Pedestrian Struck By Motor Vehicle

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7/20 EXAMPLES

Text in this Example:

DESCRIPTION OF THE ACCIDENT
WAS THIS A WITNESSED ACCIDENT (NAME AND CONTACT NUMBERS FOR WITNESS(ES)) - IF YES, WHAT DOES WITNESS SAY HAPPENED?
IF UNWITNESSED, WHAT DO LAW ENFORCEMENT SUSPECT HAPPENED?
IS IT KNOW WHERE THE VICTIM WAS WHEN STRUCK - THE SHOULDER OF THE ROAD, IN AN
INTERSECTION , MID BLOCK, OPEN ROADWAY, ETC.
VEHICLE(S) - IF VEHICLE IS AVAILABLE, PHOTOGRAPH FROM ALL SIDES INCLUDING THE FRONT OF THE VEHICLE WITH A RULER SHOWING THE HEIGHT OF THE BUMPER FROM THE GROUND TO THE FIRST PROTRUSION.)
DID THE VEHICLE STOP AT THE SCENE?
IF NO, DESCRIBE WITNESSES POSSIBLE LEADS ABOUT THE KIND OF VEHICLE INVOLVED:
IF YES, ARE CHARGES PENDING AGAINST THE DRIVER OF THE VEHICLE?
IF YES, WHAT ARE THE CHARGES:
TYPE OF VEHICLE:
AUTO
PICKUP
TRUCK
VAN
BUS
ATV
MOTORCYCLE
BICYCLE
MAKE:
MODEL:
YEAR:
BUMPER HEIGHT (ROAD TO PROJECTION ON BUMPER):
HOOD HEIGHT (ROAD TO PROJECTION ON HOOD):
DESCRIBE TRACE EVIDENCE FOUND ON THE VEHICLE AND FROM UNDERCARRIAGE, IF
APPLICABLE:
WERE OTHER VEHICLE(S) INVOLVED: IF "YES" DESCRIBE PER ABOVE:
THE VEHICLE WAS TRAVELING:
NORTH
SOUTH
EAST
WEST
UNK
WHAT LANE:
INSIDE
MIDDLE
OUTSIDE
OTHER:
IF SKID MARKS VISIBLE, WHAT IS LENGTH:
FT
POLICE HAVE ESTIMATED SPEED OF VEHICLE TO BE:
MPH
DRIVER OF VEHICLE
WAS THERE ANY INDICATION THAT THE DRIVER OF THE VEHICLE WAS UNDER THE INFLUENCE
OF ALCOHOL OR DRUGS, EXPLAIN:
DID THE OPERATOR OF THE VEHICLE GIVE ANY WARNING OF APPROACH:
NAME OF INVESTIGATOR
DMI#
PEDESTRIAN STRUCK BY MOTOR VEHICLE
NAME OF DECEDENT:
This form is to completed in addition to the ROD form in these guidelines
THE DECEDENT
DESCRIBE THE VICTIM'S CLOTHING:
LIGHT
MEDIUM
DARK
THE BODY WAS FOUND
FT. FROM THE POINT OF IMPACT.
FT. OFF/ON THE ROADWAY.
THE VICTIM WAS:
WALKING
RUNNING
STANDING
UNKNOWN
IN A CROSSWALK – EXPLAIN:
HEADING IN THE DIRECTION:
THE FLOW OF TRAFFIC WAS:
WITH
AGAINST
CROSSING THE FLOW
APPARENT CONDITION OF TH E PEDESTRIAN (INCLUDING ALCOHOL, DRUGS, ETC. -- INDICATE
DISTANCE OF NEAREST LIQUOR ESTABLISHMENT IF KNOWN)
ENVIRONMENTAL FACTORS
ROAD CONDITION:
DRY
WET
SNOW
ICE
MUD
AREA:
BUSINESS
INDUST
SCHOOL
PLAYGROUND
RESIDENTIAL
ROAD FACTORS
ROAD SURFACE:
CONCRETE
ASPHALT
BRICK
GRAVE
DIRT
NUMBER OF TRAFFIC LANES:
MEDIAN(S):
SIDEWALKS:
POSTED SPEED:
VEHICLES PARKED NEXT TO ROADWAY - DESCRIBE:
ROADWAY IRREGULARITIES: CONSTRUCTION:
EXPLAIN:
HOW ACCESSIBLE IS THIS ROAD TO PEDESTRIANS?
IF GATES ARE PRESENT, WERE THEY OPEN?
IS THIS AREA KNOWN FOR FREQUENT PEDESTRIAN TRAFFIC?
IS THE AREA KNOWN FOR OTHER PEDESTRIAN ACCIDENTS?