20190625 flesher19062515
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0Z7RB02 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
01:30 PM
Date Notified
06/25/2019
Time Arrived
01:45 PM
Date Arrived
06/25/2019
Crash Time
01:00 PM
Crash Date
06/25/2019
Investigating Officer/Deputy
DEPUTY DEREK BECKSTRAND
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0Z7RB02Additional InformationPHOTOS, RECONSTRUCTION
Photos ByDEPUTY BECKSTRAND
Reconstruction BySAWYER COUNTY SHERIFFDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
ON JUNE 25TH 2019 AT APPROXIMATELY 1330 I DEPUTY BECKSTRAND WAS ON PATROL WHEN DISPATCH ADVISED ME THAT A SUBJECT HAD HIT A
DUMPSTER AT THE HAYWARD AREA MEMORIAL HOSPITAL. ONCE I ARRIVED THE STAFF SAID THAT THEY TOOK THE DRIVER
INTO THE EMERGENCY ROOM BECAUSE SEEMED LOST AND CONFUSED. I TOOK PICTURES OF THE VEHICLE AND THE STAFF TOLD ME
THAT SON WAS ON HIS WAY. I WENT INTO THE EMERGENCY ROOM AND TALKED WITH . I ASKED IF HE KNEW WHY HE
WAS AT THE HOSPITAL BUT DIDNT KNOW. I ASKED IF HE REMEMBERED HITTING ANYTHING AND SAID NO. HOSPITAL
STAFF HAD KEYS AND SAID THEY WOULD RELEASE THEM TO SON WHEN HE ARRIVED.
Crash Time 01:00 PM
Crash Date 06/25/2019Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
19062515
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0Z7RB02 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
NO STRUCTURE
Y Coordinate
5108414.5
X Coordinate
153031.171875
Longitude
-91.484427548
Latitude
46.041247642
PARKING LOT
STH27 SB LOT
IN THE TOWN OF HAYWARD
IN SAWYER COUNTY
Location
Special StudyAccess Control
NO CONTROL
Tribal Land
Crash Classification - Jurisdiction
PRIVATE PROPERTY
Crash Classification - Location
PRIVATE PROPERTY
Relation To Trafficway
NON TRAFFICWAY - PARKING LOT
Animal Type
Weather Condition(s)
CLEAR
Environment Factor(s)
NONE
Roadway Factor(s)
NONE
Road Surface Condition(s)
DRY
Light Condition
DAYLIGHT
Manner of Collision
NO COLLISION W/VEHICLE IN TRANSPORT
First Harmful Event Location
OFF ROADWAY, LOCATION UNKNOWN
First Harmful Event
OTHER OBJECT - NOT FIXED
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
UNKNOWN
Surface Type
BLACKTOP (BITUMINOUS)
Traffic Control Inoperative/Missing
NO
Traffic Control
NO CONTROL
Traffic Way
PARKING LOT OR PRIVATE PROPERTY
Emergency Motor Vehicle Use
NOT APPLICABLE
Special Function
NO SPECIAL FUNCTION
Most Harmful Event: Collision With
OTHER FIXED OBJECT
Total Lanes
0
Speed Limit
N/A
Pre CrashTire
Mark
Direction Of Travel
NOT ON ROADWAY
Insurance?
UNKNOWN
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # RecordedTotal Occs
1
Operating As EndorsementsVehicle Type
PASSENGER CAR01 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITExtent Of Damage
MINOR DAMAGE
Vehicle Damage
2--RIGHT SIDE FRONT, 3--RIGHT SIDE MIDDLE, 4--RIGHT SIDE REAR, 5--
RIGHT REAR CORNER, 6--REAR, 12--FRONT
Initial Contact Point
12--FRONT
Bus Use
NOT A BUS
Body Style
4H - HATCHBACK 4 DOOR
Color
BLU - BLUE
Model
ESCAPE XLT
Year
2011
Make
FORD
Vehicle Identification Number
97820101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
Vehicle
UNITVEHICLECrash Time 01:00 PM
Crash Date 06/25/2019Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
19062515
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0Z7RB02 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
GORDON, WI 54838 , US
Owner Name
0101Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
UNKNOWN
Vehicle Removed ByTowed Due To Damage
NOT TOWED
VEHICLEUNIT Sequence Of Events
Event
OTHER OBJECT - NOT FIXED01
Event
OTHER FIXED OBJECT02
Event
OTHER OBJECT - NOT FIXED03
Event
04Injury
Distracted By
LocationStriking Unit #
Distracted By Action
NOT DISTRACTED
Distracted By Source
NOT APPLICABLE (NOT DISTRACTED)
Time of DeathDate of DeathHospital
HAYWARD AREA MEM HOSP
EMS Run #EMS Agency IdentifierMedical Transport
OTHER
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABLE
Ejected
NOT EJECTED
Airbag
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00101 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
GORDON, WI 54838 , US
Race
WHITE
Date of Birth
04/02/
Sex
MALE
Citations Issued
0
Driver
UN Individual
Non Motorist
Safety EquipmentITIDUALINDIV
Crash Time 01:00 PM
Crash Date 06/25/2019Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
19062515
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0Z7RB02 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
CONFUSED OR DISORIENTED (NON LUCID)
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
To/From SchoolAction Other
Action
Prior Action
UNITINDIVIDUALCrash Time 01:00 PM
Crash Date 06/25/2019Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.