Road Divided By State of New Jersey Police Crash ...

1 01 None02 Lap Belt03 Harness04 Lap Belt & Harness05 Child Restraint06 Helmet07 (reserved)08 Airbag09 Airbag & Seatbelts10 Safety Vest (Ped only)07 Shoulder / Upper Arm08 Elbow / Lower Arm / Hand09 Abdomen / Pelvis10 Hip / Upper Leg11 Knee / Lower Leg / Foot12 Entire BodyLocation of Most Severe Physical InjuryUse Code 00 for Code 99 for Other in Crash DescriptionAlso, Explain Items Marked with asterisk (*) in Crash DescriptionIf an Item Does Not Apply, Enter a Dash ( - )Overlay Page 1 of 2 Cut here 21/32 " from leftCut here 1 5/16 " from bottomCutting at designated positions will permit arrows on each side to be displayed when the appropriate overlay is paged. It will also permit the first overlay to be slightly longer than the second for easy paging. Printing should be done Portrait, Duplex, Flip on Short Edge11611790 AvailUsed 92 93 91 Refused Medical Treatment1 Yes 2 No01 Head02 Face03 Eye04 Neck05 Chest06 Back01 Amputation02 Concussion03 Internal04 Bleeding05 Contusion/Bruise/Abrasion06 Burn07 Fracture / Dislocation08 Complaint of PainType of Most Severe Physical InjurySafety Equipment 95 Hosp CodeAirbag Deployment01 Front 07 Other 02 Side 08 Multiple 94 Align with top edge of Report -9/16" from top of this overlay Which Vehicle Occupied 1 Vehicle 1 B Pedalcycle 2 Vehicle 2 P Pedestrian O Other Position In/On Vehicle01 Driver 02 thru 09 Passengers10 Cargo Area 11 Riding/Hanging on OutsideVictim's Physical Condition 01 Killed 02 Incapacitated 03 Moderate Injury 04 Complaint of PainEjection From Vehicle01 Not Ejected 02 Partial Ejection 87 AgeSex 8886101 2 34 5 6 7 8 9111111858483891103 Ejected04 TrappedRoad Divided

2 By01 Barrier Median 02 Curbed Median 03 Grass Median 04 Painted Median 05 None96 Temporary Traffic Control Zone01 None 02 Construction Zone 03 Maintenance Zone 04 Utility Zone 05 Incident Zone9798 Light Condition01 Daylight 03 Dusk 05 Dark (no street lights) 07 Dark (street lights on, spot) 02 Dawn 04 Dark ( street lights off) 06 Dark (street lights on, continuous)01 Bus (9-15 seats)02 Bus (> 15 seats)03 Van/Enclosed Box04 Cargo Tank05 Flatbed06 Dump07 Concrete Mixer08 Auto Transporter09 Garbage/Refuse10 Hopper (grain,gravel,chips)11 Pole (trailer)12 Intermodal Chassis13 No Cargo Body114115 Special Function Vehicles01 Work Equipment *02 Police03 Military04 Fire/Rescue05 Ambulance06 Taxi/Limo07 Veh Used as School Bus08 Veh Used as Other Bus09 School Bus10 Transit Bus11 Other Bus12 Veh Used as Snowplow13 Vehicle Towing Another Veh112113 Road System01 Interstate 02 State Highway 03 State /Interstate Authority04 State Park or Institution05 County06 Co Auth, Park or Inst07 Municipal08 Mun Auth.

3 Park or Inst09 Private Property10 US Govt Property99 Road Character01 Straight and Level 02 Straight and Grade 03 Straight at Hillcrest04 Curve and Level05 Curve and Grade06 Curve at Hillcrest100 Road Surface Type01 Concrete 02 Blacktop 03 Gravel 04 Steel Grid 05 Dirt 101 Road Surface Condition01 Dry 02 Wet 03 Snowy 04 Icy 05 Slush 06 Water (Standing/Moving) 07 Sand, Mud, Dirt 102 Environmental Condition01 Clear 03 Snow 05 Overcast 07 Blowing Snow 09 Severe Crosswinds02 Rain04 Fog/Smog/Smoke 06 Sleet/Hail/Freezing Rain 08 Blowing Sand/Dirt103 08 Oil06 Recreational Vehicle07 All Terrain Vehicle08 Motorcycle09 (reserved)10 any previous w/Trailer01 Car/Station Wagon/Minivan02 Passenger Van ( < 9 Seats)03 Cargo Van (10K lbs or less)04 Sport Utility Vehicle05 PickupVehicle TypePassenger Vehicles (01-19)11 Moped12 Streetcar/Trolley13 Pedalcycle19 Other Pass VehicleTrucks / Bus (20-30)20 Single Unit (2 axle)21 Single Unit (3+ axle)22 Light Truck w/Trailer23 Single Unit Truck w/Trailer24 Truck Tractor (Bobtail)25 Tractor Semi-Trailer26 Tractor Double27 Tractor Triple 29 Other Truck30 Bus / Large Van ( 9 or more Seats)10810903 Government04 Responding to Emergency05 Machinery in Use01 Personal02 Business/Commerce110111106107 State of New JerseyPolice Crash InvestigationReport NJTR-1 NOTE:Boxes 1 - 7 must be completed for all pages of the report.

4 Boxes 8-22 and 96-105 are only required on page 1 of the other information is completed as for : Crash References - Codes - 5 digit NAIC - 3 digit MVC - Codes - Body Type (Comm Veh Only)Oversize/Overweight Permit ?(Comm Veh Only)01 Yes 02 NoDirection of Travel of VehicleVehicle Use01 North 02 East03 South 04 WestVeh 2 Veh 1 Veh 2 Veh 1 Veh 2 Veh 1 Veh 2 Veh 1 Veh 2 Veh 1 Veh 2 Veh 1 10 Overturned11 Fixed Object12 Animal13 Pedestrian14 Pedalcyclist 15 Non-fixed Object16 Railcar -vehiclewith Other MV as First Event07 Left Turn / U Turn08 Backing09 Encroachment01 Same Direction ( Rear End )02 Same Direction (Side Swipe)03 Right Angle04 Opposite Direction (Head On, Angular)05 Opposite Direction (Side Swipe)06 Struck Parked Vehiclewith Below as First Event105 Crash TypeTotal Number of Motor Vehicles Involved in Crash 104129a129d129cVeh 2 Veh 1 Veh 2 130131133 Pre- Crash ActionApparent Contributing CircumstancesCell Phone In Use By DriverDriver/Pedalcyclist Actions ( 01 - 29 )

5 01 Unsafe Speed02 Driver Inattention *03 Failed To Obey Traffic Control Device04 Failed To Yield ROW to Improper Lane Change06 Improper Passing07 Improper Use/Failed to Use Turn Signal08 Improper Turning09 Following Too Closely10 Backing Unsafely11 Improper Use/No Lights12 Wrong Way13 Improper Parking14 Failure To Keep Right25 None29 Other Driver/Pedalcyclist Action Vehicle Factors ( 31 - 49 )31 Defective Lights *32 Brakes *33 Steering *34 Tires *35 Wheels *36 Windows/ Windshield * 37 Mirrors *38 Wipers *39 Veh Coupling/Hitch/Safety Chains * 49 Other Vehicle Factor 01 Going Straight Ahead02 Making Right Turn (not turn on red)03 Making Left Turn04 Making U Turn05 Starting From Parking06 Starting In Traffic07 Slowing or Stopping08 Stopped in Traffic09 Parking10 Parked11 Changing LanesUse Code 00 for Code 99 for Other in Crash DescriptionAlso, Explain Items Marked with asterisk (*) in Crash DescriptionIf an Item Does Not Apply, Enter a Dash ( - )Overlay Page 2 of 2 Cut here first 8 1/16 " from leftCut here second 1 1/8 " from leftCut here 1 9/16 " from bottomVeh 1 Veh 2 Ped12 Merging/Entering Traf Lane13 Backing14 Driverless / Moving 15 Passing16 Negotiating Curve17 Driving on Shoulder18 Right Turn on Red29 Other Veh/Cyclist Action *Pedestrian Factors ( 71 - 89 )

6 71 Failed To Obey Traffic Control Device72 Crossing Where Prohibited73 Dark Clothing/Low Visibility to Driver74 Inattentive *75 Failure to Yield ROW76 Walking on Wrong Side of Road77 Walking in Road When Sidewalk Present78 Running/Darting Across Traffic85 None89 Other Pedestrian Factors Apparent Physical Status01 Apparently Normal02 Alcohol Use03 Drug Use (Illicit) *04 Medication *05 Alcohol & Drug/Medication Use *06 Physical Handicaps07 Illness08 Fatigue09 Fell Asleep01 Handheld02 Hands FreeRoad / Environ. Factors ( 51 - 69 ) 51 Road Surface Condition *52 Obstruction/Debris In Road *53 Ruts, Holes, Bumps *54 Control Device Defective or Missing *55 Improper Work Zone *56 Physical Obstructions (viewing, etc) *57 Animals in Roadway *58 Improper/Inadequate Lane Markings *59 Sunglare *69 Other Roadway Factors Align with top edge of Report -1/2" from top of this overlayState of New JerseyPolice Crash InvestigationReport NJTR-1 Eye Color (box 30, 60)1 - Black 4 - Blue2 - Brown 5 - Hazel3 - Gray 6 - Green 7, 8, and 9 = OtherVeh 2 Veh 1 118aVeh 2 119aVeh 2 119bVeh 1 118b121 Veh 1 120 Veh 1 Veh 2 123122 Veh 2 Veh 1 124125 collision w/ Fixed Object ( 41 - 69 )

7 41 Impact Attenuator / Crash Cushion42 Bridge Overhead Structure43 Bridge Pier or Support44 Bridge Parapet End45 Bridge Rail46 Guardrail Face47 Guardrail End48 Concrete Traffic Barrier49 Other Traffic Barrier50 Traffic Sign Support 51 Traffic Signal Standard52 Utility Pole53 Light Standard54 Other Post, Pole, Support55 Culvert56 Curb57 Ditch58 Embankment59 Fence60 Tree61 Mailbox62 Fire Hydrant69 Other Fixed ObjectNon collision ( 01 - 19 )01 Overturn / Rollover02 Fire / Explosion03 Immersion04 Jackknife05 Ran Off Road - Right06 Ran Off Road - Left07 Crossed Median / Centerline08 Downhill Runaway09 Cargo / Equipment Loss or Shift10 Separation of Units11 Fell / Jumped From Vehicle12 Thrown / Falling Object13 Equipment Failure 19 Other Non CollisionCollision w/ Person, MV, or Non-FixedObject ( 21 - 39 )21 Pedalcyclist22 Pedestrian23 Train / Trolley / Other Railcar24 Deer25 Other Animal26 MV in Transport27 MV in Transport, Other Roadway28 Parked MV29 Work Zone or Maint.

8 Equipment30 Struck By Object Set In Motion By MV39 Other Non-Fixed Object Sequence of Events (select up to 4 for each vehicle) PrincipalDamageInitialImpactPrincipalDam ageInitialImpact13 Roof14 Undercarriage15 Overturned17 None Visible Clockpoint DiagramVehicle Impact Area129b1st2nd3rd4thVeh 2 EventsVeh 1 01 Police Officer02 RR Watchman, Gates, etc03 Traffic Signal04 Lane Markings05 Channelization - Painted06 Channelization - Physical07 Warning Signal08 Stop Sign13 School Zone (Signs/Controls)14 Adult Crossing GuardTraffic ControlsVehicle / Pedalcyclist Action (01-29)Pedestrian Action (31-49)31 Pedestrian Off Road32 Walking To/From School33 Walking/Jogging with Traffic34 Walking/Jogging Against Traffic35 Playing in Road36 Standing/Lying/Kneeling in Road37 Getting On/ Off Vehicle38 Pushing/Working on Vehicle39 Other Working in Roadway40 Approaching/Leaving Schoolbus41 Coming From Behind Parked (reserved)At Intersection43 Crossing at "marked" Crosswalk 44 Crossing at "unmarked" CrosswalkAt Mid-Block45 Crossing at "marked" Crosswalk 46 Crossing / Jaywalking 49 Other Pedestrian Action *09 Yield Sign10 Flagman11 No Control Present12 Flashing Traffic ControlVeh 2 Veh 1 1261271st2nd3rd4thVeh 1 Events128c128d128b128a1321.

9 Same Direction (Rear-end)- Two vehicles moving one behind the other and collide, regardless of what movements either vehicle was in the process of making. This would include a collision in which the leading vehicle spun out and became turned 180 degrees around such that the resulting same direction collision had it strike front end to front end with the following Same Direction (Sideswipe)- Two vehicles moving alongside each other and collide, with at least one of the vehicles being struck on the side. This type would include a collision resulting from one of the vehicles making an improper turn such as a left from the right lane or vice-versa or turning right from the appropriate outside lane and striking a vehicle passing on the right Right Angle- Two vehicles approaching from non-opposing angular directions collide, typically resulting as one vehicle failed to either stop or yield right of way from a Stop or Yield sign, ran a red light, or was not cleared from the intersection upon the onset of the conflicting movement's green signal.

10 4. Opposite Direction (Head-on/Angular)- Two vehicles approaching opposite directions and intending to continue in opposite directions collide in a frontal or angular manner as a result of one or both vehicles crossing the painted or unpainted centerline or Divided median of the roadway. This includes a collision resulting from one vehicle traveling the wrong way down a Divided Opposite Direction (Sideswipe)- Two vehicles approaching opposite directions and intending to continue in opposite directions collide in a sideswiping manner as a result of one or both vehicles crossing the painted or unpainted centerline or Divided median of the roadway. This also includes a collision resulting from one vehicle traveling the wrong way down a Divided Parked Vehicle- A Crash involving a vehicle in transport striking a parked vehicle within the roadway or in a parking Left Turn/U Turn- Two vehicles approaching from opposite directions collide as a result of at least one vehicle attempting to make a left or U turn in front of the opposing vehicle.