20191031 boersma19103114
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0J3XHJX 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
02:11 PM
Date Notified
10/31/2019
Time Arrived
02:39 PM
Date Arrived
10/31/2019
Crash Time
02:03 PM
Crash Date
10/31/2019
Investigating Officer/Deputy
SERGEANT NICK ALMOGHRABI
Agency Crash Number
19103114
Primary Crash Document #Document Number Override
6VL0J3XHJXAdditional InformationPHOTOS, OTHER DOCUMENTS
Photos BySGT NICK ALMOGHRABI
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
I, SGT. NICK AL-MOGHRABI, RESPONDED TO A REPORT OF A ONE VEHICLE PROPERTY DAMAGE CRASH ON TEWS ROAD AT TURTLE LANE IN THE
TOWNSHIP OF SPIDER LAKE ON 10/31/19 AT 1411 AS REPORTED BY ONSTAR. UPON ARRIVAL I MET WITH THE OPERATOR WHO STATED HE MUST
HAVE FALLEN ASLEEP WHILE TRAVELING HOME. I OBSERVED THE OPERATOR HAD BEEN TRAVELING SOUTH AND CROSSED THE CENTER LINE
ENTERING THE EAST DITCH AND GOING UP AN APPROXIMATE FOUR FOOT EMBANKMENT STRIKING MULTIPLE ROCKS TRAVELING APPROXIMATELY
15 YARDS ON THE EMBANKMENT BEFORE COMING BACK INTO THE DITCH AND TO A REST ACROSS FROM TEWS RD. I OBSERVED DAMAGE FROM
THE FRONT DRIVER'S CORNER TO THE REAR DRIVER'S CORNER AND WHAT APPEARED TO BE A BENT REAR AXEL AS THE REAR DRIVER'S SIDE
TIRE WAS ANGLED INWARD. BOTH DRIVER AND PASSENGER SIDE CURTAIN AIRBAGS HAD DEPLOYED HOWEVER THE OPERATOR WAS NOT
INJURED. THE OPERATOR, AGAINST MY ADVISE, CHOSE TO DRIVE THE VEHICLE ANOTHER MILE HOME. DURING THAT TIME THE REAR DRIVER'S
SIDE TIRE BLEW OUT AND MORE DAMAGE TO THE REAR AXEL WAS SUSTAINED.
Crash Time 02:03 PM
Crash Date 10/31/2019Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
19103114
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0J3XHJX WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
Y Coordinate
5113487.5
X Coordinate
181044.046875
Longitude
-91.126763382
Latitude
46.100407583
ON TEWS RD(FED FOREST RD 206)
0.49 MI S
OF GREEN POINT RD
IN THE TOWN OF SPIDER 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 - 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 LEFT
First Harmful Event
EMBANKMENT
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
TWO-WAY, NOT DIVIDED
Emergency Motor Vehicle Use
NOT APPLICABLE
Special Function
NO SPECIAL FUNCTION
Most Harmful Event: Collision With
EMBANKMENT
Total Lanes
2
Speed Limit
35
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
(SPORT) UTILITY VEHICLE01 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITExtent Of Damage
DISABLING DAMAGE
Vehicle Damage
7--LEFT REAR CORNER, 8--LEFT SIDE REAR, 9--LEFT SIDE MIDDLE, 10--LEFT
SIDE FRONT, 11--LEFT FRONT CORNER
Initial Contact Point
11--LEFT FRONT CORNER
Bus Use
NOT A BUS
Body Style
UT - SPORT UTILITY VEHICLE
Color
SIL - SILVER (ALUMINUM)
Model
ACADIA
Year
2012
Make
GENERAL MOTORS COR
Vehicle Identification Number
58600101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
Vehicle
UNITVEHICLECrash Time 02:03 PM
Crash Date 10/31/2019Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
19103114
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0J3XHJX WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
HAYWARD, WI 54843 , US
Owner Name
0101Driver Actions
FAILED TO KEEP IN DESIGNATED LANE, OTHER CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
NEGOTIATING CURVE
Vehicle Removed By
OPERATOR
Towed Due To Damage
NOT TOWED
VEHICLEUNIT Sequence Of Events
Event
EMBANKMENT01
Event
02Event
03Event
04IndividualInsurance Company
ACUITY,-A-MUTUAL-INSURANCE-CO
Policy Holder
UNITInjury
Distracted By
Distracted By Action
NOT DISTRACTED
Distracted By Source
NOT APPLICABLE (NOT DISTRACTED)
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
DEPLOYED-CURTAIN
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
HAYWARD, WI 54843 , US
Race
WHITE
Date of Birth
02/24/
Sex
MALE
Citations Issued
0
Driver
UN Individual
Safety EquipmentITIDUALINDIV
Crash Time 02:03 PM
Crash Date 10/31/2019Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
19103114
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0J3XHJX 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 02:03 PM
Crash Date 10/31/2019Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.