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TRACS KEY NO. <br />Investigator’s Motor Vehicle Crash Report - Driver <br />Sheetof <br />56 <br />L <br />1 <br />VEHICLE NO. <br />(cont'd) <br />DRIVER NAME (Last, First, Middle)CONTACT PHONE <br />SEX <br />01 <br />STUBBLEFIELD, CODY, A(402) 705-4224 <br />01 - Male <br />02 - Female <br />MAILING ADDRESSCITYSTATEZIP <br />110 LAKEVIEW CIR #5GRAND ISLANDNE68803 <br />99 - Unk. <br />CITATION <br />DATE OF BIRTH (MMDDYYYY)STATE <br />DOB Unk.DRIVER’S LICENSE NO.NO VIOLATIONUNKNOWN <br />03/30/1999 <br />12 <br />NE <br />H13708681 <br />DRIVER LICENSE JURISDICTIONDRIVER LICENSE STATUSDRIVER LICENSE RESTRICTIONS <br />00 - Not Licensed <br />(up to 3 choices) <br />Type Applicable for this Person <br />01 - Canadian* <br />01 - Commercial Driver License (CDL)00 - None <br />050200 <br />02 - Indian Nation* <br />02 - Non-CDL Driver License01 - Alcohol Interlock Device <br />03 - International License* <br />03 - Non-CDL Restricted Driver License02 - Automatic Transmission <br /> (other than Mexico, Canada) <br /> (learner’s permit, temporary/limited,03 - CDL Intrastate Only <br />04 - Mexican* <br /> graduated driver license, etc.)04 - Corrective Lenses14 - Mechanical Devices (special <br />05 - U.S. State <br />99 - Unknown05 - Except Class A & Class B Bus brakes, hand controls, or other <br />06 - U.S. Government <br />06 - Except Class A Bus adaptive devices) <br />Status <br />97 - Not Applicable <br />07 - Except Tractor-Trailer15 - Military Vehicles Only <br />00 - Not Licensed <br />99 - Unknown <br />06 <br />08 - Farm Waiver16 - Motor Vehicles Without Air Brakes <br />01 - Canceled or Denied <br />09 - Intermediate License Restrictions17 - Outside Mirror <br />02 - Disqualified (CDL) <br />* Name of Jurisdiction <br />10 - Learner’s Permit Restrictions18 - Prosthetic Aid <br /> Include the specific State, Province or03 - Expired <br />11 - Limited to Daylight Only <br />98 - Other <br /> Nation indicated on the Driver’s License <br />04 - Revoked <br />12 - Limited to Employment99 - Unknown <br />05 - Suspended <br />NEBRASKA 13 - Limited-Other <br />06 - Valid License <br />99 - Unknown <br />DRIVER LICENSE TYPE <br />00 - Not Licensed <br />CLASSENDORSEMENTSALCOHOL INTERLOCK PRESENT? <br />(up to 4 choices) <br />01 <br />00 <br />01 - Full Driver License <br />00 - None00 - None01 - Yes <br />05 <br />02 - Intermediate Driver License <br />02 <br />01 - Class A01 - H - Hazardous Materials02 - No <br />03 - Learner’s Permit <br />02 - Class B02 - M - Motorcycle99 - Unknown <br />04 - School Permit <br />03 - Class C03 - N - Tank Vehicle <br />05 - Temporary License <br />04 - Class M04 - P - Passenger <br />SPEEDING RELATED <br />99 - Unknown License Type <br />05 - Regular Driver License05 - S - School <br />00 <br />00 - No <br />97 - Not Applicable06 - T - Double / Triple Trailers <br />01 - Exceeded Speed Limit <br />COMMERCIAL DRIVER LICENSE (CDL) <br />98 - Other07 - X - Combination Tank Vehicle <br />02 - Racing <br />01 - Yes <br />99 - Unknown & Hazardous Materials <br />03 - Too Fast for Conditions <br />02 <br />02 - No <br />98 - Other Non-Commercial License Endorsements <br />99 - Unknown <br />99 - Unknown <br />99 - Unknown <br />DRIVER ACTIONS AT TIME OF CRASHDRIVER DISTRACTED BY <br />DRIVER CONDITION <br />98 <br />(up to 4 choices) <br />AT TIME OF CRASH <br />Action <br />04 <br />00 - Not Distracted <br />00 - No Contributing Action <br />(up to 2 choices) <br />01 <br />01 - Talking/Listening <br />01 - Disregarded Red Light <br />01 - Apparently Normal <br />02 - Manually Operating <br />02 - Disregarded Stop Sign <br />02 - Asleep or Fatigued <br /> (texting, dialing, playing game, etc.) <br />03 - Disregarded Road Markings <br />12 - Operated Motor Vehicle in <br />03 - Emotional (depressed, <br />03 - Other Action (looking away from task, etc.) <br />04 - Disregarded Traffic Sign <br /> Reckless or Aggressive Manner <br /> angry, disturbed, etc.) <br />99 - Unknown <br />05 - Failed to Keep in Proper Lane <br />13 - Over-Correcting/Over-Steering <br />04 - Ill (sick, fainted) <br />06 - Failed to Yield Right-of-Way <br />14 - Ran Off Roadway <br />05 - Physically Impaired <br />Source <br />07 - Followed too Closely <br />15 - Swerved or Avoided Due to Wind, <br />06 - Under Influence of Alcohol, <br />01 - Hands-free Mobile Phone <br />08 - Improper Backing <br />07 <br /> Slippery Surface, Motor Vehicle, <br /> Drugs or Medication <br />02 - Hand-held Mobile Phone <br />09 - Improper Passing <br /> Object, Non-Motorist in Roadway, <br />97 - Not Applicable <br />03 - Other Electronic Device <br />10 - Improper Turn <br /> etc. <br />98 - Other <br />04 - Vehicle-Integrated Device <br />11 - Operated Motor Vehicle in <br />16 - Wrong Side or Wrong Way <br />99 - Unknown if Impaired <br />05 - Passenger/Other Non-Motorist <br /> Inattentive, Careless, <br />98 - Other Contributing Action <br />06 - External (to vehicle/non-motorist area) <br /> Negligent or Erratic Manner <br />99 - Unknown <br />07 - Other Distraction (animal, food, grooming, etc.) <br />08 - Other cell phone use like GPS navigation <br />97 - Not Applicable (not distracted) <br />ALCOHOL SUSPECTEDALCOHOL TEST STATUSALCOHOL TEST TYPEALCOHOL TEST RESULT <br />ALCOHOL <br />01 - Yes01 - Test Given01 - Blood “BAC”01 - Negative <br />0202 <br />02 - No02 - Test Not Given02 - Breathalyzer “BrAC”02 - Positive <br />99 - Unknown03 - Test Refused03 - Urine03 - Pending <br />99 - Unknown if Tested98 - Other99 - Unknown <br />97 - Not Applicable <br />BAC Level: (ex: 0.132) <br />99 - Unknown <br />DRUGS SUSPECTEDDRUG TEST STATUSDRUG TEST TYPEDRUG TEST RESULTDRUG TYPE(up to 4 choices) <br />01 - Yes01 - Test Given01 - Blood01 - Negative01 - Amphetamine06 - PCP <br />DRUGS <br />02 - No02 - Test Not Given02 - Urine02 - Positive02 - Cocaine07 - Other Drug <br />99 - Unknown03 - Test Refused03 - Saliva03 - Marijuana (excludes post-crash drugs) <br />99 - Unknown if Tested98 - Other04 - Opiate97 - Not Applicable <br />99 - Unknown05 - Other Controlled Substance99 - Unknown <br />0202 <br />Agency Case No. <br />L21021121 <br /> <br />