20190205 SWARD.pdf19020504
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL15JN003 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Secondary
CrashAmendedCrash Type
NON-DOMESTICATED ANIMAL W/ NO INJURYReportable
TagsSchool Bus Related
NOActive School ZoneGovernment
Property
Trailer or TowedWork ZoneLane ClosureHit and RunOn Emergency
Total Killed
00
Total Injured
00
Total Units
01
Time Notified
05:57 PM
Date Notified
02/05/2019
Time ArrivedDate ArrivedCrash Time
05:57 PM
Crash Date
02/05/2019
Investigating Officer/Deputy
DEPUTY CHARLES LOGAN
Agency Crash NumberPrimary Crash Document #Document Number Override
6V
L
1
5
J
N
0
0
3
Structure Type
NO STRUCTURE
Y Coordinate
5102219
X Coordinate
168396.640625
Longitude
-91.282108355
Latitude
45.993255268
INTERSECTION
ON CTHB
AT MC CLAIN RD 4
IN THE TOWN OF ROUND LAKE
IN SAWYER COUNTY
Location
Special StudyAccess ControlTribal Land
Crash Classification - Jurisdiction
NO SPECIAL JURISDICTION
Crash Classification - Location
PUBLIC PROPERTY
Relation To Trafficway
TRAFFICWAY - ON ROAD
Animal Type
DEER
Weather Condition(s)
Environment Factor(s)
Roadway Factor(s)Road Surface Condition(s)
Light ConditionManner of Collision
NO COLLISION W/VEHICLE IN TRANSPORT
First Harmful Event Location
ON ROADWAY
First Harmful Event
NON DOMESTICATED ANIMAL (ALIVE)
Crash Scene
Reporting Threshold
NO
Truck Bus or HazMat
NO
Road GradeRoad CurvatureSurface Type
Traffic Control Inoperative/MissingTraffic ControlTraffic Way
Emergency Motor Vehicle UseSpecial FunctionMost Harmful Event: Collision With
NON DOMESTICATED ANIMAL (ALIVE)
Total LanesSpeed LimitPre CrashTire
Mark
Direction Of Travel
EASTBOUND
Insurance?
YES
Total HazMat Types
0
Total TrailersTotal # 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
Vehicle
Crash Time 05:57 PM
Crash Date 02/05/2019This report does not include any CJIS data.
3of1
Wisconsin Motor Vehicle Crash
Form DT4000
19020504
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL15JN003 WISCONSIN MOTOR VEHICLE
CRASH REPORT
01
Driver DistractionsNOT DISTRACTED
01
Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle FactorsWhat Driver Was Doing
Vehicle Removed ByTowed Due To Damage
TOWED DUE TO DISABLING DAMAGE
Extent Of Damage
DISABLING DAMAGE
Vehicle Damage
10--LEFT SIDE FRONT, 11--LEFT FRONT CORNER
Initial Contact Point
11--LEFT FRONT CORNER
Bus UseBody Style
UT - SPORT UTILITY VEHICLE
Color
GLD - GOLD
Model
SRX
Year
2012
Make
CADILLAC
Vehicle Identification Number
10370101
Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
VE
H
I
C
L
E
UN
I
T
UN
I
T
VE
H
I
C
L
E
IndividualInsurance Company
PROGRESSIVE-CLASSIC-INS-CO
Policy Holder
UN
I
T
Injury
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
Trapped/ExtricatedEjection PathEjected
AirbagInjury Severity
NO APPARENT INJURY00
1
01
Tint ComplianceEye Protection
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
WINTER, WI 54896 , US
RaceDate of Birth
11/14/
Sex
FEMALE
Citations Issued
0
Driver
IT
Equipment
Individual
UN
IN
D
I
V
ID
U
A
L
Crash Time 05:57 PM
Crash Date 02/05/2019This report does not include any CJIS data.
3of2
Wisconsin Motor Vehicle Crash
Form DT4000
19020504
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL15JN003 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 UseSuspected Alcohol Use
Action Other
Action
To/From SchoolLocationPrior ActionStriking Unit #
Time of DeathDate of DeathHospital
UN
I
T
Non Motorist
IN
D
I
V
I
D
U
A
L
Crash Time 05:57 PM
Crash Date 02/05/2019This report does not include any CJIS data.
3of3
Wisconsin Motor Vehicle Crash
Form DT4000