Trunkline Evaluation

CLEAR FORM

Location Information
Roadway:
Control Section:
CS BMP:
CS EMP:

Reviewed By:

Segment

Intersection

Signalized

Unsignalized

Curved

Straight

2-Lane2-way

Multi Lane Divided

28051

PR Number:
PR BMP:
PR EMP:

3.83

Intersecting Rd:

Fair

Action
Needed

08/24/2015

Freeway
Route:

992703

Good

Roadway Condition

Date:

Margaret Szajner

M-37
Center Rd

No Action

The pavement is in good condition.

Notes

Signing

Advance warning signing, chevrons and target arrows for the curve are erected and meet
Notes
standards. All warning signs have reflective post strips.

Roadside

Paved shoulders.

Notes

Signal
N/A

Notes

Pavement Marking

All pavement markings meet current standards.

Notes

Geometrics
Two-Lane Two-way roadway with a horizontal curve.
Notes

External #

Crash ID

0086009

9349699

Page 01 of 01
Incident # 13839-15

ORI:

MI 2812800
08/02/2015

Crash Type

02

Special Study

Clear
Activity

Road Name

Road Type

M 37

HWY
Traffic Way

100 Feet N

01 - Not physically divided

Intersecting Road

Road Type

CENTER

RD

Unit Type

MV

State Driver License Number

Yes

##############################
##############################
ARMADA, MI 48005 (###) ###-####
Interlock
4

Alcohol
Yes
No
Refused
Not offered
Test Type
Field
PBT
Breath
Blood
Vehicle Registration
State
Insurance / Policy #

###########

MI

#################

Vehicle
Description

First Impact

08

08

First
Sequence of
Events
01 ( indicates MOST harmful event)

.00

No

NONE

No
Blood

Airbag Deployed

Sex

Airbag Deployed

01 - Going Straight Ahead

Date of Birth (Age)

Injury

Passenger Information

Sex

Airbag Deployed

Date of Birth (Age)

Injury

Passenger Information

Airbag Deployed

Date of Birth (Age)

Injury

Passenger Information

Airbag Deployed

Date of Birth (Age)

Injury

Airbag Deployed

Ambulance

Hospital

Trapped

Ambulance

Hospital

Trapped

Ambulance

Hospital

Trapped

Ambulance

Position Restraint

Ejected

Sex

Trapped

Position Restraint

Ejected

Sex

Hospital

Position Restraint

Ejected

Sex

Fourth

Position Restraint

Ejected

Hospital

Trapped

Ambulance

Position Restraint

Ejected

Hospital

Trapped

Carrier Source

Driver's CDL Type

Ambulance

GVWR

Cargo Body Type

##############################
##############################
###################################, ## #####-####

Contact Name:
Contact Date:
Contact Time:

Fourth

ICCMC

Endorsements
H
N

Third

Passenger Car

Action Prior

Position Restraint

Ejected

Vehicle Type

2007

17 - Motor veh in transport

Passenger Information

Person Advised of Damaged Traffic Control

0
Year

02 - Cross centerline/median
Sex

Other

Special Vehicles Private Trailer Type Vehicle Defect

01 - Private

Date of Birth (Age)

Type & Axle Per Unit

First
Second

Citation Issued
Hazardous

Test Results
Urine

Third

Injury

TRUCK/BUS

Ambulance

Second

Passenger Information

Owner Information

Airbag Deployed

Vehicle Use

06 - Drove left of center

Hospital

Color

Date of Birth (Age)

Vehicle Type

01

WHI

Vehicle Direction

Injury

Interstate/Intrastate

Total Occupants Hazardous Action

NONE

VIBE

Loss of control

Divided Roadway

NICKERSON'S TOWING

PONTIAC
6

Restraint

Model

Driveable

Divided Roadway

Sex

04

Drugs
Yes
Test Type
Towed To/By

Test Results
Urine

Passenger Information

Carrier Information

01

Endorsements
Cycle
Farm
Recreation

Yes

Make

Extent of
Damage

Position

O
Trapped

##############################

VIN

Location of
Greatest Damage

Ejected

Injury

No

99

Yes

01 - No access control

License Type
Operator
Chauffer
Moped

##/##/#### (26)

Driver Information

Driver Condition
1
2
3

Posted

55

Suffix

Date of Birth (Age)

MI #############

Speed Limit

02

Access Control

Prefix

01

Total Lanes

Wet
Suffix

Distance

ORV/Snowmobile

11 - NON-FRWY Curved roadway

Road Condition

Daylight

Non-Traffic Area

Area

Light
Lane Closed

Prefix

Unit Number Unit Known

Special Checks
Fatal

Deer
Fleeing Police

Weather

On Road

Construction Zone (if applicable)

Type

09 - Mayfield Twp

None
Hit and Run

School Bus

Relation to Roadway

None

Charlie Jetter

Special Circumstances

Head On

Traffic Control

28 - Grand Traverse

LOCATION

No. of Units

14:26

City/Twsp

U N I T / D R I V E R

Reviewer

Grand Traverse Co Sheriff's Office

Crash Time

County

PASSENGERS

Closed

Department Name

Crash Date

File Class 93001

Incident Disposition

STATE OF MICHIGAN TRAFFIC CRASH REPORT

OWNERS

SANITIZED SANITIZED SANITIZED SANITIZED

Authority: 1949 PA 300, Sec.257.622

Compliance: Required
MSP UD-10E
Penalty: $100 and/or 90 days (Rev 11/2006)

P
S

T
X

Medical Card

USDOT

CDL Exempt
Farm
Other

MPSC

CDL Restrictions
28

29

Hazardous Material
Placard

30
ID #

35

Cargo Spill

Owner Information

(###) ###-####
Damaged Property

Owner & Phone

36

Class #

Public

02

U N I T / D R I V E R

Unit Type

MV

State Driver License Number

Yes

Date of Birth (Age)

MI #############

Injury

Position

01

##############################
##############################
WILLIAMSBURG, MI 49690 (###) ###-####

Driver Condition
1
2
3

99

Alcohol
Yes
No
Refused
Not offered
Test Type
Field
PBT
Breath
Blood
Vehicle Registration
State
Insurance / Policy #

###########

MI

#################

Vehicle
Description

First Impact

01

Interlock

Ejected

No

Yes

01

First
Sequence of
Events
17 ( indicates MOST harmful event)

Test Results

No

0
Year

Cycle

Action Prior

01 - Going Straight Ahead

Third

Sex

##/##/#### (50)
Injury

Fourth

Airbag Deployed

Passenger Information

Sex

Airbag Deployed

Airbag Deployed

Injury

Passenger Information

Airbag Deployed

Date of Birth (Age)

Injury

Passenger Information

Airbag Deployed

Date of Birth (Age)

Injury

Airbag Deployed

KINGSLEY AREA EMG AMBULANCE SERVICES

Hospital

Trapped

Ambulance

Hospital

Trapped

Ambulance

Position Restraint

Hospital

Trapped

Ambulance

Position Restraint

Ejected

Sex

Ambulance

Position Restraint

Ejected

Sex

MUNSON MEDICAL CENTER

Trapped

Yes

Ejected

Sex

Hospital

10

Position Restraint

Ejected

Sex

Date of Birth (Age)

07
Ejected

Not Equipped

Date of Birth (Age)

Injury

Position Restraint

Date of Birth (Age)

Passenger Information

Hospital

Trapped

Ambulance

Position Restraint

Ejected

Hospital

Trapped

Carrier Source

Driver's CDL Type

Ambulance

GVWR

Type & Axle Per Unit

First
Second

Cargo Body Type

Third

##############################
##############################
###################################, ## #####-####

Fourth

P
S

T
X

Medical Card

USDOT

CDL Exempt
Farm
Other

Owner Information

(###) ###-####
Witness Information

(###) ###-####

Investigated
Reported Date (Time)
1st Investigator Name (Badge)
at Scene Yes 08/02/2015 (14:27) NICK WHITE (939)

2nd Investigator Name (Badge)

Narrative

UNIT 1 WAS TRAVELING SOUTHBOUND UPON S M 37. VEHICLE BEGAN

BRAKING PRIOR TO APPROACHING CURVED ROADWAY. DUE TO SPEED,
VEHICLE LOST CONTROL AND CROSSED CENTER LINE. VEHICLE THEN
STRUCK UNIT 2 (MOTORCYCLE) HEAD ON. UNIT 2 WAS TRAVELING
NORTHBOUND UPON S M 37. TRAFFIC CRASH WAS EXTENSIVE. DRIVER 2
AND PASSENGER 1 WERE EJECTED. MEDICAL PERSONNEL ARRIVED ON
SCENE AND PROVIDED FIRST AID. DRIVER 2 AND PASSENGER 1 WERE
DECEASED. ROADWAY CONDITIONS WERE WET FROM FRESH RAIN
WITNESS INDICATED PRIOR TO CRASH, UNIT 1 PASSED AT A HIGH RATE
OF SPEED. WITNESS STATED AS UNIT 1 WAS APPROACHING CURVED
PORTION OF S M 37, VEHICLE BRAKED HEAVILY. UNIT 1 THEN LOST
CONTROL CROSSING LEFT OF CENTER CAUSING COLLISION WITH UNIT

Photos By

950
Diagram

MPSC

CDL Restrictions
28

29

Hazardous Material
Placard

Witness Information

##############################
##############################
###################################, ## #####-####

ICCMC

Endorsements
H
N

2.

Vehicle Type

2003

01 - Private

Date of Birth (Age)

Vehicle Type

Other

Motor veh in transport

Injury

Interstate/Intrastate

Citation Issued
Hazardous

Test Results
Urine

Vehicle Use

Passenger Information

TRUCK/BUS

KINGSLEY AREA EMG AMBULANCE SERVICES

SIL

Second

##############################
##############################
WILLIAMSBURG, MI 49690 (###) ###-####

Owner Information

Ambulance

Color

Vehicle Direction

00 - None

Special Vehicles Private Trailer Type Vehicle Defect

K1200LT
Driveable

02

MUNSON MEDICAL CENTER

Not Equipped
No
Blood

Total Occupants Hazardous Action

Hospital

10

Model

BMW
7

Restraint

Sex

NICKERSONS

Make

Extent of
Damage

Endorsements
Cycle
Farm
Recreation

Airbag Deployed

Drugs
Yes
Test Type
Towed To/By

Urine

Passenger Information

Carrier Information

Trapped

##############################

VIN

Location of
Greatest Damage

PASSENGERS

License Type
Operator
Chauffer
Moped

##/##/#### (57)

Driver Information

WITNESS OWNERS

SANITIZED SANITIZED SANITIZED SANITIZED

Unit Number Unit Known

Cargo Spill

30
ID #

35

36

Class #