Fire Truck Accident Report

FORM PR-1 REV01.01

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ADDRESS

(Street Number and Name)

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CITY OR TOWN STATE

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1711 6 Winter St
Ansonia

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CITY OR TOWN STATE

CT

Ansonia
OPERATOR LICENSE #

CT

OPERATOR

LICENSE #

173453904
OWNER'S NAME (Enter SAME if Owner is Operator)

146544456
OWNER'S NAIVIE (Enter SAME if Owner is Operator)

SAME AS ABOVE

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City of Ansonia Fire Oept.
ADDRESS (Street Number and Name)

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ADDRESS

(Street Number and Name)

SAME AS ABOVE
CITY OR TOWN . STATE. ZIP CODE BODY TYPE

253 Main St~
I-C-ITY--O-R--TO-W--N----~-;------ST-A-T-E-----Z-IP-C-O-D-E---;-B~O-D-Y-TY--p-E-l

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SAME AS ABOVE
REGISTRATION # STATE VEHICLE YEAR AND MAKE

4d Sed 1999 Strn

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REGISTRATION # STATE

Ansonia

CT
VEHICLE

06401
YEAR AND MAKE

Truck

129PHO

CT

I_T_R_U_C_K_7~C_T_L2_0_0_6 P_ie_rc_e

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L/31
~1. IL.JJ ~ ~

SOURCE OF CARRIER NAME. Shipping PapersfTrip Manifest

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USDOT#

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~O~D~riv~e~r~n~·=S~id~e~o=fv~e~h=icFle~~~~IC~C~M=C~#~~~~~~----~ GROSS VEHICLE WEIGHT HAZARDOUS MATERIAL PLACARD ,~~'_ .. ,RATING # -+R_E_Q_U_IR_E_D_? Yes __ DISPLAYED? __ ~O~~_es 0 No ~4~D~i9~it~# ~ 0 __··~O~N_O 1 Digit #__ ~NFORCEoMENT ACTION TAKEON

HAZARDOUSOCARGO RELEASED? Yes

0 No

0
0

None

,XIArrest #'S

Written Warning

Verbal Warning

STATUTE OR ORDINANCE

IA 1/141

14-299
AUTOMOBILE INSURANCE

SUBJECT~ Operator CCarrier OF ACTION Owner Pedestria

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- NAME -POLICY

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~~A_I_ls_ta_te __0_1_9_0_9_85_2_3 __ 05_/_1_6

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PARTS OF VEHICLE DAMAGED

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IA 1---------------------------~----------------_1 Drivers Side Front
~~H~~~7sTOWED TO:

PARTS OF VEHICLE

DAMAGED

00

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VEHICLE TOWED TO:

Passenger Side Front

TOWED

DUE TO DAMAGE

0 TOWED

DUE TO DAMAGE

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L. M. N.

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P. Q. 1 2 4 1 1 2

1 2 3 4 5 6 7

1 C 01 2 2 W W W W N 01 N 03 Uvino, Louis

TRAFFIC UNIT # 1 TRAFFIC UNIT # 2 1 Main St Ansonia, CT

OPERATOROR PEDESTRIAN # 1 OPERATOR OR PEDESTRIAN # 2

2

3 4

Esposito, Michael Landon, Amy Marra, James Marra, Rebecca

8 Cascio Street Ansonia, CT

221 Park Rd Oxford, CT 3 Whippoorwill Dr Seymour, CT 3 Whippoorwill Dr Seymour, CT

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PR-1

Page # 2 of 3

Police Case Number

1100017118 ACCIDENT DIAGRAM

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MaIn Street

INDICATE NORTH

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Kingston Drive

Unit 2

Kingston Dnvc

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.•.•.. , .. 1
Main Street

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MAP NOT TO SCALE
1

TRAFFIC UNIT # East

1 On

TRAVELING Kingston Drive

TRAFFIC UNIT # South

2 On

TRAVELING Main Street

OP #2 (Foster) stated, he was traveling south bound on Main Street going to a fire emergency call on East Main Street, when he was struck by veh #1 at the intersection of Main Street and Kingston Drive. OP #1 (Foster) explained he had his emergency lights illuminated and had pressed the siren as he approached the intersection. OP #1 (Foster) stated as soon as he saw head lights from his passenger side of his emergency vehicle he attempted to swerved left to avoid contact with Veh #1, but it was too late and his emergency vehicle collided with Veh #1. OP #1 (Foster) refused medical treatment. OP # 1 (Boroski) stated she was at the yellow traffic light at Kingston Drive and Main Street traveling east bound, when she saw a fire truck traveling south bound. OP #1 (Boroski) stated it was too late to stop and she collided with the fire engine. OP #2 (Boroski) was transported to Bridgeport Hospital for her injuries. Witness #1 (Marra, James) stated he was traveling north bound on Main Street when he saw a fire truck traveling south bound on Main Street heading in his direction with their lights and sirens on. Witness #1 (Marra, James) explained he pulled over to the right as he does normally when an emergency vehicle goes by him with their lights and sirens on. Witness #1 (Marra, James) stated he then saw Veh #1 run a red light and collided with the fire truck in the interection.

Witness #2 (Marra, Jessica) stated her and her husband (James Marra) were traveling north on Main Street, when her husband pulled over to the right to allow the emergency vehicle which was traveling south bound on Main Street with their lights and sirens on. Witness #2 (Marra, Jessica) stated her husbands traffic light was green the time of the accident and she then saw Veh #1 travel through the red light and then collided with the fire truck in te intersection.
DA,vIAGE TO PROPERTY OTHER THAN INVOLVED VEHICLES 1. DESCRIBE THE NATURE AND Er."TENTOF PROPER1Y DAMAGE NAME AND ADDRESS OF PROPERTY OWNER 2. DESCRIBE THE NATURE AND EA"TENT PROPER1Y DAMAGE OF NAME AND ADDRESS OF PROPERTY OWNER o/-E~FFICER ~;; -1~~' 10 S-6 I POLICE AGENCY IDENTIFICATION 002 I

RANK AND SIGNATURE OF INVEST~ Patrol Sergeant Guisto, Jenifer
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I 12/15/2011

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REPORT DATE I CASE STATU~ISUP.SRyjS~)(;,7D lea red by Arre

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Page

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3 of 3

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Police Case Number

1100017118
INDICATE NORTH

ACCIDENT DIAGRAM

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RAFFIC UNIT # On

TRAVELING

TRAFFIC UNIT # On

TRAVELING

Witness # 3 (Landan) stated she was traveling north on Main Street, when she saw a fire engine traveling South on Main Street with their lights and sirens on when they collided with Veh #1. Witness #2 (Landan) stated Veh#1 had a red traffic light at the time of the accident. Investigation was consistent with staternenfs above. OP #1 (Boroski) was found at fault for the accident charging her with; Failure to Obey Traffic Signal 14-299.

DAMAGE TO PROPERTY OTHER THAN INVOLVED V:::HICLES

1. DESCRIBE THE NATUREAND EXTENT OF PROPERTY DAMAGE. NAMEAND ADDRESS OF PROPERTYOWNER 2. DESCRIBE THE NATURE AND EA"TENTOF PROPERTY DAMAGE NArvlEAND ADDRESS OF PROPERTY OWNER 10

LR"'NK AND SIGNAlGuisto,OF INVEST~TIN~-E~dOFFICER URE Patrol Sergeant Jenifer . =--'-'-'12-'
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POLICE AGENCY IDENTIFICATION 002

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REPORT DAI E 12/15/2011

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CASE STATUrW~~!':: leared by Arr,
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