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Tfpe of Terrain <br /> Lake or Stream <br />~Road Kight-o f-Way <br /> R~ilroad Right-of-Way <br /> Other (Describe) , <br /> <br />City, Towuship, or Village <br /> <br /> r--'l Private Marked Trail <br /> IZZ] Governmental Marked Trail <br /> [223 Private Unmarked Propen'y <br /> <br />Section Number <br /> <br />Within City or Village Limits <br />Oovernment Unmarked Property <br />Outside City or Village Limits <br /> <br /> Light Heavy Blowing <br />Weather [] Clear ~ Cloudy [] Rain or Sl~et [] Fog [] Snow [] Snow '{'-"] Snow <br />[] Other contributing factors <br /> <br />Light Conditions [ZZ] 'Daytight [:3 Dawn F--1 Dusk ,~ Dark <br /> <br />s!yp_e of Accident <br /> Struck Fixed Object ffZ] Collision with Train <br /> Machine Rollover [Z] Machine-Car Collision <br /> Broke through Ice {ZZl Equipment Malfunction <br /> Barbed Wire or Fence IZZ] Stuck Guy Wire or Cable <br /> Operator Injured in Mechanism of Machine <br /> Equipment Malfunction (describe) for Vehicle #1 or #2 <br /> <br />r--i Machine-Machine Collision [ZD Excessive Speed <br />~' Operator tbxown from Machine [Z] Loss of control <br />f--I' Passenger thrown from Machine <br />UD Passenger thrown from Object being towed by Machine <br />C-'-I Clothing Caught in Machine <br /> <br />Did this accident involve the use of alcohol o? drugs? <br /> Operator # l~Wcs,Yes <br /> <br />Was chemical test taken? <br /> Operator 1 [ZZ} Yes Operator 2 [~ Yes <br /> ~ No <br /> <br />B.A.C I <br />CAr, }_. Operator <br /> I #2 [Z] Yes[ZINc <br /> <br />Estimated speed at the time of accident: ~ ~- d//0 MPH <br /> <br />Describe accident in detail explaining cause. <br /> <br />Draw an example of machines travel and collision. Mark <br />machines #1 & #2. Place an arrow in box showing north. <br /> <br /> <br />