20191008 campbell-ruidSAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0JB3P3H 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
01
Total Units
02
Time Notified
04:59 PM
Date Notified
10/08/2019
Time Arrived
05:04 PM
Date Arrived
10/08/2019
Crash Time
04:55 PM
Crash Date
10/08/2019
Investigating Officer/Deputy
DEPUTY NATHAN FREY
Agency Crash Number
19100821
Primary Crash Document #Document Number Override
6VL0JB3P3HAdditional InformationPHOTOS
Photos ByC. DEPEW 344
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
UNIT 1 WAS TRAVELING NORTH ON COUNTY B AT APPROXIMATELY 55 MILES PER HOUR. UNIT 2 WAS TRAVELING SOUTH ON COUNTY A AND
FAILED TO YIELD AT THE MARKED STOP SIGN OF COUNTY B. UNIT 1 ATTEMPTED TO AVOID A COLLUSION, BUT STRUCK UNIT 2 IN THE DRIVERS
DOOR/ FRONT DRIVERS WHEEL AREA. UNIT 1 RAN OFF THE ROAD ON COUNTY B, 92' FROM THE POINT OF INITIAL IMPACT. UNIT 2 RAN OFF THE
ROAD ON COUNTY B, 217' WEST OF THE IMPACT. THE OPERATOR OF UNIT 1 WAS CHECKED BY EMS ON SCENE AND RELEASED. THE OPERATOR
OF UNIT 2 WAS EXTRICATED AND TRANSPORTED BY SAWYER EMS.
Crash Time 04:55 PM
Crash Date 10/08/2019Wisconsin Motor Vehicle Crash
Form DT4000 1 of 6
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0JB3P3H WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
NO STRUCTURE
Y Coordinate
5100679.5
X Coordinate
174109.65625
Longitude
-91.207488379
Latitude
45.982174179
ON CTHB WB
84 FT W
OF CTHA SB
IN THE TOWN OF ROUND LAKE
IN SAWYER COUNTY
Location
Special StudyAccess Control
FULL 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
08--FRONT TO SIDE
First Harmful Event Location
ON ROADWAY
First Harmful Event
MOTOR VEH IN TRANSPORT
Crash Scene
Intersection Type
T-INTERSECTION
Junction Location
INTERSECTION
Within Interchange Area
NO
Truck Bus or HazMat
NO
Road Grade
HILLCREST
Road Curvature
STRAIGHT
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
MOTOR VEH TRAN OTHER RDWY
Total Lanes
2
Speed Limit
55
Pre CrashTire
Mark
Direction Of Travel
WESTBOUND
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
2--RIGHT SIDE FRONT
Bus Use
NOT A BUS
Body Style
UT - SPORT UTILITY VEHICLE
Color
SIL - SILVER (ALUMINUM)
Model
OUTLANDER
Year
2017
Make
MITSUBISHI
Vehicle Identification Number
86110101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
Vehicle
UNITVEHICLECrash Time 04:55 PM
Crash Date 10/08/2019Wisconsin Motor Vehicle Crash
Form DT4000 2 of 6
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0JB3P3H WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
COUDERAY, WI 54828 , US
Owner Name
0101Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
GOING STRAIGHT
Vehicle Removed ByTowed Due To Damage
TOWED DUE TO DISABLING DAMAGE
VEHICLEUNIT Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
MOTOR VEH TRAN OTHER RDWY02
Event
03Event
04IndividualInsurance Company
PROGRESSIVE-UNIVERSAL-INSURANCE-COMP
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
COUDERAY, WI 54828 , US
Race
WHITE
Date of Birth
10/13/
Sex
FEMALE
Citations Issued
0
Driver
UN Individual
Safety EquipmentITIDUALINDIV
Crash Time 04:55 PM
Crash Date 10/08/2019Wisconsin Motor Vehicle Crash
Form DT4000 3 of 6
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0JB3P3H 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
UNITINDIVIDUALTruck Bus or HazMat
NO
Road Grade
HILLCREST
Road Curvature
STRAIGHT
Surface Type
BLACKTOP (BITUMINOUS)
Traffic Control Inoperative/Missing
NO
Traffic Control
STOP SIGN
Traffic Way
TWO-WAY, NOT DIVIDED
Emergency Motor Vehicle Use
NOT APPLICABLE
Special Function
NO SPECIAL FUNCTION
Most Harmful Event: Collision With
MOTOR VEH TRAN OTHER RDWY
Total Lanes
2
Speed Limit
55
Pre CrashTire
Mark
Direction Of Travel
SOUTHBOUND
Insurance?
UNKNOWN
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # RecordedTotal Occs
1
Operating As EndorsementsVehicle Type
UTILITY TRUCK/PICKUP TRUCK02 Unit Type
TRUCK
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITVehicle Removed ByTowed Due To Damage
TOWED DUE TO DISABLING DAMAGE
Extent Of Damage
DISABLING DAMAGE
Vehicle Damage
10--LEFT SIDE FRONT, 11--LEFT FRONT CORNER, 12--FRONT
Initial Contact Point
11--LEFT FRONT CORNER
Bus Use
NOT A BUS
Body Style
PK - PICKUP
Color
RED - RED
Model
RANGER
Year
2001
Make
FORD
Vehicle Identification Number
96350202 Country of Issuance
UNITED STATES
St
WI
Plate Type
LTK - LIGHT TRUCK
License Plate Number
Vehicle
UNITVEHICLECrash Time 04:55 PM
Crash Date 10/08/2019Wisconsin Motor Vehicle Crash
Form DT4000 4 of 6
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0JB3P3H WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
HAYWARD, WI 54843 , US
Owner Name
0202Driver Actions
DISREGARDED STOP SIGN
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
GOING STRAIGHT
VEHICLEUNIT Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
MOTOR VEH TRAN OTHER RDWY02
Event
03Event
04Injury
Distracted By
Prior Action
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 #
1910853
EMS Agency Identifier
6000954
Medical Transport
EMS GROUND
Trapped/Extricated
TRAPPED/EXTRICATED
Ejection Path
NOT EJECTED/NOT APPLICABLE
Ejected
NOT EJECTED
Airbag
DEPLOYED-FRONT
Injury Severity
SUSPECTED SERIOUS INJUR00202 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
04/11/
Sex
MALE
Citations Issued
0
Driver
UN Individual
Non Motorist
Safety EquipmentITIDUALINDIV
Crash Time 04:55 PM
Crash Date 10/08/2019Wisconsin Motor Vehicle Crash
Form DT4000 5 of 6
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0JB3P3H WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
NOT OBSERVED
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
UNITINDIVIDUALCrash Time 04:55 PM
Crash Date 10/08/2019Wisconsin Motor Vehicle Crash
Form DT4000 6 of 6
This report does not include any CJIS data.