Original

Locked

TOTAL NUMBER OF
VEHICLES INVOLVED

Report

STATE OF LOUISIANA
UNIFORM MOTOR VEHICLE TRAFFIC CRASH REPORT

1
TIME (0000)

DATE OF CRASH

DISTRICT/ZONE

TROOP

05042016 2338 06B07 B

PARISH

LAT.

PARISH CODE

ORLEANS

LONG.

36

CITY OR TOWN

ORLEANS
HIGHWAY #

CRASH
OCCURRED ON
A. INTERSTATE
B. U.S. HWY
C. STATE HWY
D. PARISH ROAD
E. CITY STREET
F. OFF ROAD/
PRIVATE PROPERTY
G. TOLL ROAD

MILEPOST

0
FEET

DISTANCE

E 0

ROAD SURFACE

A.
B.
C.
D.
E

DRY
WET
SNOW/SLUSH
ICE
CONTAMINANT
(SAND, MUD,
DIRT, OIL, ETC.)
Y. UNKNOWN
Z. OTHER .................

SW
NE

SW

NE

SE

ST

ST

 AT INTERSECTION

MANUFACTURING OR INDUSTRIAL
BUSINESS CONTINUOUS
BUSINESS, MIXED RESIDENTIAL
RESIDENTIAL DISTRICT
RESIDENTIAL SCATTERED
SCHOOL OR PLAYGROUND
OPEN COUNTRY
OTHER ..............................................

MOTORCYCLE

C
VAN

OFF-ROAD
VEHICLE

LT. TRUCK
(P.U., ETC.)

A. ONE-WAY ROAD
B. TWO-WAY ROAD WITH
NO PHYSICAL SEPARATION
C. TWO-WAY ROAD WITH A
PHYSICAL SEPARATION
D. TWO-WAY ROAD WITH A
PHYSICAL BARRIER
Y. UNKNOWN
Z. OTHER
............................................

RELATION TO
ROADWAY
A.
B.
C.
D.
E.
F.
G.
Y.
Z.

RR TRAIN
INVOLVED

PEDALCYCLE

SCHOOL BUS

A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Y.
Z.

SINGLE UNIT
TRACTOR
TRUCK W/ 3
SEMI-TRAILER
AXLES OR MORE

TRUCK/
TRAILER

A. NO CONTROL
(UNLIMITED ACCESS TO
ROADWAY)
B. PARTIAL CONTROL
LIMITED ACCESS TO ROADWAY
C. FULL CONTROL
(ONLY RAMP ENTRANCE & EXIT)
Y. UNKNOWN
Z. OTHER .............................................

MOTOR
HOME

NEW

INVESTIGATION
COMPLETE

Y N

ORLEANS

DEPARTED SCENE

OTHER

DPSSP 3105 (REV. JAN. 2005)

LOG TRUCK/
TRAILER

I
GARBAGE/
REFUSE

CONCRETE
MIXER

TIME CALLED

ARRIVED HOSPITAL

HOPPER

DUMP TRUCK/
TRAILER

CARGO TANK

AUTO
TRANSPORTER

POLE TRAILER

NO
CARGO
BODY

OTHER

ARRIVED SCENE

RESCUE
UNIT

FIRE
DEPARTMENT

EMS

TIME OF NOTIFICATION

POLICE

DEPARTMENT

INVESTIGATING
POLICE
AGENCY

P___________________________________________________________________
ONTIFF, ANTHONY
INVESTIGATING OFFICERS NAME (PRINT)

VAN/ENCLOSED
BOX

Z
SUV

NAME OF AGENCY
INVESTIGATING
AGENCY

VIOLATIONS
MOVEMENT PRIOR TO CRASH
VISION OBSCUREMENTS
CONDITION OF DRIVER
VEHICLE CONDITIONS
ROAD SURFACE
ROADWAY CONDITION
LIGHTING
WEATHER
TRAFFIC CONTROL
KIND OF LOCATION
CONDITION OF PEDESTRIAN
PEDESTRIAN ACTIONS

LIGHTING

FLATBED

BUS

S
TRUCK/
TRACTOR

ARRIVED SCENE

A
B

A. DAYLIGHT
B. DARK - NO STREET
LIGHTS
C. DARK - CONTINUOUS STREET
LIGHT
D. DARK - STREET LIGHT AT
INTERSECTION ONLY
E. DUSK
F. DAWN
Y. UNKNOWN
Z. OTHER ........................................

FARM
EQUIPMENT

TRUCK
DOUBLE

SINGLE UNIT
TRUCK W/ 2
AXLES

A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.

BUS W/SEATS
FOR 16 OR
MORE OCC.

SECONDARY FACTOR

STRAIGHT-LEVEL
STRAIGHT-LEVEL ELEVATED
CURVE-LEVEL
CURVE-LEVEL ELEVATED
ON GRADE-STRAIGHT
ON GRADE-CURVE
HILLCREST-STRAIGHT
HILLCREST-CURVE
DIP, HUMP-STRAIGHT
DIP, HUMP-CURVE
UNKNOWN
OTHER ........................................

AMBULANCE

ORLEANS

FATALITY

CARGO BODY TYPE

BUS W/SEATS
FOR 9 -15
OCCUPANTS

EMERGENCY
VEHICLE IN
USE

AMBULANCE
NEW
SERVICE

PHOTOS
MADE

INJURY

PRIMARY FACTOR

ACCESS CONTROL

ON ROADWAY
SHOULDER
MEDIAN
BEYOND SHOULDER - LEFT
BEYOND SHOULDER - RIGHT
BEYOND RIGHT OF WAY
GORE
UNKNOWN
OTHER ....................................

TIME CALLED
EMERGENCY
SERVICES

X
X

 NOT AT INTERSECTION

ALIGNMENT

TYPE OF ROADWAY

A, B, C, OR S
WITH TRAILER

PASSENGER
CAR

HIT &
RUN

PUBLIC
PROPERTY
DAMAGE

X
 NOT AT INTERSECTION

VEHICLE CONFIGURATION

E-04846-16

CONTRIBUTING FACTORS AND CONDITIONS

KIND OF LOCATION

A.
B.
C.
D.
E.
F.
G.
Z.

SW

PED

NO ABNORMALITIES
SHOULDER ABNORMALITY
HOLES
DEEP RUTS
BUMPS
LOOSE SURFACE MATERIAL
CONSTRUCTION, REPAIR
OVERHEAD CLEARANCE LIMITED
CONSTRUCTION - NO WARNING
PREVIOUS CRASH
WATER ON ROADWAY
ANIMAL IN ROADWAY
OBJECT IN ROADWAY
OTHER .............................

Service Road

NW

FELICITY

WEATHER
A. CLEAR
B. CLOUDY
C. RAIN
D. FOG/SMOKE
E. SLEET/HAIL
F. SNOW
G. SEVERE CROSSWIND
H. BLOWING SAND, SOIL,
DIRT, SNOW
Y. UNKNOWN
Z. OTHER .......................................

 AT INTERSECTION

STREET/HIGHWAY

ROADWAY
CONDITIONS

A.
B.
C.
A. CONCRETE D.
B. BLACK TOP E.
F.
C. BRICK
G.
D. GRAVEL
H.
E. DIRT
I.
Y. UNKNOWN
J.
Z. OTHER
........................... K.
L.
M.
Z.

NE

WRITE APPROPRIATE LETTER IN BLOCK

(ONE PER COLUMN)

WORK
ZONE

STREET/HIGHWAY

MILES
FEET

01

TCHOUPITOULAS


MILES

0
0

ROADWAY NAME

DISTANCE

180

PAGE #

Quadrant

CITY CODE

NEW

160507083454322

A. STATE
B. CITY

2338

C. PARISH
Z. OTHER

TIME OF ARRIVAL

TIME ALL LANES OPENED

1215
0245
05042016

DATE REPORT COMPLETED

________________________________________________________
SIGNATURE

1186
BADGE #

______________________
SUPERVISORS
INITIALS OR BADGE#

Original

Locked

Report

160507083454322
COMPUTER NUMBER

1
CONF

A
V.I.N.

OR

VEH #

PEDESTRIAN

see page 1 for

selections

2015 LAMBORGHINI HURICAN

STATE

YEAR

NUMBER

2017 LA ZEY654
YEAR

TRAILER
DESCRIPTION

MAKE

VEHICLE
TOWED

TYPE

GVWR/GCWR

PASSENGER

TYPE

0
COMMERCIAL/
BUSINESS VEHICLE

GOVERNMENT VEHICLE

PERSONAL VEHICLE

OF

NEW

ORLEANS

REASON TOWED
A. VEHICLE DAMAGE
B. DRIVER ARRESTED
C. INSURANCE VIOLATION
Z. OTHER

STATE

YEAR
LICENSE
PLATE

VEHICLE
CLASSIFICATION

REMOVED
BY C I T

A.YES
B. NO
C. LEFT AT SCENE

# TIRES

# DOORS # AXLES

MODEL

ZHWUC1ZF9FLA02899

LICENSE
PLATE

02

E-04846-16
MAKE

YEAR

CARGO BODY TYPE

PAGE #

STATE OF LOUISIANA
UNIFORM MOTOR VEHICLE TRAFFIC CRASH REPORT
VEHICLE/PEDESTRIAN

NUMBER

COMPLETE INFORMATION BELOW IF THIS VEHICLE IS BEING USED FOR COMMERCE/BUSINESS, & HAS A GVWR/GCWR IN EXCESS
OF 10,000 LBS., OR HAS A HAZMAT PLACARD, OR IS A BUS WITH SEATING FOR NINE OR MORE INCLUDING THE DRIVER.
US DOT #
CARRIER NAME ______________________________________________________________________________________________________________MC/MX (ICC) #
STREET ADDRESS: __________________________________________________________________CITY __________________________________________________STATE__________ ZIP __________________

INTERSTATE CARRIER Y N

TRANSPORTING HAZARDOUS MATERIAL Y N

NAME (LAST, FIRST, MI) OF

ADAMS,

DRIVER

CLASS

JASON

DATE OF
BIRTH

STREET ADDRESS ____________________________________________________________________TELEPHONE

#__________________________
3908
EDENBORN AVENUE

LA

METAIRIE
CITY ____________________________________________________________________________STATE___________
ZIP

UPPER BODY
CLOTHING
LIGHT

DARK

Y N
LOWER BODY
LIGHT
CLOTHING

OWNERS NAME (LAST, FIRST, MI OR COMPANY NAME)

Same as
Driver

AXIS

EJECTION

03141986

VENTURES,

DARK

LLC,

EXTRICATED

AIR
BAG

OCC
PROT
SYS

SEX

RACE

AGE

INJURY

70002 A B A B A M W 30 B

8268901

PEDESTRIAN ONLY

POSITION

TRANSPORTED TO MEDICAL FACILITY

INSTRUCTED TO
EXCHANGE INFORMATION?

CLASS ENDORSEMENTS DRIVERS LICENSE NUMBER

LA E

PEDESTRIAN

TRAP/

STATE

HAZ MAT
RELEASED Y N

PLACARDS DISPLAYED Y N

ID#

NAME OF
FACILITY

SEX

A. YES
B. NO

UNIVERSITY

RACE

ALIREZA

C. REFUSED AID
Y. UNKNOWN

HOSPITAL

AGE

INJURY CODE

TELEPHONE # __________________________

413
IONA STREET
STREET ADDRESS __________________________________________________________________________________________________________________________________________________________________

LA

METAIRIE
70005
CITY ______________________________________________________________________________________________________
STATE _____________________________________ZIP ________________________

STATE FARM
INSURANCE CO. NAME __________________________________________________

2868850 184
06232016
POLICY NUMBER ________________________________________
EXPIRATION DATE ________________________

(NOT AGENCY NAME)

AGENTS NAME/ADDRESS ________________________________________________________________________________________________________

PHONE # ____________________________________

CODES
SEATING POSITION
A - FRONT SEAT-LEFT SIDE
(MOTORCYCLE DRIVER)
B - FRONT SEAT-MIDDLE
C - FRONT SEAT-RIGHT SIDE
D - SECOND SEAT-LEFT SIDE
(MOTORCYCLE PASSENGER)
E - SECOND SEAT-MIDDLE
F - SECOND SEAT-RIGHT SIDE
G - THIRD ROW-LEFT SIDE
(MOTORCYCLE PASSENGER)
H - THIRD ROW-MIDDLE
I - THIRD ROW-RIGHT SIDE

DPSSP 3106 (REV. MAR. 2005)

J - SLEEPER SECTION OF CAB (TRUCK)

K - PASSENGER IN OTHER ENCLOSED
PASSENGER OR CARGO AREA
(NON-TRAILING UNIT)
L - PASSENGER IN OTHER UNENCLOSED
PASSENGER OR CARGO AREA (NONTRAILING UNIT)
M- PASSENGER ON TRAIN OR STREETCAR
N- TRAILING UNIT
O- RIDING ON VEHICLE EXTERIOR (NONTRAILING UNIT)
Y- UNKNOWN

EJECTION

TRAPPED OR
EXTRICATED

AIRBAG

A- NOT EJECTED
A- DEPLOYED
A- NOT TRAPPED
B- TOTALLY EJECTED B-TRAPPED/EXTRI- B- NON
C-PARTIALLY
DEPLOYED
CATED
EJECTED
C-NON-DEPLOYC-TRAPPED/NOT
Y- UNKNOWN
ED/SWITCH
EXTRICATED
OFF
Y- UNKNOWN
D-NOT
APPLICABLE
Y- UNKNOWN

OCCUPANT PROTECTION
SYSTEM USED
A- NONE USED-VEHICLE
OCCUPANT
B- SHOULDER BELT ONLY USED
C-LAP BELT ONLY USED
D-SHOULDER AND LAP BELT
USED
E- CHILD SAFETY SEAT
IMPROPERLY USED
F- CHILD SAFETY SEAT USED
G-HELMET USED
Y- RESTRAINT USE UNKNOWN

INJURY
A- FATAL
B-INCAPACITATING/SEVERE
C-NON-INCAPACITATING/
MODERATE
D-POSSIBLE/
COMPLAINT
E- NO INJURY

Original

Locked

Report

160507083454322
PAGE #

CONTRIBUTING FACTORS AND CONDITIONS

WRITE APPROPRIATE LETTER IN BLOCK

VISION
OBSCUREMENTS

A. RAIN, SNOW, ETC. ON WINDSHIELD

B. WINDSHIELD OTHERWISE OBSCURED
C. VISION OBSCURED BY LOAD
D. TREES, BUSHES, ETC.
E. BUILDING
F. EMBANKMENT
G. SIGN BOARDS
H. HILLCREST
I. PARKED VEHICLES
J. MOVING VEHICLES
K. BLINDED BY HEADLIGHTS
L. BLINDED BY SUNGLARE
M. DISTRACTED BY NEON LIGHTS IN
FIELD OF VIEW
N. NO OBSCUREMENTS
Y. UNKNOWN
Z. OTHER ....................................................

VIOLATION

A. EXCEEDING STATED SPEED LIMIT

B. EXCEEDING SAFE SPEED LIMIT
C. FAILURE TO YIELD
D. FOLLOWING TOO CLOSELY
E. DRIVING LEFT OF CENTER
F. CUTTING IN, IMPROPER PASSING
G. FAILURE TO SIGNAL
H. MADE WIDE RIGHT TURN
I. CUT CORNER ON LEFT TURN
J. TURNED FROM WRONG LANE
K. OTHER IMPROPER TURNING
L. DISREGARDED TRAFFIC CONTROL
M. IMPROPER STARTING
N. IMPROPER PARKING
O. FAILED TO SET OUT FLAGS, FLARES
P. FAILED TO DIM HEADLIGHTS
Q. VEHICLE CONDITION
R. DRIVER CONDITION
S. CARELESS OPERATION
T. IMPROPER BACKING
U. NO VIOLATIONS
Y. UNKNOWN
Z. OTHER .................................................

TRAFFIC
CONTROL
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
P.
Q.
R.
S.
T.
U.
V.
Y.
Z.

STOP SIGN
YIELD SIGN
RED SIGNAL ON
YELLOW SIGNAL ON
GREEN SIGNAL ON
GREEN TURN ARROW ON
RIGHT TURN ON RED
LIGHT PHASE UNKNOWN
FLASHING YELLOW
FLASHING RED
OFFICER, FLAGMAN
RR CROSSING, SIGN
RR CROSSING,SIGNAL
RR CROSSING, NO CONTROL
WARNING SIGN (SCHOOL, ETC.)
SCHOOL FLASHING SPEED SIGN
YELLOW NO PASSING LINE
WHITE DASHED LINE
YELLOW DASHED LINE
BIKE LANE
CROSSWALK
NO CONTROL
UNKNOWN
OTHER .......................................

HEADED
N E
S W

CONDITION
OF DRIVER/PED

REASON FOR
MOVEMENT

2ND
3RD

OVERTURN/ROLLOVER
FIRE/EXPLOSION
IMMERSION
JACKKNIFE
CARGO/EQUIPMENT LOSS OR SHIFT
FELL/JUMPED FROM MOTOR VEHICLE
THROWN OR FALLING OBJECT
EQUIPMENT FAILURE (BLOWN
TIRE, BRAKE FAILURE, ETC.)
I. SEPARATION OF UNITS
IN TRANSPORT
J. RAN OFF ROAD RIGHT
K.. RAN OFF ROAD LEFT
L. CROSSED MEDIAN/CENTERLINE
M. DOWNHILL RUNAWAY
N. OTHER NON-COLLISION

O.
P.
Q.
R.

PEDESTRIAN
ACTIONS
A. CROSSING, ENTERING ROAD
AT INTERSECTION
B. CROSSING, ENTERING
ROAD NOT AT INTERSECTION
C. WALKING IN ROAD WITH
TRAFFIC
D. WALKING IN ROAD AGAINST
TRAFFIC
E. SLEEPING IN ROADWAY
F. STANDING IN ROADWAY
G. GETTING ON OR OFF OTHER
VEHICLE
H. PUSHING, WORKING ON
VEHICLE IN ROAD
I. OTHER WORKING IN
ROADWAY
J. PLAYING IN ROADWAY
K. NOT IN ROADWAY
Y. UNKNOWN
Z. OTHER

PEDESTRIAN
PEDALCYCLE
RAILWAY VEHICLE (TRAIN, ENGINE)
ANIMAL

S. MOTOR VEHICLE IN TRANSPORT

T. PARKED MOTOR VEHICLE
U. STRUCK BY FALLING, SHIFTING
CARGO OR ANYTHING SET IN MOTION
BY MOTOR VEHICLE
V. WORK ZONE/MAINTENANCE
EQUIPMENT
W. OTHER NON-FIXED OBJECT

A.
B.
C.
D.
E.
F.
G.
H.
I.
J.

STOPPED
PROCEEDING STRAIGHT AHEAD
TRAVELING WRONG WAY
BACKING
CROSSED MEDIAN INTO
OPPOSING LANE
CROSSED CENTER LINE INTO
OPPOSING LANE
RAN OFF ROAD (NOT WHILE
MAKING TURN AT INTERSECTION)
CHANGING LANES ON
MULTI-LANE ROAD
MAKING LEFT TURN
MAKING RIGHT TURN

VEHICLE
CONDITION
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
Y.
Z.

X. IMPACT ATTENUATOR/CRASH CUSHION

Y. BRIDGE OVERHEAD STRUCTURE
Z. BRIDGE PIER OR SUPPORT
AA. BRIDGE RAIL
BB. CULVERT
CC. CURB
DD. DITCH
EE. EMBANKMENT
FF. GUARDRAIL FACE
GG. GUARDRAIL END
HH. CONCRETE TRAFFIC SUPPORT
II. OTHER TRAFFIC BARRIER
JJ. TREE (STANDING)
KK. UTILITY POLE/LIGHT SUPPORT

VEHICLE
LIGHTING
A.
B.
C.
Y.

HEADLIGHTS ON
HEADLIGHTS OFF
DAYTIME RUNNING LIGHTS
UNKNOWN

TRAFFIC
CONTROL
CONDITIONS

ALCOHOL ............................................
A. TEST REFUSED
B. NO TEST GIVEN
C. TEST GIVEN, RESULTS PENDING
D. TEST GIVEN, BAC ................

J
CC
QQ

4th
MOST HARMFUL EVENT

QQ
T. ENTERING TRAFFIC FROM
SHOULDER
U. ENTERING TRAFFIC FROM
MEDIAN
V. ENTERING TRAFFIC FROM
PARKING LANE
W. ENTERING TRAFFIC FROM
PRIVATE LANE OR DRIVEWAY
X. ENTERING FREEWAY FROM
ON RAMP
Y. LEAVING FREEWAY VIA
OFF RAMP
Z. OTHER OR UNKNOWN

B
C
.

DRUGS...........................................................
A. TEST NOT GIVEN
B. TEST GIVEN, RESULTS PENDING
C. TEST REFUSED
D. DRUGS REPORTED (SPECIFY IN NARRATIVE)

g%

AFFIX BLOOD ALCOHOL KIT LABEL HERE

(OR ENTER BLOOD ALCOHOL KIT NUMBER)

DISTANCE TRAVELED
AFTER IMPACT

138'

3rd

ALCOHOL/DRUGS SUSPECTED..........................
A. NEITHER ALCOHOL NOR DRUGS
B. YES-ALCOHOL
C. YES-DRUGS
D. YES-ALCOHOL AND DRUGS
Y. UNKNOWN

CONTROLS FUNCTIONING
CONTROLS NOT FUNCTIONING
CONTROLS OBSCURED
LANE MARKING UNCLEAR
OR DEFECTIVE
E. NO CONTROLS
Y. UNKNOWN

SCENE

2nd

ALCOHOL/DRUG
INVOLVEMENT

A.
B.
C.
D.

FINAL LOCATION
OF VEHICLES

1st

K. STOPPED PREPARING TO,

OR MAKING U-TURN
L. MAKING TURN, DIRECTION
UNKNOWN
M. STOPPED, PREPARING TO
TURN LEFT
N. STOPPED, PREPARING TO
TURN RIGHT
O. SLOWING TO MAKE LEFT TURN
P. SLOWING TO MAKE RIGHT
TURN
Q. SLOWING TO STOP
R. PROPERLY PARKED
S. PARKING MANEUVER

DEFECTIVE BRAKES
DEFECTIVE HEADLIGHTS
DEFECTIVE REAR LIGHTS
DEFECTIVE SIGNAL LIGHTS
ALL LIGHTS OUT
DEFECTIVE STEERING
TIRE FAILURE
WORN OR SMOOTH TIRES
ENGINE FAILURE
DEFECTIVE SUSPENSION
NO DEFECTS OBSERVED
UNKNOWN
OTHER ......................................

LL. TRAFFIC SIGN SUPPORT

MM. TRAFFIC SIGNAL SUPPORT
NN. OTHER POST, POLE, OR
SUPPORT
OO. FENCE
PP. MAILBOX
QQ. OTHER FIXED OBJECT (WALL,
BUILDING, TUNNEL, ETC.)
YY. UNKNOWN

COLLISION WITH FIXED OBJECT

MOVEMENT PRIOR TO CRASH

TO AVOID OTHER VEHICLE

TO AVOID PEDESTRIAN
TO AVOID ANIMAL
TO AVOID OTHER OBJECT
PASSING
VEHICLE OUT OF CONTROL,
NOT PASSING
G. VEHICLE OUT OF CONTROL, PASSING
H. FOR TRAFFIC CONTROL
I. DUE TO CONGESTION
J. DUE TO PRIOR CRASH (COLLISION)
K. DUE TO DRIVER CONDITION
L. DUE TO DRIVER VIOLATION
M. DUE TO VEHICLE CONDITION
(FAILURE)
N. DUE TO PAVEMENT CONDITION
O. HIGH WIND
P. NORMAL MOVEMENT
Y. UNKNOWN
Z. OTHER ....................................................

DAMAGE TO VEHICLE

N- UNDERCARRIAGE
O- TOTAL
P- OTHER
Q- NONE
Y- UNKNOWN

A.
B.
C.
D.
E.
F.
G.
H.

COLLISION WITH PERSON, MOTOR

VEHICLE, OR NON- FIXED OBJECT

A.
B.
C.
D.
E.
F.

TCHOUPITOULAS

1ST

A. CELL PHONE
B. OTHER ELECTRONIC DEVICE
(PAGER, PALM PILOT, NAVIGATION
DEVICE, ETC.)
C. OTHER INSIDE THE VEHICLE
D. OTHER OUTSIDE THE VEHICLE
E. NOT DISTRACTED
Y. UNKNOWN

DIRECTION BEFORE CRASH

ON HIGHWAY, STREET OR DRIVE

AREA DAMAGED

SEQUENCE OF EVENTS/HARMFUL EVENTS

NON COLLISION

A. NORMAL
B. INATTENTIVE
C. DISTRACTED
D. ILLNESS
E. FATIGUED
F. APPARENTLY ASLEEP/BLACKOUT
G. DRINKING ALCOHOL - IMPAIRED
H. DRINKING ALCOHOL - NOT IMPAIRED
I. DRUG USE - IMPAIRED
J. DRUG USE - NOT IMPAIRED
K. PHYSICAL IMPAIRMENT
(EYES, EAR, LIMB)
Y. UNKNOWN
Z. OTHER .....................................................

DRIVER
DISTRACTION

03
E-04846-16

SPEED
EST.

POSTED

U N K 3 00
CITATION NO

FR

SKIDMARK DATA (FEET)

FL
RR
RL

R.S. OR ORD. NO
VEH. PED.

EXTENT OF DEFORMITY

B H
C H
D H

1ST
2ND
3RD

A- NONE
B- VERY MINOR
C- MINOR
D- MINOR/MODERATE
E- MODERATE
F- MODERATE/SEVERE
G- SEVERE
H-VERY SEVERE
Y-UNKNOWN

__________________________________________

______________________________________

__________________________________________

______________________________________

__________________________________________

______________________________________

__________________________________________

______________________________________

__________________________________________

______________________________________

NOTICE OF INSURANCE VIOLATION

__________________________________
INVESTIGATING OFFICERS INITIALS
DPSSP 3106

Original

Locked

Report

1
STATE OF LOUISIANA
UNIFORM MOTOR VEHICLE TRAFFIC CRASH REPORT
ADDITIONAL OCCUPANT SUPPLEMENT

60507083454322
COMPUTER NUMBER

PAGE #

04

E-04846-16
VEH #

TRAP/

OCCUPANTS NAME (LAST, FIRST, MI)

LIRETTE,

POSITION

KRISTI

835
MARIGNY STREET
STREET ADDRESS 5
__________________________________________________________________

A. YES
B. NO

C. REFUSED AID
Y. UNKNOWN

POSITION

C. REFUSED AID
Y. UNKNOWN

POSITION

C. REFUSED AID
Y. UNKNOWN

C. REFUSED AID
Y. UNKNOWN

POSITION

C. REFUSED AID
Y. UNKNOWN

EXTRICATED

AIR
BAG

EJECTION

EXTRICATED

AIR
BAG

EJECTION

EXTRICATED

AIR
BAG

TRAP/
POSITION

AGE

INJURY

OCC
PROT
SYS

SEX

RACE

AGE

INJURY

OCC
PROT
SYS

SEX

RACE

AGE

INJURY

OCC
PROT
SYS

SEX

RACE

AGE

INJURY

EJECTION

EXTRICATED

AIR
BAG

OCC
PROT
SYS

SEX

RACE

AGE

INJURY

OCC
PROT
SYS

SEX

RACE

AGE

INJURY

OCC
PROT
SYS

SEX

RACE

AGE

INJURY

TRANSPORTED TO MEDICAL FACILITY

A. YES
B. NO

C. REFUSED AID
Y. UNKNOWN

NAME OF
FACILITY

CITY _____________________________________________________ STATE _______ ZIP______________________

TRAP/

OCCUPANTS NAME (LAST, FIRST, MI)

POSITION

EJECTION

EXTRICATED

AIR
BAG

TRANSPORTED TO MEDICAL FACILITY

A. YES
B. NO

C. REFUSED AID
Y. UNKNOWN

NAME OF
FACILITY

CITY _____________________________________________________ STATE _______ ZIP______________________

TRAP/

OCCUPANTS NAME (LAST, FIRST, MI)

POSITION

EJECTION

EXTRICATED

AIR
BAG

TRANSPORTED TO MEDICAL FACILITY

A. YES
B. NO

CITY _____________________________________________________ STATE _______ ZIP______________________

DPSSP 3108

RACE

NAME OF
FACILITY

OCCUPANTS NAME (LAST, FIRST, MI)

STREET ADDRESS __________________________________________________________________

SEX

TRANSPORTED TO MEDICAL FACILITY

A. YES
B. NO

VEH #

EJECTION

TRAP/

OCCUPANTS NAME (LAST, FIRST, MI)

STREET ADDRESS __________________________________________________________________

OCC
PROT
SYS

NAME OF
FACILITY

CITY _____________________________________________________ STATE _______ ZIP______________________

VEH #

AIR
BAG

TRANSPORTED TO MEDICAL FACILITY

CITY _____________________________________________________ STATE _______ ZIP______________________

STREET ADDRESS __________________________________________________________________

EXTRICATED

TRAP/
POSITION

A. YES
B. NO

VEH #

INJURY

NAME OF
FACILITY

OCCUPANTS NAME (LAST, FIRST, MI)

STREET ADDRESS __________________________________________________________________

AGE

TRANSPORTED TO MEDICAL FACILITY

A. YES
B. NO

VEH #

EJECTION

TRAP/

OCCUPANTS NAME (LAST, FIRST, MI)

STREET ADDRESS __________________________________________________________________

RACE

NAME OF
FACILITY

CITY _____________________________________________________ STATE _______ ZIP______________________

VEH #

SEX

TRANSPORTED TO MEDICAL FACILITY

A. YES
B. NO

STREET ADDRESS __________________________________________________________________

OCC
PROT
SYS

NAME OF
FACILITY

TRAP/

OCCUPANTS NAME (LAST, FIRST, MI)

CITY _____________________________________________________ STATE _______ ZIP______________________

VEH #

AIR
BAG

CAAABFW23A

LA

STREET ADDRESS __________________________________________________________________

EXTRICATED

TRANSPORTED TO MEDICAL FACILITY

70122
EW ORLEANS
CITY N
_____________________________________________________
STATE _______ ZIP______________________
VEH #

EJECTION

C. REFUSED AID
Y. UNKNOWN

NAME OF
FACILITY

INVESTIGATING OFFICERS INITIALS

Original

Locked

Report

160507083454322
OFFICERS NARRATIVE: DESCRIBE ANY UNUSUAL CIRCUMSTANCES ASSOCIATED WITH CRASH, INCLUDING OFFICERS OBSERVATIONS AND OPINIONS.
INCLUDE WITNESS NAMES, ADDRESSES, PHONE NUMBERS, ETC.

PAGE #

IF NECESSARY, INDICATE DAMAGE TO PUBLIC OR PRIVATE PROPERTY (WITH OWNERS NAME & ADDRESS) AT THE END OF THE NARRATIVE.

05

REFER TO EACH BY VEHICLE NUMBER

E-04846-16

On Wednesday 4 May 2016, at approximately 2338hrs, Detective A. Pontiff, Unit 3714, of the New
Orleans Police Departments Fatality Investigations Unit, was dispatched to the 1800 Block of
Tchoupitoulas Street to investigate a single vehicle crash with one confirmed fatality.
Upon arrival, Detective Pontiff along with other members of the Fatality Unit, processed the scene
and learned the following: Vehicle #1 was eastbound on Tchoupitoulas Street at a very high rate of
speed and failed to negotiate a left curve in the roadway approaching Felicity Street. Vehicle #1
struck the right curb and left the roadway sliding on the undercarraige of vehicle #1 across the
grassy area into a concrete flood wall. Vehicle #1 then rotated off of the flood wall and came to a
rest in and under some shrubbery.
Upon striking the flood wall, the driver, identified later as Jason Adams, was ejected from
vehicle #1 and the passenger, later identified as Kristi Lirette, was restrained and suffered lethal
injuries as a result of the crash. Mrs Lirette was pronounced deceased on scene at 2352hrs, by Dr.
Stibert of University Hospital. Mr. Adams was transported to University Hospital with severe but
non life threatening injuries. A DWI blood Kit was completed and placed into evidence for later
analysis by the LSP Crime Lab.
All further information regarding this investigation will be forwarded in a supplemental report.

NON-COLLISION
WITH MOTOR
VEHICLE

REAR END

HEAD-ON

RIGHT ANGLE

LEFT TURN

LEFT TURN

LEFT TURN

RIGHT TURN

RIGHT TURN

SIDESWIPE
SAME

SIDESWIPE
OPPOSITE

OTHER

MANNER OF
COLLISION

NORTH