20190130 JOHNSON.pdfSAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12WMLW2 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
00
Total Units
01
Time Notified
04:47 AM
Date Notified
01/30/2019
Time Arrived
04:55 AM
Date Arrived
01/30/2019
Crash Time
04:47 AM
Crash Date
01/30/2019
Investigating Officer/Deputy
DEPUTY CASEY CULHANE
Agency Crash Number
19013002
Primary Crash Document #Document Number Override
6V
L
1
2
W
M
L
W
2
Additional InformationNONE, PHOTOS,
RECONSTRUCTION
Photos ByDEPUTY CULHANE
Reconstruction BySAWYER COUNTY SHERIFFDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
UNIT 1 WAS NORTH BOUND ON EYTCHESON ROAD. UNIT 1 LEFT THE ROADWAY RIDING UP IN THE DITCH. UNIT 1 THEN ROLLED OVER COMING TO
REST ON ITS ROOF TOP.
Crash Time 04:47 AM
Crash Date 01/30/2019Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12WMLW2 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
NO STRUCTURE
Y Coordinate
5109717.5
X Coordinate
153573.46875
Longitude
-91.478386758
Latitude
46.053213244
ON EYTCHESON RD
953 FT S
OF LEO'S RD
IN THE TOWN OF LENROOT
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 - NOT ON ROAD
Animal Type
Weather Condition(s)
SNOW
Environment Factor(s)
NONE
Roadway Factor(s)
NONE
Road Surface Condition(s)
SNOW
Light Condition
DARK/UNLIT
Manner of Collision
NO COLLISION W/VEHICLE IN TRANSPORT
First Harmful Event Location
SHOULDER RIGHT
First Harmful Event
DITCH
Crash Scene
Intersection Type
NOT AN INTERSECTION
Junction Location
NON-JUNCTION
Within Interchange Area
NO
Truck Bus or HazMat
NO
Road Grade
UPHILL
Road Curvature
STRAIGHT
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
DITCH
Total Lanes
02
Speed Limit
45Pre CrashTire
Mark
Direction Of Travel
NORTHBOUND
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
01
Train/Bus # InjuredTotal Occs
01
Operating As EndorsementsVehicle Type
(SPORT) UTILITY VEHICLE01
Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UN
IT
Extent Of Damage
FUNCTIONAL DAMAGE
Vehicle Damage
2--RIGHT SIDE FRONT, 3--RIGHT SIDE MIDDLE, TOP
Initial Contact Point
2--RIGHT SIDE FRONT
Bus UseNOT A BUSBody Style
4D - 4DR
Color
BLK - BLACK
Model
BLAZER
Year
2004
Make
CHEVROLET
Vehicle Identification Number
91470101
Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
VE
H
I
C
L
E
UN
I
T
Vehicle
Crash Time 04:47 AM
Crash Date 01/30/2019Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12WMLW2 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
HAYWARD, WI 54843 , US
Owner Name
01
Driver DistractionsUNKNOWN IF DISTRACTED
01
Driver Actions
UNKNOWN
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
GOING STRAIGHT
Vehicle Removed By
ROADRUNNER TOWING
Towed Due To Damage
TOWED BUT NOT DUE TO DISABLING DAMAG
UN
I
T
VE
H
I
C
L
E
Sequence Of Events
EventRUN OFF ROADWAY RIGHT01
Event
02
Event
03
Event
04
IndividualInsurance Company
THE-GENERAL-AUTOMOBILE-INS-CO-INC
Policy Holder
UN
I
T
Injury
Trapped/Extricated
UNKNOWN
Ejection Path
UNKNOWN
Ejected
UNKNOWN
Airbag
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00
1
01
Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY
Safety Equipment
RESTRAINT USED - TYPE UNKNOWN
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
HAYWARD, WI 54843 , US
Race
WHITE
Date of Birth
04/25/
Sex
FEMALE
Citations Issued
01
Driver
IT
Equipment
Individual
UN
IN
D
I
V
ID
U
A
L
Crash Time 04:47 AM
Crash Date 01/30/2019Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12WMLW2 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00
1
01
Drug Test ResultsDrug Test TypeDrug Test GivenTEST 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
UN
I
T
Non Motorist
IN
D
I
V
I
D
U
A
L
Violations
DescriptionFAILURE OF OPERATOR TO NOTIFY POLICE OF ACCIDENTSeq Num006Statute Number346.70(1)Issue To?
001
UTC Number
BB32851001
Address14688 CO RD B
HAYWARD, WI 54843 , US
GovernmentSAWYER COUNTY
PR
O
P
OW
N
E
R
01
Fixed Objects Struck
Property Owner
Damage Tag Number
01
Structure NumberStruck Object
DITCH
Striking Unit
0101
Crash Time 04:47 AM
Crash Date 01/30/2019Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.