20190817 larson - hamblin19081724
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0DT5JN1 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
03:13 PM
Date Notified
08/17/2019
Time Arrived
03:18 PM
Date Arrived
08/17/2019
Crash Time
03:13 PM
Crash Date
08/17/2019
Investigating Officer/Deputy
DEPUTY IAN HALL
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0DT5JN1Additional InformationPHOTOS, RECONSTRUCTION
Photos ByDEPUTY HALL
Reconstruction BySAWYER COUNTY SHERIFFDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
ON AUGUST 17, 2019, AT APPROXIMATELY 13:15 I DEPUTY HALL RESPONDED TO A TWO VEHICLE CRASH AT THE INTERSECTION OF CO HWY K AND
PENINSULA ROAD IN THE HAYWARD TOWNSHIP. I ARRIVED ON SCENE AND OBSERVED A SILVER FORD TAURUS (UNIT 1) HAD STRUCK A WHITE
FORD FARM TRUCK. IT APPEARED UNIT 1 WAS TRAVELING SOUTH ON CO HWY K AND THE WHITE TRUCK PULLED OUT IN FRONT OF UNIT 1. I
IDENTIFIED THE DRIVER IF UNIT 1 AS AND THE DRIVER OF THE TRUCK AS 5. BOTH
PARTIES WERE EXCHANGING INFORMATION. I ASKED JEFFREY WHAT HAPPENED AND HE SAID THE TRUCK PULLED OUT IN FRONT OF HIM AS HE
WAS TRAVELING SOUTH ON CO HWY K. I ASKED WHAT HAPPENED AND HE SAID HE STOPPED AT THE STOP SIGN AT THE INTERSECTION
OF CO HWY K AND PENINSULA RD. ROBERT SAID HE WAS TRAVELING WEST AND HE LOOKED BUT DIDN'T SEE UNIT 1 AND PULLED OUT FROM THE
STOP SIGN AND SAW UNIT 1 AT THE LAST SECOND BEFORE THE IMPACT. UNIT 1 STRUCK THE RIGHT FRONT OF TRUCK. WAS
ABLE TO REMOVE HIS TRUCK AFTER I TOOK PHOTOGRAPHS. UNIT 1 WAS REMOVED BY A-1 TOWING. WHILE TAKING SCENE PHOTOGRAPHS I DID
OBSERVE TALL VEGETATION WHICH COULD HAVE BEEN A CONTRIBUTING FACTOR TO ROBERT NOT SEEING UNIT 1. THE VEGETATION WAS ON THE
NORTH EAST SIDE OF THE INTERSECTION. NO CITATIONS WERE ISSUED TO EITHER DRIVER.
Crash Time 03:13 PM
Crash Date 08/17/2019Wisconsin Motor Vehicle Crash
Form DT4000 1 of 8
This report does not include any CJIS data.
19081724
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0DT5JN1 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
NO STRUCTURE
Y Coordinate
5104680.5
X Coordinate
160633.546875
Longitude
-91.383809914
Latitude
46.011548322
ON CTHK SB
31 FT S
OF PENINSULA RD
IN THE TOWN OF HAYWARD
IN SAWYER COUNTY
Location
Special StudyAccess Control
PARTIAL 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)
VISUAL OBSTRUCTION (S)
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
FOUR-WAY INTERSECTION
Junction Location
INTERSECTION
Within Interchange Area
NO
Truck Bus or HazMat
NO
Road Grade
LEVEL
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 IN TRANSPORT
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
3
Operating As EndorsementsVehicle Type
PASSENGER CAR01 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITExtent Of Damage
DISABLING DAMAGE
Vehicle Damage
12--FRONT
Initial Contact Point
12--FRONT
Bus Use
NOT A BUS
Body Style
4D - 4DR
Color
SIL - SILVER (ALUMINUM)
Model
TAURUS
Year
2006
Make
FORD
Vehicle Identification Number
43040101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
Vehicle
UNITVEHICLECrash Time 03:13 PM
Crash Date 08/17/2019Wisconsin Motor Vehicle Crash
Form DT4000 2 of 8
This report does not include any CJIS data.
19081724
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0DT5JN1 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
GOING STRAIGHT
Vehicle Removed ByTowed Due To Damage
TOWED DUE TO DISABLING DAMAGE
VEHICLEUNIT Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
RUN OFF ROADWAY RIGHT02
Event
03Event
04UnknownInsurance Company
PROGRESSIVE-ADVANCED-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-FRONT
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
02/09/
Sex
MALE
Citations Issued
0
Driver
UN Individual
Safety EquipmentITIDUALINDIV
Crash Time 03:13 PM
Crash Date 08/17/2019Wisconsin Motor Vehicle Crash
Form DT4000 3 of 8
This report does not include any CJIS data.
19081724
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0DT5JN1 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
UNITINDIVIDUALInjury
Distracted By
LocationStriking Unit #
Distracted By Action
Distracted By Source
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 INJURY00201 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
6--SECOND SEAT-RIGHT SIDE
Safety Equipment
CHILD RESTRAINT SYSTEM - FORWARD FACING
On Duty Crash
Driver License NumberAddress
HAYWARD, WI 54843 , US
Race
WHITE
Date of Birth
10/27
Sex
FEMALE
Citations Issued
0
Passenger
UN Individual
Non Motorist
Safety EquipmentITIDUALINDIV
Crash Time 03:13 PM
Crash Date 08/17/2019Wisconsin Motor Vehicle Crash
Form DT4000 4 of 8
This report does not include any CJIS data.
19081724
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0DT5JN1 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00201Drug 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
UNITINDIVIDUALInjury
Distracted By
LocationStriking Unit #
Distracted By Action
Distracted By Source
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 INJURY00301 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
5--SECOND SEAT-MIDDLE
Safety Equipment
CHILD RESTRAINT SYSTEM - FORWARD FACING
On Duty Crash
Driver License NumberAddress
HAYWARD, WI 54843 , US
Race
WHITE
Date of Birth
08/04/
Sex
MALE
Citations Issued
0
Passenger
UN Individual
Non Motorist
Safety EquipmentITIDUALINDIV
Crash Time 03:13 PM
Crash Date 08/17/2019Wisconsin Motor Vehicle Crash
Form DT4000 5 of 8
This report does not include any CJIS data.
19081724
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0DT5JN1 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00301Drug 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
UNITINDIVIDUALTruck Bus or HazMat
NO
Road Grade
LEVEL
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 IN TRANSPORT
Total Lanes
2
Speed Limit
45
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
UTILITY TRUCK/PICKUP TRUCK02 Unit Type
TRUCK
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITWhat Driver Was Doing
GOING STRAIGHT
Vehicle Removed By
OPERATOR
Towed Due To Damage
NOT TOWED
Extent Of Damage
FUNCTIONAL DAMAGE
Vehicle Damage
1--RIGHT FRONT CORNER
Initial Contact Point
1--RIGHT FRONT CORNER
Bus Use
NOT A BUS
Body Style
TK - TRUCK
Color
WHI - WHITE
Model
F450
Year
2000
Make
FORD
Vehicle Identification Number
12490202 Country of Issuance
UNITED STATES
St
WI
Plate Type
FRM - FARM
License Plate Number
Vehicle
UNITVEHICLECrash Time 03:13 PM
Crash Date 08/17/2019Wisconsin Motor Vehicle Crash
Form DT4000 6 of 8
This report does not include any CJIS data.
19081724
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0DT5JN1 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
HAYWARD, WI 54843 , US
Owner Name
0202Driver Actions
FAILED TO YIELD RIGHT-OF-WAY
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
VEHICLEUNIT Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
02Event
03Event
04IndividualInsurance Company
RURAL-MUTUAL-INS-CO-(ATTN:-CLAIMS-DEPT)
Policy Holder
UNITInjury
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 INJURY00402 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
03/27/
Sex
MALE
Citations Issued
0
Driver
UN Individual
Non Motorist
Safety EquipmentITIDUALINDIV
Crash Time 03:13 PM
Crash Date 08/17/2019Wisconsin Motor Vehicle Crash
Form DT4000 7 of 8
This report does not include any CJIS data.
19081724
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0DT5JN1 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00402Drug 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
UNITINDIVIDUALCrash Time 03:13 PM
Crash Date 08/17/2019Wisconsin Motor Vehicle Crash
Form DT4000 8 of 8
This report does not include any CJIS data.