Accepted Date 1/3/2023 8:32 AM Master Record Number 103528907

Generated Date 1/3/2023 8:32 AM Type Of Crash Suspected Minor Injury

Report Form Level 3 Approved By 254

Tennessee Electronic Traffic Crash Report

Incident Information
Date of Crash Day Of Crash Local Agency Number Reporting Agency Name Agency Tracking Number
12/20/2022 Tuesday 0330700 Collegedale Police Dept 22-14607
Time of Crash Time Notified Time Arrived County City
12:31 12:31 12:33 Hamilton Collegedale
Total Vehicles Total Occupants Total Non-Occupants Total Killed Total Injured Total UnInjured
1 1 2 0 2 1
Hit and Run Solved Police Pursuit School Bus Involved Photos Taken By Photographer Name
No No No No
Area Interchange Related Intersection Type
Business No OTHER
Block Number Roadway Number Roadway Name Suffix Mile Marker
10000 RAMP 0.00
Estimated Distance Distance Type Direction From Highway/Intersection Suffix Intersect Number
STATE HWY 317
Roadway Local Id Intersect Local Id

Relation To Junction Relation to Roadway Route Signing

Rail Grade Crossing On Roadway State Route
Work Zone Construction Zone
Construction Zone Intermittent Moving Work
Construction Location Workers Present
Transition Area No
First Harmful Event Trafficway Type
Other Non-Collision Trafficway-OPEN
Weather Conditions Light conditions Latitude Longitude Rail Crossing Id
Clear Daylight 35.053130 -85.048570 719676Y
Manner of Collision
Not Collision with Motor Vehicle in Transport
1st Collision Factor 2nd Collision Factor 3rd Collision Factor

Incident Management
Secondary Crash Secondary Crash Type Blockage Occurred
No Yes
Roadway / Lanes Blocked Roadway Lanes/ Cleared
Dec 20 2022 12:31PM Dec 21 2022 10:22PM
Lanes Blocked
Lane 1, Lane 2
Incident Started Incident Cleared
Dec 20 2022 12:21PM Dec 21 2022 10:22PM

Investigating Officer Details

Investigation Complete Rank First Name Middle Initial Last Name Suffix
No SGT JOSHUA E BOOTH
Badge Number District/Zone Car Number Report Date
254 WEST 194 12/21/2022

SF - 1481 (Rev 7/21) 1 of 6 RDA 1348

Vehicle Number Number of Occupants Driver Presence
1 1 Driver Operated

Driver Information
First Name Middle Initial Last Name Suffix Date Of Birth Age
JORGE LUIS CRUZ-VEGA 11/8/1958 64
Address Line 1 Address Line 2 City State Zip Code
110 MOREHEAD DRIVE COLUMBIA GA 30907
Phone 1 Phone 2 Phone 3 Race Ethnicity Gender
Caucasian|Mexican|Puerto Rican|Other
7068602060 Hispanic M
White
Drivers License Number Drivers License State Expiration Date Drivers License Class Drivers License Status
054227419 GA 2024 T Valid
Safety Equipment Airbag Seat Position
Shoulder And Lap Belt Used Unknown If AirBag Available Front Seat-Left Side
Endorsement 1 Complied With Endorsement 2 Complied With Endorsement 3 Complied With
Double/Triple Trailers Yes
Restriction 1 Complied With Restriction 2 Complied With Restriction 3 Complied With
Corrective Lenses Yes
Ejected Ejection Path Trapped/Extricated
Not Ejected Not Trapped
Injury Code Medical Transport Ambulance/Hospital EMS Run#
No Injury Not Transported
Incident Responder? Incident Responder Type
No

Driver Conditions and Actions

Hit and Run Driver/Vehicle Maneuver Distraction
No Hit And Run Going Straight Unknown
Driver's 1st Condition Driver's 2nd Condition Driver's 3rd Condition
Appeared Normal
Driver's 1st Action Drivers 2nd Action
Other
Driver's 3rd Action Driver's 4th Action Driver's 5th Action

Alcohol and Drugs

Officer Suspect Alcohol Use Determination Method Alcohol Test Status
Unknown Unknown Test Given
1st Alcohol Test Type 1st Alcohol Test Result 2nd Alcohol Test Type 2nd Alcohol Test Result
Whole Blood Pending
Officer Suspect Drug Use Determination Method Drug Test Status
No Evidential Test (Breath, Blood, Urine) Test Given
1st Drug Test Type 1st Drug Test Result 2nd Drug Test Type 2nd Drug Test Result 3rd Drug Test Type 3rd Drug Test Result
Blood Test No Drug Reported

Driver Violations
1st Violation 1st Violation Category 1st Violation Description 1st Violation Statute
58295 Other Moving FAILURE TO YIELD 55-8-197
2nd Violation 2nd Violation Category 2nd Violation Description 2nd Violation Statute
Pending RECKLESS ENDANGERMENT 39-13-103
3rd Violation 3rd Violation Category 3rd Violation Description 3rd Violation Statute
Pending RECKLESS ENDANGERMENT 39-13-103
4th Violation 4th Violation Category 4th Violation Description 4th ViolationStatute
VANDALISM OF CRITICAL
Pending 39-14-411
INFRASTRUCTURE
5th Violation 5th Violation Category 5th Violation Description 5th ViolationStatute

SF - 1481 (Rev 7/21) 2 of 6 RDA 1348

Vehicle Information
Owner Same as Driver Owner First Name Owner Middle Name Owner Last Name Owner Suffix
No STARRETTE HOUSTON TRUCKING LLC
Address Line 1 Address Line 2 City State Zip Code Phone 1
2019 WESTSIDE DRIVE AUGUSTA GA 30709
Phone 2 Phone 3 Vehicle Year Vehicle Make Vehicle Model Color
7068602060 2019 KW T880 Gray
VIN License Plate Number State Plate Expiration Body Style
1XKZP4EX8KJ278906 C9790B Georgia 102023 Unknown Single or Combo GT 26K
HAZMAT? FMCSA Reportable? Bus Use Unit Type
No Yes Not Used As School Bus Motor Vehicle Not In-Transport Within the Trafficway
Gross Weight Vehicle Configuration
26001 or Greater Tractor Semi-trailer
Vehicle Operation Type Cargo Body Type
Commercially Owned/Used Pole
1st Factor 2nd Factor 3rd Factor
NONE
Vehicle Special Use Emergency Use
Unknown No
Towed Towed Location
Driven From Scene
1st Trailer 1st Trailer License Plate Information 2nd Trailer 2nd Trailer License Plate Information
Semi Trailer All Types GA WD1378 2023
Insurance 1 Insurance 1 Type Insurance 1 Carrier Insurance 1 Start Date Insurance 1 End Date
TP9882984-05 Owner NATIONAL UNION FIRE INSURANCE 4/1/2022 4/1/2023
Insurance 2 Insurance 2 Type Insurance 2 Carrier Insurance 2 Start Date Insurance 2 End Date

Insurance 3 Insurance 3 Type Insurance 3 Carrier Insurance 3 Start Date Insurance 3 End Date

Vehicle Damage and Roadway Characteristics

Most Harmful Event Fire in Vehicle
Other Non-Collision No
Events 1 Events 2 Events 3
Other Non-Collision Railway Train Motor Vehicle-In-Transport On Same Roadway
Events 4 Events 5 Events 6

Point of First Impact Extent of Damage Officer Damage Estimate

Right Side-Near Rear Functional Damage Greater Than Threshold
Areas of Vehicle Damage
Other
Travel Direction Traveling On
North APISON PIKE
Trafficway Flow Roadway Surface Type Number of Travel Lanes
Two-Way Not Divided Asphalt Two Lanes
Trafficway Hazards
None
Traffic Control Devices Traffic Control Device Functioning Roadway Route Signing
RR Gates Device Functioning Properly State Route
Roadway Surface Conditions Roadway Character Alignment Roadway Character Profile
Dry Straight Grade
Speed Limit Access control
35 Full Control Only Ramp Entry and Exit

Commercial Carrier Information

US DOT Carrier Name Carrier Type ICC MC TN DOS
03220663 STARRETTE HOUSTON TRUCKIN Intrastate 100787 TN000055
Address Line 1 Address Line 2 City State Zip Code Phone
2019 WESTSIDE DRIVE AUGUSTA GA 30709 7068602060
1st Hazardous Materials HAZMAT Class Placard Placard # Released Hazardous Materials Released

2nd Hazardous Materials HAZMAT Class Placard Placard # Released Hazardous Materials Released

3rd Hazardous Materials HAZMAT Class Placard Placard # Released Hazardous Materials Released

SF - 1481 (Rev 7/21) 3 of 6 RDA 1348

Non-Motorist Information
Person Type
Occupant-Non MV Transport Device
First Name Middle Name Last Name Suffix Date Of Birth Age
ANDREOUS F FOSTER 7/19/1987 35
Address Line 1 Address Line 2 City State Zip Code
985 MOUNT ZION ROAD APARTMENT 1B MORROW GA 30260
Phone 1 Phone 2 Phone 3 Gender Race Ethnicity Seating Position
Black or
4047196452 M African Non-Hispanic
American
Safety Equipment Incident Responder? Incident Responder Type
Other No
Injury Code Medical Transport Ambulance/Hospital EMS Run#
Suspected Minor Injury EMS-Ground ERLANGERR 22-051168

Alcohol and Drugs

Officer Suspect Alcohol Use Determination Method Alcohol Test Status
No Observed Test Not Given
1st Alcohol Test Type 1st Alcohol Test Result 2nd Alcohol Test Type 2nd Alcohol Test Result

Officer Suspect Drug Use Determination Method Drug Test Status

No Observed Test Not Given
1st Drug Test Type 1st Drug Test Result 2nd Drug Test Type 2nd Drug Test Result 3rd Drug Test Type 3rd Drug Test Result

Conditions and Actions

Vehicle Striking Non-Motorist Non-Motorist Location
14 Not Intersection-Other Not On Roadway
Condition 1 Condition 2
Appeared Normal
Condition 3

Action 1 Action 2
None
Action 3 Action 4

SF - 1481 (Rev 7/21) 4 of 6 RDA 1348

Person Type
Occupant-Non MV Transport Device
First Name Middle Name Last Name Suffix Date Of Birth Age
KEVIN T NEWSOME 12/1/1974 48
Address Line 1 Address Line 2 City State Zip Code
109 MEADOWVIEW WAY FAYETTEVILLE GA 30214
Phone 1 Phone 2 Phone 3 Gender Race Ethnicity Seating Position
Black or
4045422274 M African Non-Hispanic
American
Safety Equipment Incident Responder? Incident Responder Type
Not Applicable No
Injury Code Medical Transport Ambulance/Hospital EMS Run#
Suspected Minor Injury EMS-Ground ERLANGER 22-051167

Alcohol and Drugs

Officer Suspect Alcohol Use Determination Method Alcohol Test Status
No Observed Test Not Given
1st Alcohol Test Type 1st Alcohol Test Result 2nd Alcohol Test Type 2nd Alcohol Test Result

Officer Suspect Drug Use Determination Method Drug Test Status

No Observed Test Not Given
1st Drug Test Type 1st Drug Test Result 2nd Drug Test Type 2nd Drug Test Result 3rd Drug Test Type 3rd Drug Test Result

Conditions and Actions

Vehicle Striking Non-Motorist Non-Motorist Location
15 Not Intersection-Other Not On Roadway
Condition 1 Condition 2
Appeared Normal
Condition 3

Action 1 Action 2
None
Action 3 Action 4

SF - 1481 (Rev 7/21) 5 of 6 RDA 1348

Collision Witnesses
First Name Middle Name Last Name Suffix Date Of Birth
MICHAEL RADAR
Address Line 1 Address Line 2 City State Zip Code
4036 EAST FREEDOM CIRCLE Ooltewah TN 37363
Phone 1 Phone 2 Phone 3
4235845145

First Name Middle Name Last Name Suffix Date Of Birth

JEREMY MILLWOOD
Address Line 1 Address Line 2 City State Zip Code
215 RAMSEY BRIDGE ROAD Cleveland TN 37323
Phone 1 Phone 2 Phone 3
4236501962

First Name Middle Name Last Name Suffix Date Of Birth

ROGER LEWIS
Address Line 1 Address Line 2 City State Zip Code
1473 OAK LANE ACWORTH GA 30102
Phone 1 Phone 2 Phone 3
7706332659

First Name Middle Name Last Name Suffix Date Of Birth

SONYA LEWIS
Address Line 1 Address Line 2 City State Zip Code
1465 OAK LANE ACWORTH GA 30102
Phone 1 Phone 2 Phone 3
7703099332

First Name Middle Name Last Name Suffix Date Of Birth

WALTER CANNON
Address Line 1 Address Line 2 City State Zip Code
4125 MCDONALD ROAD Collegedale TN 37323
Phone 1 Phone 2 Phone 3
4234248888

Narrative
V1 was crossing the railroad tracks at 10000 Apison Pike in Collegedale, Tn. when it was hit by a Norfolk Southern Train causing a derailment of 3 diesel engines
and 10 cargo cars / boxes.

The Semi was carrying an oversized load containing a 135' long concrete bridge span. The total length of truck and load was 167' 0" 8' 6" wide and 13 '6" tall and
weighing 185,000 pound on 13 axles.

Statements( included) state that V1 was turning left at Apison Pike and University Drive, and after making the left turn it was crossing the tracks, but still
positioned in the oncoming lane of travel. There were cars being held up by one of Wright Brothers Construction workers in the southbound lane. The trucking
companies paid escort service vehicle was on the north side of the tracks, in the north bound lane. While still in this lane of travel the crossing arms of the railway
started flashing and coming down. The driver was unable to negotiate the truck to get in the north bound lane and the back side of the load along with two of the
towing dollies were struck by the train.

The load along with the two dollies were detached from the rest of the truck and sent down the railway with the train causing the train to derail. 3 engines and 10
cars left the railway and landed between the railway and Tucker Road.

A level 1 inspection was completed by THP and the truck was deemed safe to operate. Report # TNTFDR000055

All witness statements and other documentation are attached to this report.

Charges pending are Reckless Endangerment x2, TCA 39-13-103 and Vandalisim of a Critical Infrastructure TCA 39-14-411.

SF - 1481 (Rev 7/21) 6 of 6 RDA 1348

t
A PISON PIKE
 DRIVERNEHICLE EXAMINATION REPORT Aspen 3.0.0.17
Tennessee Department of Safety Report Number: TNTFDR000055
Commercial Vehicle Division Inspection Date: 12/20/2022
1150 Foster Avenue Start: 04:38 PM CT End: 5:07:19 PM CT
Nashville, TN 37243 Inspection Level: I - Full
Phone: (615)743-4990 Fax: (615)253-2278 HM Inspection Type: None
STARRETTE HOUSTON TRUCKING LLC Driver: CRUZ-VEGA, JORGE L
2019 WESTSIDE DR License#:054227419 State: GA
AUGUSTA, GA 30907 Date of Birth: 11/08/1958
USDOT#: 03220663 Phone#: (706)860-2060 Co Driver:
MC/MX#: Fax#: License#: State:
State#: Date Of Birth:
Location: APISON PIKE/ TUCKER RD MilePost: Shipper: WRIGHT BROTHERS CONSTRUCTION
Highway: Origin:ATLANTA, GA Bill of Lading: 131964
County: HAMILTON, TN Destination:CHATTANOOGA, TN Cargo: BUILDING MATERIALS
VEHICLE IDENTIFICATION
Unit IYQg Make Year State Plate # Equipment ID GVWR CVSA # CVSA Issued # OOS Sticker
1 TT KW 2019 GA C9790B 1XKZP4EXBKJ278906 52, 000
2 PT TRLR 2004 GA NONE 4U3S027284L004822 109,360

BRAKE ADJUSTMENTS
Axle# 1 2 2 ~ § § I
Right 1 N/A 1 1/2 1 1/4 1 1/2 lmml
Left N/A 1 1/2 1 1/4 1/4 1/4 lmml
Chamber C-30 NONE C-30 C-30 C-30 C-30 C-30

lviOLATIONS
I ~;; Code Section Unit OOS Citation# Verify Crash Violations Discovered
392.2Y 392.2 D N N N Failure to yield right of way
I
392.2 392.2 D N N N Violation of Local Laws - Explain :
HazMat: No HM Transported. Placard: No Cargo Tank:
I
special Checks: T-r-affi
_1_c_E_n-fo-r-ce_m
_e_n_t_
; L-o-c-al Enforcement; Post Crash
-----------------------~

CERTIFICATION of REPAIRMAN:
I certify that the violations marked above have been satisfactorily repaired.

Failure to return this report with the required certification can result in penalties up to $1 ,000 per day for each day the violation continues, up to a total of $10,000 .
Signature Of Repairer X: Facility: Date:._ _ _ _ __

•••NOTE TO DRIVER: This report must be furnished to the motor carrier whose name is listed above .

CARRIER CERTIFICATION: The undersigned certifies that all driver and vehicle violations on this report have been corrected and are in compliance with the Motor Carrier Safety and
HM Regulations insofar as they are applicable to motor carriers and drivers. This certification MUST BE SIGNED by the Motor Carrier and RETURNED WITHIN 15 Days to the address
at the top of this form.
Signature Of Motor Carrier X:_ _ _ _ _ __ _ _ __ _ _ _ _ __ _ __ Title: _ _ __ _ _ __ _ _ Date: _ _ _ _ __

;~R~~e~~~~-~E~A
1 1

Page of II Ill 11111111111111111111111111111111111

X_ _ _ _ _ _ _ __ _ _ _ _ _ _ 03220663 TN TNTFDR000055
 12/21/22

ON 12/20/22 I hauling a bridge beam for the job sit in Hamilton Co., TN. I was coming toward the
intersection to make the 1st turn. I stopped and waited on the contractor (Wright Brothers Construction)
to pull up the stop sign ln the concrete island. The contractor directed my front escort to proceed to the
next intersection across the railroad tracks to block traffic coming from the right. He (Dakota Clayton)
said that he would block the on coming traffic on the bridge in front of the railroad track. This load is
167' overall length. I must use the oncoming traffic lane to make the right turn at the end of the bridge.
The contractor (Dakota Clayton) got out of his pickup on the bridge to hold traffic and waved for me to
proceed across the bridge. I started driving across the railroad tracks, there was no train coming. No
alarms and the cross arms where up. After I started crossing the tracks, a white pickup truck pulls up to
my truck head on and blocks me from fully crossing the railroad track. I start blowing the horn for the
truck to move. The alarms start sounding and the cross arms start coming down and hit the bridge
beam. I start trying to pull forward and get the pickup to back up, but the train was to fast and hit the
beam before I got completely across the tracks. After impact I jumped out of my truck to run and check
on the train engineers to see if they were ok.

l_