20191104 walsh-olson19110411
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5JR 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
02
Time Notified
11:28 AM
Date Notified
11/04/2019
Time Arrived
11:45 AM
Date Arrived
11/04/2019
Crash Time
11:27 AM
Crash Date
11/04/2019
Investigating Officer/Deputy
DEPUTY AMANDA REED
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0GMH5JRAdditional InformationPHOTOS
Photos ByDEPUTY AMANDA REED
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
ON NOVEMBER 4TH, 2019, I, DEPUTY REED RESPONDED TO A TWO VEHICLE PROPERTY DAMAGE ACCIDENT IN THE HOSPITAL PARKING LOT. I
FOUND THE DRIVER OF THE TRUCK INVOLVED, KEVIN WALSH, TO BE AT FAULT. HE ALSO DID NOT HAVE INSURANCE. HE BACKED INTO A CAR
DRIVEN BY CAUSING DAMAGE TO THE CAR.
Crash Time 11:27 AM
Crash Date 11/04/2019Wisconsin Motor Vehicle Crash
Form DT4000 1 of 6
This report does not include any CJIS data.
19110411
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5JR WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
HOUSE/BUILDING
Y Coordinate
5107492.5
X Coordinate
152741.921875
Longitude
-91.48748319
Latitude
46.032827276
PARKING LOT
STH27 NB LOT 11040
(HOUSE/BUILDING 11040)
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)
SNOW
Environment Factor(s)
NONE
Roadway Factor(s)
NONE
Road Surface Condition(s)
WET
Light Condition
DAYLIGHT
Manner of Collision
02--FRONT TO REAR
First Harmful Event Location
IN PARKING LANE OR ZONE
First Harmful Event
MOTOR VEH IN TRANSPORT
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
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
MOTOR VEH IN TRANSPORT
Total Lanes
02
Speed LimitPre CrashTire
Mark
Direction Of Travel
NOT ON ROADWAY
Insurance?
NO
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
2
Train/Bus # RecordedTotal Occs
1
Operating As EndorsementsVehicle Type
UTILITY TRUCK/PICKUP TRUCK01 Unit Type
TRUCK
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITExtent Of Damage
NO DAMAGE
Vehicle Damage
NO DAMAGE
Initial Contact Point
6--REAR
Bus Use
NOT A BUS
Body Style
4D - 4DR
Color
BLK - BLACK
Model
AVALANCHE
Year
2002
Make
CHEVROLET
Vehicle Identification Number
44190101 Country of Issuance
UNITED STATES
St
WI
Plate Type
LTK - LIGHT TRUCK
License Plate Number
Vehicle
UNITVEHICLECrash Time 11:27 AM
Crash Date 11/04/2019Wisconsin Motor Vehicle Crash
Form DT4000 2 of 6
This report does not include any CJIS data.
19110411
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5JR WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
WINTER, WI 54896 , US
Owner Name
0101Driver Actions
UNSAFE BACKING
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
BACKING
Vehicle Removed By
OPERATOR
Towed Due To Damage
NOT TOWED
VEHICLEUNIT Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
PARKED MOTOR VEHICLE02
Event
03Event
04Injury
Distracted By
LocationStriking Unit #
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
RESTRAINT USE UNKNOWN
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
WINTER, WI 54896 , US
Race
WHITE
Date of Birth
07/02/
Sex
MALE
Citations Issued
2
Driver
UN Individual
Non Motorist
Safety EquipmentITIDUALINDIV
Crash Time 11:27 AM
Crash Date 11/04/2019Wisconsin Motor Vehicle Crash
Form DT4000 3 of 6
This report does not include any CJIS data.
19110411
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5JR 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
UNITINDIVIDUAL Violations
DescriptionOPERATE MOTOR VEHICLE W/O INSURANCEStatute Number344.62(1)Issue To?
001
UTC Number
BE64942701
DescriptionUNSAFE BACKING OF VEHICLEStatute Number346.87Issue To?
001
UTC Number
BE64942602
Truck Bus or HazMat
NO
Road Grade
LEVEL
Road Curvature
CURVE RIGHT
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
MOTOR VEH IN TRANSPORT
Total Lanes
2
Speed LimitPre CrashTire
Mark
Direction Of Travel
NOT ON ROADWAY
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # RecordedTotal Occs
1
Operating As EndorsementsVehicle Type
PASSENGER CAR02 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITInitial Contact Point
12--FRONT
Bus Use
NOT A BUS
Body Style
4D - 4DR
Color
SIL - SILVER (ALUMINUM)
Model
GRAND PRIX
Year
2004
Make
PONTIAC
Vehicle Identification Number
35160202 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
Vehicle
Crash Time 11:27 AM
Crash Date 11/04/2019Wisconsin Motor Vehicle Crash
Form DT4000 4 of 6
This report does not include any CJIS data.
19110411
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5JR WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
HAYWARD, WI 54843 , US
Owner Name
ULTIMATE AUTO BODY
(715) 699-16010202Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
SLOW/STOPPING
Vehicle Removed By
OPERATOR
Towed Due To Damage
NOT TOWED
Extent Of Damage
MINOR DAMAGE
Vehicle Damage
12--FRONT
VEHICLEUNITUNITVEHICLE Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
MOTOR VEH IN TRANSPORT02
Event
03Event
04Organization/Company
ULTIMATE AUTO BODY
Insurance Company
NATIONAL-INDEMNITY-CO
Policy Holder
UNITInjury
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 INJURY00202 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY
Safety Equipment
RESTRAINT USE UNKNOWN
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
HAYWARD, WI 54843 , US
Race
WHITE
Date of Birth
08/20/
Sex
MALE
Citations Issued
0
Driver
UN Individual
Safety EquipmentITIDUALINDIV
Crash Time 11:27 AM
Crash Date 11/04/2019Wisconsin Motor Vehicle Crash
Form DT4000 5 of 6
This report does not include any CJIS data.
19110411
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5JR WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Distracted By
Individual Condition
APPEARED NORMAL
Drug Type
00202Drug 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 #
Distracted By Action
NOT DISTRACTED
Distracted By Source
NOT APPLICABLE (NOT DISTRACTED)
Non Motorist
UNITINDIVIDUALCrash Time 11:27 AM
Crash Date 11/04/2019Wisconsin Motor Vehicle Crash
Form DT4000 6 of 6
This report does not include any CJIS data.