20190621 andersonSAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0Z7RB01 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
11:28 AM
Date Notified
06/21/2019
Time Arrived
11:46 AM
Date Arrived
06/21/2019
Crash Time
11:25 AM
Crash Date
06/21/2019
Investigating Officer/Deputy
DEPUTY CALEB JORSTAD
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0Z7RB01Additional InformationPHOTOS
Photos ByDEPUTY JORSTAD
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
ON JUNE 21, 2019 I DEPUTY JORSTAD WITH THE SAWYER COUNTY SHERIFF'S OFFICE RESPONDED TO HIGHWAY CC IN THE TOWNSHIP OF HUNTER
FOR A VEHICLE THAT HAD GONE IN THE DITCH NEAR THE WATER. WHEN I ARRIVED ON SCENE I SPOKE TO . TOLD
ME HE HAD BEEN NEGOTIATING THE CURVE ON HWY CC WHEN THE PASSENGER SIDE TIRES WENT OFF OF THE BLACKTOP AND ONTO THE
GRAVEL, WHICH PULLED THE VEHICLE INTO THE DITCH. WAS NOT HURT AND WAITED WITH THE VEHICLE UNTIL IT WAS TOWED OUT BY A-
1 TOWING.
Crash Time 11:25 AM
Crash Date 06/21/2019Wisconsin 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
6VL0Z7RB01 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
NO STRUCTURE
Y Coordinate
5094640
X Coordinate
175083.90625
Longitude
-91.190848446
Latitude
45.928424155
ON CTHCC SB
0.48 MI N
OF WOODLAND DR
IN THE TOWN OF HUNTER
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)
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
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
LEVEL
Road Curvature
CURVE LEFT
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 FUNCTION
Most Harmful Event: Collision With
DITCH
Total Lanes
2
Speed Limit
25
Pre CrashTire
Mark
Direction Of Travel
SOUTHBOUND
Insurance?
YES
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
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
SIL - SILVER (ALUMINUM)
Model
PRIUS
Year
2016
Make
TOYOTA
Vehicle Identification Number
95550101 Country of Issuance
UNITED STATES
St
MN
Plate Type
AUT - AUTOMOBILE
License Plate Number
Vehicle
UNITVEHICLECrash Time 11:25 AM
Crash Date 06/21/2019Wisconsin 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
6VL0Z7RB01 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
ORLANDO, FL 32809 , US
Owner Name
0101Driver Actions
UNKNOWN
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
NEGOTIATING CURVE
Vehicle Removed ByTowed Due To Damage
TOWED BUT NOT DUE TO DISABLING DAMAG
VEHICLEUNIT Sequence Of Events
Event
DITCH01
Event
02Event
03Event
04Organization/CompanyInsurance Company
TRAVELERS-INDEMNITY-CO-OF-CONNECTICUT
Policy Holder
UNITInjury
Distracted By
Distracted By Action
UNKNOWN
Distracted By Source
UNKNOWN
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
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: MINNESOTA COUNTRY: UNITED STATES
Address
SAINT PAUL, MN 55105 , US
Race
WHITE
Date of Birth
08/25/
Sex
MALE
Citations Issued
0
Driver
UN Individual
Safety EquipmentITIDUALINDIV
Crash Time 11:25 AM
Crash Date 06/21/2019Wisconsin 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
6VL0Z7RB01 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL
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
LocationStriking Unit #Non Motorist
UNITINDIVIDUALCrash Time 11:25 AM
Crash Date 06/21/2019Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.