USE ONLYVEHICLE TYPEDESCRIBE VEHICLE DAMAGESHADE DAMAGED AREAINSURANCE CARRIER:POLICY NUMBER:DIR OF TRAVELON STREET OR HIGHWAYSPEED LIMITPCF ICC PUC CHPPARTY 3DRIVERS LICENSE NO.STATE:CLASS:SAFETY EQUIPVEH YR.MAKE/MODEL/COLORLICENSE NO.STATEDRIVERNAME (First, Middle, Last)PED.STREET ADDRESS:OWNERS NAME: SAME AS DRIVERPARKED VEH CITY/STATE/ZIPOWNERS ADDRESS: SAME AS DRIVERBICYCL-IST SEXHAIREYESHEIGHTWEIGHTDOBRACEDISPOSITION OF VEHICLE ON ORDERS OF: OFFICER DRIVER OTHER OTHERHOME PHONE:BUSINESS PHONEPRIOR MECHANICAL DEFECT: NONE APPARENT REFER TO NARRATIVE CHP USE ONLYVEHICLE TYPEDESCRIBE VEHICLE DAMAGESHADE DAMAGED AREAINSURANCE CARRIER:POLICY NUMBER:DIR OF TRAVELON STREET OR HIGHWAYSPEED LIMITPCF ICC PUC CHPPREPARERS NAME:REVIEWERS NAME:DATE REVIEWED:TRAFFIC COLLISION CODINGDATE OF COLLISION:TIME:NCIC NUMBER:OFFICER I.D.NUMBER:PROPERTYDAMAGEOWNERS NAME/ADDRESS:NOTIFIED YES NODESCRIPTION OF DAMAGE:SEATING POSITIONSAFETY EQUIPMENTEJECTED FROM VEH.1 2 3 4 5 6 7OCCUPANTS Air bag deployedM/C BICYCLEHELMET None in Vehicle Air bag not deployed Not ejected Unknown OtherDriver Fully ejected Lap Belt Used Not Required No Partially ejected Shoulder Harness UsedCHILD RESTRAINT Yes Unknown Shoulder Harness Not Used In vehicle used Lap/Shoulder Harness Used In vehicle not usedPassenger Lap/Shoulder Harness Not Used In vehicle use unknown No Passive Restraint Used In vehicle improper use Yes Passive Restraint Not Used None in vehicleITEMS MARKED BELOW WHICH ARE FOLLOWED BY AN ASTERISK (*) SHOULD BE EXPLAINED IN THE NARRATIVE.PRIMARY COLLISION FACTOR LIST NUMBER OF PARTY AT FAULTTRAFFIC CONTROL DEVICES123TYPE OF VEHICLE123MOVEMENT PROCEDING COLLISIONVC Section Violated CitedYes No Controls functioningPassenger car/Station wagonStoppedControls not functioning*Passenger car with trailerProceeding StraightControls obscuredMotorcycle/ScooterRan Off RoadOther Improper DrivingNo controls present/factor*Pickup or panel truckMaking Right TurnOther Than DriverTYPE OF COLLISIONPickup/Panel truck with trailerMAKING LEFT TURNUnknown *Head-onTruck or Truck tractorMaking U TurnFell Asleep *SideswipeTruck/Truck tractor with trailerBackingRear EndSchool busSlowing/StoppingWEATHER (Mark 1 to 2 items)BroadsideOther BusPassing Other VehicleClearHit ObjectEmergency VehicleChanging LanesCloudyOverturnedHwy. Const. EquipmentParking ManeuverRainingVehicle/PedestrianBicycleEntering TrafficSnowingOther: Other VehicleOther Unsafe TurningFog/Visibility ftMOTOR VEHICLE INVOLVED WITHPedestrianXing Onto Opposite LaneOther: Non-collisionMopedParkedWindPedestrianMergingOther Motor VehicleOTHER ASSOCITED FACTOR (Mark 1 to 2 items)TRAVELING WRONG WAYLIGHTINGMotor Veh. on other roadwayVC Section Violation:Cited YesNoOTHER: DaylightParked motor vehicleDusk/DawnTrainDark Street LightsBicycleVC Section Violation:Cited YesNoDark No Street LightsAnimal: Dark Street Lights no functioningFixed Object:Other Object: VC Section Violation:Cited YesNoSOBRIETY DRUG PHYSICAL (Mark 1 to 2 items)Had Not Been DrinkingROADWAY SURFACEVision ObscurementHSD UNDER INFLUENCEDryInattentionHsd Not Under Unflu. *WetStop and GoTrafficHsd Impairment Unk.*Snowy IcyEntering/Leaving rampUnder Drug Influ.*Slippery (muddy, Oily, etc.)Previous collisionImpairment Physical *Unfamiliar with roadImpairment Not KnownROADWAY CONDITIONS (Mark 1 to 2 items)Defective Veh. EquipCitedYesNoNOT APPLICABLESLEEPY / FATIGUEDHoles, deep ruts*PEDESTRIANS ACTIONLoose material on Rdwy*No pedestrian involvedUninvolved vehicleSPECIAL INFORMATIONObstruction on Rdwy*Crossing in Crosswalk at inters