xt7qnk361p0s_771 https://exploreuk.uky.edu/dips/xt7qnk361p0s/data/mets.xml https://exploreuk.uky.edu/dips/xt7qnk361p0s/data/88m6.dao.xml Inland Steel Company 185 Cubic Feet archival material 88m6 English University of Kentucky Copyright has not been assigned to the University of Kentucky  Contact the Special Collections Research Center for information regarding rights and use of this collection. Wheelwright Collection Coal miners -- Housing -- Kentucky. Coal mines and mining -- Appalachian Region -- History. Company towns -- Kentucky -- Wheelwright. Community development -- Kentucky -- Wheelwright. Coal mines and mining -- Kentucky -- Wheelwright Vehicle (Accident Report Forms) text Vehicle (Accident Report Forms) 2016 https://exploreuk.uky.edu/dips/xt7qnk361p0s/data/88m6/Box_128/Folder_18/88m6_128_18__4177.pdf section false xt7qnk361p0s_771 xt7qnk361p0s l l
READ 1‘ MOTOR VEHICLE ACCIDENT REPORT 1‘ FILL IN
‘ 1. E ' . v ‘ 1
< *R F“ LY r COMMONWEALTH OF KENTUCKY l ‘ OMl’LETELY
INSTRUCTIONS
Every driver of a motor vehicle involved in an accident which results in injury or death or property damage of $50 or more must make a report on this form
within twenty-four hours. The failure or refusal oi any person to report an accident as required is a cause for the suspension or revocation of the operator‘s or
chaufleur's license and vehicle registration of such person. Such failure or refusal is also a misdemeanor. punishable by a fine not in excess of 8500.
If the driver is physically incapable of making the report. the owner or any occupant of the vehicle may he required to do so. A witness may also be required to
make a report. A supplementary report will he required whenever an original report is insufficient.
l The purpose of this report is to obtain data useful in accident prevention and for the administration oi the Financial Responsibility Law. Complete and clear
' answers to all the questions are necessary. An accura'e original report will avoid the necessity for supplementary reports. If you have difficulty in filling in the
report, consult your nearest police authority.
5. A street car, bicycle, or animal-draum 'vehicle should be
V recorded as a vehicle for the purpose of this report. A person
OBSERVE THE FOLLOWING RULES! on skates, coastenwagon, sled, etc. should be classed as a
1. Print or type all names and addresses. pizdjstrmn. Describe the conveyance and show it: exact loca-
2. Answer all questions to the best of your knowledge. If 6. The nature and extent of all damages and injuries must be
unable to answer any question. mark “not known". clearly and completely stated. Whenever a doctor's state-
“ , ,. , _ ment of injuries or a garage estimate of the cost of repair:
3- Under. LOCATION. of acctdent and on the diagram ”‘0‘” is immediately available, give this information. Otherwise
sigfurnt Information to locate the exact scene of the ac- give your best estimate.
U en ' 7. Use a second report form or a. sheet of paper the same size
4. Under “Type of Vehicle" indicate the exact type or combina- ‘0 ”DO” uddztxonal vehiclesn injured persons, w1tne55e5._0r
tion of vehicles; that is, coach, sedan with two-wheel house any other information for WhICh there 15 ”01 suffrcxent space.
trailer, tractor and semi—trailer, truck and four-wheel trailer, 8. SIGN THE REPORT in the space at the bottom of the reverse
motorcycle. etc. ride of the form.
ALL REPORTS ARE CONFIDENTIAL AND CANNOT BE USED AS EVIDENCE IN A {Y TRIAL
Mail to: DEPARTMENT OF KENTUCKY STATE POLICE, FRANKFORT, KENTUCKY
W_,___ _ __ ill Eli, _, _.., ,.____ _ L,_,_.__ AM
PLACE VVIIERE City, town DO NOT WRITE
ACCIDENT OCCURRED: (‘nuniv or township IN THIS SPACE
71f ua'zden-t was uutude {11y f miles \, l limits (,f l ‘1 N
umzls1nd1catedlxtumefrom .leh 5},th ‘ ' ‘ 0-
L -, mum! town. [‘58 [um dis— 2 I» of J. r _ ,
0 l lame: and two dira’tzunx if l miles l l _ l f ”y 07 MM ‘
mfcrmry. . [Curl H'm! l _ center of y‘ I
C , fl . . 7.. ,7 , , ,,, . _ 77. ,, .iiwl. , .
ROAD ON WHICH h
A ACCIDENT OCCURRED:
T GIN numr m WM! or hzghuuy numb" f I" X or Slum 1' no highway numb” identify by namr l
I / 7 AT ITS INTERSECTION VVITII: l
(‘hffk (171d . Vilma Hi mlnsrtlmx «fret! vvr highway numhe‘r ‘
0 . ’ OR lct‘l ‘
(ample/6' one . ‘ \mm \lmlh ‘
N l NOT AT INTERSECTION: f L of
l Show neuer inlermlme rlrrrl or highway,
{(1.1 ‘ hnuv’ numb". ( urw OVMIA’I’.701,7(ladl’VOSA‘nK. ‘
lull-l ”'?,” / ullry, driveway. (ulwrl. mtlrpoil‘ undrrfiam, l
w nth" ulmzlifymg landmark. Shaw rxurl
Jul/mm. Ming two dzrnlionx and I'm) dir- ’
,, Mme" xi nnrrsary.
l Time Date Of Day of
‘ Accident 1‘) Week Hour A.M. P.M. _7 ,l,__ >
’ VEHICLE No. I: VEHICLE N0. 2:
l l
l I’rur .Uukr [Iv/v ‘wrlun. Irmh. luxx. bu: r'lz ,,\ I'mr .’ilukr Type lsnlan, truth. (on, bui, etc.) H I
‘ Vehicle Icc. Vehicle i.C.C.
License l’luic l’latc l.1<‘cn~c l’ldtc . I‘Iulc i
I’v'ur ‘ I W ‘~ mnhn TM or \H, l i’mn \lulr Number Yrs or .\'o
v - , . l
DRIVER l DRI\ER . ?
})Vllll m 25m 'ull runny l Print or type full namt
Driver's l Driver's
.\(ldre<> ‘ .\(I(lr(‘~\ .
\Incl or R.F.[). (113‘ and Slulr \lru'l n R I7 I) (‘ily and State
Driver's (“Chauffeur l [)rh-U'5 l 2Chauffeur
License ’ , Operator Age Sex ‘ Liccme < 7, Operator Age Sex
V Mm .Vumhrr' ‘ 7 Beginner Wm Number \ ‘ l39ginner
E Driver's l Driver's l
. H Occupation Race ‘ ()(‘t‘updllun Race _ l
(arprnlrr \ Us: llzrk. (i . H'hm ”cc/u. ll . l ( urprnlrr. lulu (lc'rk. (it, Whrlr, mgm. (It.
I
OWNER l ()\VNER . . V. . . .
C Print 11) Iypr 'ull azumr Print or /ypr 'ull name
L Owner': ‘ Owner's
E Address l ,\(I(Il(‘s$ ‘ . . . . .
.\lrr':'l or R I? ll. ( :ly anri Nlulr ' Sin-u or R.F D. (‘in and State
S . _
I'HIS VEHICLE l THIS VEHICLE
\VAS GOING at m.p h. l \V.\S GOING . at .. , , .m.p.h.
Earl, (all {m nmg unrlh. cup/ml purkml. etc Speed he‘flrrg rllizrlrul l Earl. raxt [liming rim 1h, \Iupprd. parkrd, z'lz. Spccd befon‘ uarjrnt
Speed Maximum l Speed Maximum ;
1m limit m.p.h. stile speed m.p.h. ‘ on limit m.p.h. safe speed m.p.h. r
Sir"! or highway l ‘17”! :77 highway
PAR TS OF Approximate cost l l'.\R'lS ()F Approxvimate‘cost
VEHICLE DAMAGED to repair vehicle 3 VEHICLE DAMAGED to repair vehicle 3 .
IS THIS VEHICLE COVERED BY ”Yes IS THIS VEHICLE COVERED BY ; Yes
AI'TOMOBILE LIABILITY INSI'RXNCE? No _\I"l‘i)MOBILE LIABILITY INSI’RANC‘E? . . 7; No
Total
"“hm’Z' NAME OF INSI RANCE Ci). NAME OF INSI'RANCE CO. ‘
W M 5
involved Vehicle Vel’iit‘lC
.. removed to . _ _rcimchd 10 _ “.__ _J . . V
F———_—m'M—_“——i—"¥ ‘_A "__“"v "vi'r‘rw‘W—_—Wl
l DAMAGE TO PROPERTY l
l OTHER THAN VEHICLES , . g
i Name objnl. 5hou‘ uu‘nrrxhip, and ‘mlr nature of damage _
l Approxxmat‘h
l .,, . . cosrtore air 3 ...
l ll'hrrr war durum? (In vch. 2; prdrctnan 110 feel east; etc.)
‘ WITNESSES:
: Name Address . . ..,, ., . .. ..
l
l Name Address ,, , .
: Driver T In vehicle
I Name . . Address I; Passenger J No. ..
N First aid Injured Ll Pedestrian
; Age . Scx Race given by taken to M
Name Sprrify olhcr
U
Did p rson Nature and
R die? extent of lnjlyl'leS ,
E ‘ Driver I In vehicle
D Name ., . , Address ! v Passenger; N0. .
Total FIFSL aid Injured l.“ Pedestrian
mlmhcr Age SC, Race given l)‘,' V taken to V . .
injurrrt ' ' .Vumc Sprrfl'v olhn
“."d
hum Did person Nature and~
-- the? V .. . . extent oi injuries , , . . H V. ,, .,-- ‘.. ,, 777 4;. ”_v 7 '_77;W ,
EORM SP-74 ‘Prlnte {1.3, A.

 ENS'I'RI'C'I‘IUNS FUR LOCATING ACCIDENT AND MAKING THE DIAGRAM
ll'lt’r‘l'i‘ It) SHOW ON THE DI:I(.'R¢‘I.W:
ii) The directions from which the vehicles were approaching before the collision. The same for any pedestrian.
. ill Hie point of collision. This can often be determined from the debris on the street or roadway.
iJi Atty objects such as, bridges, buildings, poles, guard rail. animals. etc. that were involved.
"".‘l where the vehicles came to rest after the collision.
I‘VIFIT TO SELECT AS A LANDMARK FROM WHICH TO .ME/ISURE DISTANCES:
it (toodfundniarks in rural areas are: Highway junctions, bridges (number or name), railroad crossings, county lines,
city limits, historical markers, permanent public buildings, or other well established. easily recognized points.
.it 5'71 cities use house numbers, entrances to public or well-known buildings, or measurements to the curb line of the
nearest cross street.
(3‘: Good location descriptions are extremely important to accident prevention. Please be as accurate as possible.
(4i Use an automobile speedometer to measure long distances. Report miles and tenths or fractions (1.4 miles north of
“bometown” city limit).

I [NDHAI‘IC m 'i‘iiis IN“ N“ NW“ 7 I 7 7 ‘ INDICATE on; THIS Indicate North 7 T I 77 W 7 I T I 3
DIALRNH INIIA'I‘ I“ ‘\’I"’w I ‘ DIAGRAM WHAT by Arrow l
IIAPI'I \IC!) 8 EX4.MPLE OF A I HAPPENED 510? l

DIAGRAM FOR A (D "W .
, . w . C. . . . ‘
«WV? rm. J_.!» -. _, ,.;/,1 wilt/tort.“ [mlt’ TXPVL ’I‘L’, EA {13,1pr ()1. A I l
x‘,» ACCIDENT . . , x
7 1’ ,M ,. , TW V DIAGRAM FOR A _.,
_WT 23(11): 7 I 7 TVV'T'WW ”WI / BE E.E‘ , , V ‘ TYPICAL l
r. m .. pm... ,/ INTERAEC’IIOIVS . . . M v, 5'; .% r
— ”,4:/..-..- / ACCIDENT AT Ar» m . > E l

i ”r -~ — _.-, , 4:2f/ INTERSECTION é: ‘

r6) ,.;; ‘" fl , m ,, W 7 77 7 N , l/ , ,, 77 W. , 7 ,, fr. Ni

”ii, . ii“ i; i; l.‘ f 4’ .‘xo. 1 slipped oil the edge (if the pavement. No. 2, going north on \iliinis Street failed to stop before entering

lii gr irinu inch on iii“ I>(1‘\'l'lli(,‘n[ the driver turned too sharply and intersection with I\I.’lill Street. No. I was going east on Mam Strcet.

sl"i"~ ‘In _~ ii 1' " . . ‘liv wrong side ol the road where it struck the No. 2 struck the right rear side of No. l and then went over Iht’ciirb at

likt r: ' «II t i , Sloth Vthicles left the roadway after the collision the northwest corner alter striking a pedestrian. l‘he pedestrian was

2] :l ' . ‘3‘ z ., ' r ‘t‘H'pllwIIt‘ polo. crossing Main Street l'roin the southwest corner to the northwest corner.

(Tear of before mailing report
I ' l“ ._I. i- Wait“: W'II‘xI' HAPPENED I'Vllll All“. \ , / V ,
:'v.~ .r . . , .>i : , '«-/ ::t: h the scene of your “‘.,“:i}: Lil)“. I ,' 1
. . » 1.11! -; :--:. '.. ; . . in highway "tamer or numbers. \ / /
. ,\ . r‘ .‘wli r1! {’I'ilf‘l'l‘llnh‘y -*‘-—(l i \ \ I / / I l
' ' ,..... 'I / \lrrrr: tilllYi/lLilll)” “W“ . \ / l
’l .’ ,‘-‘-.,_$’,"' "" , . x l /
' ' ‘ i ‘ _\l1rlt JI‘lllerV {I7lil rltr lion. ‘
’ I “ 'L L ' I ' " " lrinrlnrrirlw. iilr‘rii’i/t‘ lritrrlrriiirlg. ‘ /
’l/ I “““ "GU“ '1‘ ““ ‘i' b. numr rri nutriliwi —
I I A I H‘ 1 y n. lndzzali' rliil’lll by ilrl'ilii ll . ® ,
\ln'wt m hll'll‘lld\ l l g
-r,,, tr:i.r':7ti» I l I 5‘ I
ROAD (Ill/\ltHI'E‘I-le‘, ROAD SL'RFAtLE ROAD DEFECTS TRAFFIC (‘.ON'I‘ROI. LIGHT W'EATHER
i’ 41m 2‘ la n lt'lzr’ilc wm’ .(‘IM 16 nm or NH)" It‘ll/w la unw or murwr i(‘lir'r‘k rmr’l (Check our!
Sli ,i. lil I'iil’i l‘r‘ l'ctt-r‘Iiw'~lir-iilrlr'r-r .‘Qinii sun l).i\light (‘ltuir
_ _ . llrrw 'Il‘r'llllll‘ bumps Sliilirdilllrgll signal “”4; . Raining
(iii \r \\i'l Loose iii ilt'i'i.il on (?itrr’vi oi \\ itr‘liiimii I).t\\ n ‘ Snowing ‘
. r Kiiitlrh ~iii'l.ii 1‘ It [6 il'ii‘~\lil‘_[ t- tll‘\ ,
I l\’o.irl iiiidci tonsir l\‘ l\’. t‘llivlll.illi \iuiml I)“Ik'lk“‘ “”““ , “’54
[,,‘ ”ship \nowx . liphIr-rl
,, ”I ‘ ' \NM ..ilm u,,,,«, rim Il.irl{lii‘>> , street 1‘ M I i
Hlmr‘ l I‘ \ No tlc‘lt‘ils .\Hl:.ilii‘ iriiilt l;irv'«i‘li! not lighted ‘ ””1 PM” i
; ' ,, , "'l
‘ DRIVERS‘ VIOLATIONS CONDITION OF DRIVERS AND PEDES'I'RIAN 1WHAT PEDESTRIAN WAS DOING
‘i‘yb ,. .,wn, 1 lljlgwr ,, , . , ‘ (C'l’k l' rmir’)
Ilr(i\.i‘i' (”I W V” r (m I H «r it bath 0711' (W monitor each driver and Drum" )it link only 07“” ‘ J (‘rossinguiit (iiiie‘r‘sectlirln A with i
, l , pedestrian) l 2 led. signal l
. llrinntr lllltlt‘l' the lllIlllL‘l‘th‘ ol [1)rl\;r l) 1 , ”Ad \()I I’M” (hml‘mh ‘ ‘ Crossing atintcrscction ~ l
intoximiih “ US '1; [1,1,1 MN, drink/”A’- If 503 against signal _ i
lf~..~rr-.lr-t] Littliil :pewl ' ‘ ‘\.H_ . .1 ‘ . V . ()lwioiislv drunk 7, Crossing at intersection no ‘_‘
llirl not ;;miii llL'lll oi way to re ’7‘ \‘H “ful . 'l‘ ,\lrllll} IlllILIll‘t‘d ‘ signal . ~ l
\'-}iir|r- ‘Bl’lfdn'in; I ‘1: tep ) . r 1 _\l}i]it\‘ [11H impaired ; Crossing at intersection , i
7 . l‘izl no: gl'dfll right ol way to , , ”I I if ”.1 (limb (yrs, I . ‘ \lil known it impaired ‘ diagonally , l
l pedestrian . ~prtm y\l.\, eh“ _ ~ . . _. . , _ 4' Crossing not at iiitenectirin ,
. llrllinwcrl too «lo-e1} . . N” “Pl“n'm ‘10“? 1” TM” known It (l'mkmgr, ‘ Coming from behind parked cars ‘
i . 11111)“)er ”“4an . 7i . Deter is notknown , ,,, VVIIIUUIIWIII‘HIIUI level '( l '1 \leking in roadway “"th ;
i ‘ (In wrong side of road ~ ' ‘ . g , , two below) g l
‘ not mermkirig VEHICLE CONDITION , REASON FOR lNO'I SEEING 1 LJ \Vith traffic 1
l l L Failed to gin proper signal ‘ lChI't'l? 071? 07 "10"” I ‘ DANGER i‘ Against traffic '
. 4 , liiipi'opcr turii Driver ‘ IlTth‘t‘ it‘hr'rk one or morcl i: ,‘ Sidewalks available I
l ‘ . Disregarded stop-nnrlego l 2 . l 3 : I; Sidewalks not available ‘
1 {final , 7’ Delcctivc briikcs 1 . g Ruin. mu“; “(3 on wind» > J I’iishing or working on \'(‘I’ll(‘l(’ i
l 1:] :_ Disregarded stop sign .. l| l j Improper lights 1 shield 1 (Bthcr working on rozidwiiy ‘
. llisrcgarrlcrl iilht‘t tr.ittir~ d i - - 'I‘ __ _ _ _ . . _,J I lavtng on roadway
" . r n . _- . l’(cs,(rtips.tlt. _. . .V ‘
control ‘ _a ,. DCIt’HlVefilt‘t-l’lng l . . g Hiiching on vehitle
5 ; ,1 r7 Improper starting from mechanism l ‘ .,. Iéllll‘lmt: l w Not on roadway (Explain):
‘ 7 parked pmm’on . 1 ‘ . ,_ Defective tires l L; ,4 Embankment ‘ . .. . . . . . .
i l; iv, Improper parking location l U i l iii] T, Signlmard l , . .. . . ,, ,
{7" [7 Otherim r0 ’ructions: l ,_ ,, l r ,7 , ,, -. . l C: . .. ,, . ‘
' ,, J P I}L l A LI ., ._ . ‘ . ‘ ‘ . y Parked VLhKILS l 59“.,” ,,,;m “(1,0,1
I r ”mom i, - r ,. . , . ,. .. .. ..
p . g . -- l IT, Lg No defects ‘ « J . ' f ' v l _ '_A,_A,M —
l _ _] ,7 No improper derlllg or r ,1 _ 1 .j ,‘ .. _. "1’" ‘« 3' “""" r Pedestrian s
i parktqgm I ,7 act 9 Lgsfrfejw‘ W??? ,,V A, 1 Wm "VENOCISE‘L _.,elcoggurzatioirmc.-,.;fleeces,
l WITNESSES
I Name . . ., . ., . ..Address . . . . ., ..,,.,.,...;\ge . _, ,.
‘ Name A pproximale
I Name .. V, , . V . . . _ .. ”Address. . .. .. V . . i. .. . ..,Age... H
Name A pproximale
Investigated by. , ., .. . .. .. , ..Badge No. Department , ,. , ,. .,.. ,, V .. H V. . .
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