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County <br /> <br />City, T...ownship, or Village <br /> <br />Section Number. <br /> <br />I <br />I <br />I <br />I <br /> <br />Type of Terrain <br />r-~ Lake or Stream <br />~ Road Right-of-Way <br />122 Railroad Right-of-Way <br />[223 Other (Describe) <br /> <br />a-"-J Private Marked Trail <br />I"--1 Governmental Marked Trail <br />F-3 Private Unmarked Property <br /> <br /> ~ Within City or Village Limits <br /> 12D Government Unmarked Property <br />· ED Outside City or Village Limits <br /> <br /> Light Heavy Blowing <br />Weather [] Clear [] Cloudy [] Rain or Sleet [] Fog [] Snow [] Snow [] Snow <br />[] Other contributing factors <br /> <br />Light Conditions ED Daylight r-'-] Dawn [~3 Dusk ED Dark <br /> <br />' I <br /> <br />Type of Accident <br />C22 Struck Fixed Object r-"l Collision with Train <br />I-~ Machine Rollover UD Machine-Car Collision <br />ED Broke through Ice ED Equipment Malfunction <br />ED Barbed Wire or Fence 1222 Stuck Guy Wire or Cable <br />ED Operator Injured in Mechanism of Machine <br />ED Equipment Malfunction (describe) for Vehicle #1 "or #2 <br /> <br /> C2 Machine-Machine Collision f-"l Excessive Speed <br /> r---q Operator thrown from Machine r--'l Loss of control <br /> 122 Passenger thrown from Machine <br />ED Passenger thrown from Object being towed by Machine <br />· ED Clothing Caught in Machine <br /> <br />Did this accident involve the use of alcohol or drugs*. <br /> Operator gl [-] Yes <br /> <br />Was chemical test taken? <br /> Operator 1 F~ ~eo~ Operator <br /> <br />IEstimated speed at the time of accident: <br /> <br />MPH <br /> <br />Describe accident in detail explaining cause. <br /> v <br /> <br />Draw an example of machines travel and collision. <br />machines # I &//2. <br /> <br /> Mark' <br />Pla~e an arrow in box showing north. <br /> ! <br /> <br /> <br />