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County <br /> <br />TFpe of Terrain <br /> ~ Lak~ or Stream <br /> <br />City, T~.ownship, or Village <br /> <br />V"l Private Marked Trail <br /> <br />Number. <br /> <br />CE] Within City or Village Limits <br /> <br />CMl Road Right-of-Way <br />C:3 Rail.mad Right-of-Way <br />F'-I Other (Describe) <br /> <br />U:I Governmental Marked Trail <br />t-'-I Private U~marked Property <br /> <br /> r-"l Government Unmarked Property <br />· '~-1 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 UD Daylight r-"l Dawn ry'l Dusk r--1 Dark ' <br /> <br />Type of Accident <br />r---I Struck Fixed Object [::1 Collision with Train <br />~ Machine Rotlover UZl Machine-Car Collision <br />F-'l Broke through Ice r---1 Equipment Malfunction <br />UZl Barbed Wire or Fence C'-I Stuck Guy Wire or Cable <br /> r--1 Operator Injured in Mechanism of Machine <br /> ['--1 Equipment Malfunction (describe) for Vehicle #1"or ~ <br /> <br />r---1 Machine-Machine Collision ~ Excessive Speed <br />~-I Operator thrown from Machine C--] Loss of control <br />F-1 Passenger thrown from Machine <br />c--1 Passenger thrown from Object being towed by Machine <br />· 12. Clothing Caught in Machine <br /> <br />Did this accident involve the use of alcohol or dm#s? B.^.C <br /> Operator [] [] No operato 2 [] :2 No <br /> <br />B.A C. [ <br /> <br />Was chemical test taken? <br /> 1 ~.~,~ Yes Operator 2 ~ Yes <br /> . Opemtor No ~ ,No <br /> <br />Estimated speed at the time of accident: <br /> <br />MPH <br /> <br />Descr/be accident in detail explaining cause. <br /> <br />Draw an example of machines travel and collision. <br />machines # I & #2. <br /> <br /> Mark <br />PlaTe an arrow in box showing north. <br /> <br /> <br />