20190219 schrockSAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKS9 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
07:06 PM
Date Notified
02/19/2019
Time Arrived
07:12 PM
Date Arrived
02/19/2019
Crash Time
07:06 PM
Crash Date
02/19/2019
Investigating Officer/Deputy
DEPUTY NATHAN FREY
Agency Crash Number
19021905
Primary Crash Document #Document Number Override
6VL13ZQKS9Additional InformationNONE
Photos By
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
UNIT 1 WAS NORTHBOUND ON HENKS ROAD, APPROACHING STATE HIGHWAY 27. THE OPERATOR WAS TRAVELING TOO FAST FOR CONDITIONS
AND WAS UNABLE TO NEGOTIATE A RIGHT CORNER. THE VEHICLE SLID THROUGH THE CORNER AND INTO SEVERAL LARGE TREES OVER AN
EMBANKMENT. THE OPERATOR WAS ABLE TO GET OUT OF THE VEHICLE AND RECEIVED A FOREHEAD INJURY FROM THE AIRBAG DEPLOYMENT.
THE OPERATOR REFUSED MEDICAL. THE VEHICLE WAS SEVERELY DAMAGED (TOTALED) AND REMOVED BY ROADRUNNER TOWING.
Crash Time 07:06 PM
Crash Date 02/19/2019Wisconsin 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
6VL13ZQKS9 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
Y Coordinate
5095885
X Coordinate
151288.9375
Longitude
-91.497742896
Latitude
45.927943929
ON HENKS RD
996 FT W
OF STH27 NB
IN THE TOWN OF BASS LAKE
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)
WEATHER CONDITIONS
Roadway Factor(s)
NONE
Road Surface Condition(s)
SNOW, ICE
Light Condition
DARK/UNLIT
Manner of Collision
NO COLLISION W/VEHICLE IN TRANSPORT
First Harmful Event Location
SHOULDER LEFT
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
LEVEL
Road Curvature
CURVE RIGHT
Surface Type
OTHER
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 FUNCTION
Most Harmful Event: Collision With
DITCH
Total Lanes
2
Speed Limit
55
Pre CrashTire
Mark
Direction Of Travel
NORTHBOUND
Insurance?
NO
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
TRUCK
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITExtent Of Damage
DISABLING DAMAGE
Vehicle Damage
1--RIGHT FRONT CORNER, 11--LEFT FRONT CORNER, 12--FRONT
Initial Contact Point
12--FRONT
Bus Use
NOT A BUS
Body Style
4H - HATCHBACK 4 DOOR
Color
BLU - BLUE
Model
DURANGO
Year
2005
Make
DODGE
Vehicle Identification Number
79560101 Country of Issuance
UNITED STATES
St
WI
Plate Type
TMP - TEMPORARY PLAT
License Plate Number
VEHICLEUNIT Vehicle
Crash Time 07:06 PM
Crash Date 02/19/2019Wisconsin 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
6VL13ZQKS9 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
HAYWARD, WI 54843 US
Owner Name01Driver Distractions
NOT DISTRACTED
01Driver Actions
SPEED TOO FAST/COND
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
NEGOTIATING CURVE
Vehicle Removed ByTowed Due To Damage
TOWED DUE TO DISABLING DAMAGE
UNITVEHICLE Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
CROSS CENTERLINE02
Event
RUN OFF ROADWAY LEFT03
Event
DITCH04
Injury
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABL
Ejected
NOT EJECTED
Airbag
DEPLOYED-FRONT
Injury Severity
POSSIBLE INJURY00101 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY
Safety Equipment
NONE USED - VEHICLE OCCUPANT
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
HAYWARD, WI 54843 , US
RaceDate of Birth
02/25/
Sex
MALE
Citations Issued
0
Driver
ITEquipment
Individual
UNINDIVIDUALCrash Time 07:06 PM
Crash Date 02/19/2019Wisconsin 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
6VL13ZQKS9 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
OTHER
Drug Type
00101Drug 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
UNIT Non Motorist
INDIVIDUALCrash Time 07:06 PM
Crash Date 02/19/2019Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.