20191005 galvin19100525
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FB0006 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
10:40 PM
Date Notified
10/05/2019
Time Arrived
10:42 PM
Date Arrived
10/05/2019
Crash Time
10:40 PM
Crash Date
10/05/2019
Investigating Officer/Deputy
DEPUTY MATTHEW JEFSON
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0FB0006Additional InformationPHOTOS
Photos ByDEPUTY JEFSON
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
I WAS DISPATCHED TO A ONE VEHICLE PROPERTY DAMAGE ACCIDENT ON STH 27/77 NEAR EATON RD. I ARRIVED AND NOTICED A SILVER SUV IN
THE OPPOSITE DITCH AND SKID MARKS IN THE DITCH ON BOTH SIDES. THE VEHICLE DID HIT A UTILITY POLE. I MADE CONTACT WITH THE DRIVER
AND MADE SURE THAT HE WAS ALRIGHT. I ASKED HIM WHAT HAD HAPPENED AND HE STATED THAT DUE TO THE RAIN AND GLARE COMING FROM
A ONCOMING VEHICLE HE RAN OFF THE ROAD AND OVER CORRECTED GOING INTO THE OTHER DITCH AND HIT A POLE. DRIVER WAS CONFUSED
ON WHERE HE WAS. HE BELIEVED THAT HE WAS AT THE ENTRANCE TO WATERS EDGE ASSISTED LIVING BUT WAS IN FACT APPROXIMATELY 3
MILES PAST THAT. HE WAS TRANSPORTED BACK TO WATERS EDGE BY AMBULANCE. XCEL ENERGY DID HAVE TO DO SOME WORK ON THE POLE
AND THE VEHICLE WAS REMOVED THE NEXT MORNING BY ROADRUNNER TOWING.
Crash Time 10:40 PM
Crash Date 10/05/2019Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
19100525
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FB0006 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
Y Coordinate
5110063.5
X Coordinate
152381.59375
Longitude
-91.493999017
Latitude
46.055713783
ON STH27 SB
182 FT E
OF EATON RD
IN THE TOWN OF LENROOT
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)
RAIN
Environment Factor(s)
GLARE
Roadway Factor(s)
NONE
Road Surface Condition(s)
WET
Light Condition
DARK/UNLIT
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
DIVIDED HWY W/O TRAFFIC BARRIER
Emergency Motor Vehicle Use
NOT APPLICABLE
Special Function
NO SPECIAL FUNCTION
Most Harmful Event: Collision With
OTHER POST, POLE OR SUPPORT
Total Lanes
2
Speed Limit
55
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
1--RIGHT FRONT CORNER, 2--RIGHT SIDE FRONT, 3--RIGHT SIDE MIDDLE, 12-
-FRONT
Initial Contact Point
12--FRONT
Bus Use
NOT A BUS
Body Style
UT - SPORT UTILITY VEHICLE
Color
SIL - SILVER (ALUMINUM)
Model
TRAVERSE
Year
2009
Make
CHEVROLET
Vehicle Identification Number
42910101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
Vehicle
UNITVEHICLECrash Time 10:40 PM
Crash Date 10/05/2019Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
19100525
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FB0006 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
HAYWARD, WI 54843 , US
Owner Name
0101Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
NEGOTIATING CURVE
Vehicle Removed By
ROADRUNNER TOWING
Towed Due To Damage
TOWED DUE TO DISABLING DAMAGE
VEHICLEUNIT Sequence Of Events
Event
RUN OFF ROADWAY RIGHT01
Event
RUN OFF ROADWAY LEFT02
Event
DITCH03
Event
UTILITY POLE04
IndividualInsurance Company
AMERICAN-INSURANCE-COMPANY,-THE
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
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
HAYWARD, WI 54843 , US
Race
WHITE
Date of Birth
08/31/
Sex
MALE
Citations Issued
0
Driver
UN Individual
Safety EquipmentITIDUALINDIV
Crash Time 10:40 PM
Crash Date 10/05/2019Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
19100525
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FB0006 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
LocationStriking Unit #Non Motorist
UNITINDIVIDUALCrash Time 10:40 PM
Crash Date 10/05/2019Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.