20190122 JEROME.pdfON JANUARY 22, 2019, I DEPUTY AMBER AL-MOGHRABI WAS WORKING PATROL FOR THE SAWYER COUNTY SHERIFF'S DEPARTMENT. AT
APPROXIMATELY 11:46 I WAS ADVISED BY DISPATCH ALONG WITH DEPUTY REED, TO RESPOND TO CHIPPEWA FLOWAGE ROAD FOR A ONE
VEHICLE ACCIDENT. DISPATCH ADVISED THAT THE VEHICLE HAD HIT THE GUARDRAIL AND THAT THERE WERE NO INJURIES. DISPATCH ALSO ADVISED THAT ROADRUNNER TOWING WOULD BE EN ROUTE WITH AN ESTIMATED TIME ARRIVAL OF AN HOUR. UPON ARRIVAL I NOTICED A MALE
SUBJECT STANDING OUTSIDE OF THE WHITE DODGE DURANGO. I RAN THE LICENSE PLATE , WHICH CAME BACK TO . I ASKED
THE MALE SUBJECT IF HE WAS AND HE STATED HE WAS. I THEN ASKED DISPATCH TO RUN , WHO CAME BACK CLEAR AND VALID. I
ASKED WHAT HAD HAPPENED. HE STATED HE WAS TRAVELING WESTBOUND ON CHIPPEWA FLOWAGE ROAD COMING FROM COUDERAY. HE
STATED HE WAS GOING APPROXIMATELY 30 MPH, WHICH HE STATED WAS PROBABLY FASTER THAN HE SHOULD HAVE BEEN GOING FOR THESE
CONDITIONS. HE STATED HE WASNT SURE HOW SLIPPERY THE ROADS WERE UNTIL HE GOT AROUND THE CURVE. STATED THAT WHEN HE GOT AROUND THE CURVE HIS BACK END STARTED TO SLIDE SO HE TURNED THE STEERING WHEEL SO THAT HE WOULD MISS THE GUARDRAIL BUT
SLID RIGHT INTO THE GUARDRAIL AND THE BACK END SWUNG AROUND SO HE WAS FACING THE OTHER DIRECTION. STATED THAT HE WAS
19012200938
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HL8 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Secondary
CrashAmendedCrash Type
DT4000 (STANDARD CRASH)Reportable
TagsSchool Bus Related
NOActive School ZoneGovernment
Property
Reporting
ThresholdTrailer or TowedWork ZoneLane ClosureHit and RunOn Emergency
Total Killed
00
Total Injured
01
Total Units
01
Time Notified
11:46 AM
Date Notified
01/22/2019
Time Arrived
11:55 AM
Date Arrived
01/22/2019
Crash Time
11:45 AM
Crash Date
01/22/2019
Investigating Officer/Deputy
DEPUTY AMBER ALMOGHRABI
Agency Crash Number
19012201
Primary Crash Document #Document Number Override
6V
L
1
3
W
8
H
L
8
Additional InformationPHOTOS
Photos ByDEPUTY AMBER AL-MOGHRABI
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
Crash Time 11:45 AM
Crash Date 01/22/2019Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
WEARING HIS SEATBELT AND THAT HE HAD NOT BEEN DRINKING OR ON ANY DRUGS. HE STATED HE WAS HEADED HOME FROM A FRIENDS HOUSE
IN COUDERAY. I LOOKED AT THE VEHICLE WHICH HAD A SEVERE AMOUNT OF DAMAGE TO THE DRIVER SIDE FRONT DOOR. THE DOOR APPEARED
TO BE SMASHED UP AND COMING OFF OF ITS HINGES. I ALSO NOTICED THAT THE AIR BAGS DID NOT GO OFF. I TOOK PICTURES OF THE VEHICLE WHICH WILL BE ENTERED INTO EVIDENCE. I ASKED IF HE HAD ANY INJURIES AND HE STATED THAT HE HAD A SMALL CUT ON HIS LEFT HAND
AND BUMPED HIS HEAD. I ASKED HIM MULTIPLE TIMES IF HE WANTED AN AMBULANCE OR TO HAVE AN EMT CHECK HIM OUT AND HE REFUSED
EVERY TIME I ASKED HIM. SEE REPORT.
19012200938
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HL8 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
NO STRUCTURE
Y Coordinate
5090667.5
X Coordinate
176598.6875
Longitude
-91.168687853
Latitude
45.893480472
ON FLOWAGE RD
1246 FT E
OF HELSING RD
IN THE TOWN OF OJIBWA
IN SAWYER COUNTY
Location
Special StudyAccess Control
NO CONTROL
Tribal Land
Crash Classification - Jurisdiction
NO SPECIAL JURISDICTION
Crash Classification - Location
PUBLIC PROPERTY
Relation To Trafficway
TRAFFICWAY - ON ROAD
Animal Type
Weather Condition(s)
CLOUDY, SNOW
Environment Factor(s)
NONE
Roadway Factor(s)
NOT APPLICABLE
Road Surface Condition(s)
SNOW, ICE
Light Condition
DAYLIGHT
Manner of Collision
NO COLLISION W/VEHICLE IN TRANSPORT
First Harmful Event Location
ON ROADWAY
First Harmful Event
GUARDRAIL END
Crash Scene
Intersection Type
NOT AN INTERSECTION
Junction Location
NON-JUNCTION
Within Interchange Area
NO
Truck Bus or HazMat
NO
Road Grade
DOWNHILL
Road Curvature
CURVE - UNKNOWN DIRECTION
Surface Type
BLACKTOP (BITUMINOUS)
Traffic Control Inoperative/Missing
NO
Traffic Control
NO CONTROL
Traffic Way
TWO-WAY, NOT DIVIDED
Emergency Motor Vehicle Use
NOT APPLICABLE
Special Function
NO SPECIAL FUNCTIONMost Harmful Event: Collision With
GUARDRAIL END
Total Lanes
2
Speed Limit
35Pre CrashTire
Mark
Direction Of Travel
WESTBOUND
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
1
Operating As EndorsementsVehicle Type
(SPORT) UTILITY VEHICLE01
Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UN
IT
Model
DURANGO
Year
2017
Make
DODGE
Vehicle Identification Number
69490101
Country of Issuance
UNITED STATES
St
WI
Plate Type
LTK - LIGHT TRUCK
License Plate Number
Vehicle
Crash Time 11:45 AM
Crash Date 01/22/2019Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
19012200938
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HL8 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
HAYWARD, WI 54843 , US
Owner Name
01
Driver DistractionsNOT DISTRACTED
01
Driver Actions
SPEED TOO FAST/COND
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
NEGOTIATING CURVE
Vehicle Removed By
ROADRUNNER TOWING
Towed Due To Damage
TOWED DUE TO DISABLING DAMAGE
Extent Of Damage
DISABLING DAMAGE
Vehicle Damage
9--LEFT SIDE MIDDLE, 10--LEFT SIDE FRONT, 11--LEFT FRONT CORNER
Initial Contact Point
11--LEFT FRONT CORNER
Bus UseNOT A BUSBody Style
UT - SPORT UTILITY VEHICLE
Color
WHI - WHITE
VE
H
I
C
L
E
UN
I
T
UN
I
T
VE
H
I
C
L
E
Sequence Of Events
EventGUARDRAIL END01
Event
02
Event
03
Event
04
IndividualInsurance Company
USAA-CASUALTY-INS-CO
Policy Holder
UN
I
T
Helmet ComplianceHelmet Use
Seat Position
1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
HAYWARD, WI 54843 , US
Race
WHITEDate of Birth
03/14/
Sex
MALE
Citations Issued
0
Driver
IT
Equipment
Individual
UN
IN
D
I
V
ID
U
A
L
Crash Time 11:45 AM
Crash Date 01/22/2019Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
19012200938
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HL8 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Injury
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00
1
01
Drug Test ResultsDrug Test TypeDrug Test Given
TEST NOT GIVEN
Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given
TEST NOT GIVEN
Suspected Drug Use
NO
Suspected Alcohol Use
NO
Action Other
Action
To/From SchoolLocationPrior ActionStriking Unit #
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABL
Ejected
NOT EJECTED
Airbag
NON DEPLOYED
Injury Severity
POSSIBLE INJURY00
1
01
Tint ComplianceEye Protection
UN
I
T
Non Motorist
IN
D
I
V
I
D
U
A
L
Crash Time 11:45 AM
Crash Date 01/22/2019Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.