20190810 siegfried19081029
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FB0004 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
06:52 PM
Date Notified
08/10/2019
Time Arrived
07:23 PM
Date Arrived
08/10/2019
Crash Time
06:52 PM
Crash Date
08/10/2019
Investigating Officer/Deputy
DEPUTY MATTHEW JEFSON
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0FB0004Additional InformationPHOTOS
Photos ByM.JEFSON
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
I RESPONDED TO A CALL OF A VEHICLE IN THE DITCH NEAR THE OJIBWA PARK JUST OFF OF STH 70. I ARRIVED AND MET WITH THE DRIVER WHO
WAS THE REGISTERED OWNER. HE ADVISED THAT HE DAZED OFF AND STARTED TO GO OFF THE SHOULDER OF THE ROAD. HE DID NOT WANT TO
OVER CORRECT SO HE KEPT THE VEHICLE STRAIGHT AND HIT THE ENTRANCE AND JUMP OVER LANDING IN THE SWAMP. THERE WAS DISABLING
DAMAGE TO THE FRONT OF THE TRUCK AND IT WAS REMOVED BY A TOW COMPANY.
Crash Time 06:52 PM
Crash Date 08/10/2019Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
19081029
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FB0004 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
Y Coordinate
5080752
X Coordinate
182750.984375
Longitude
-91.083059523
Latitude
45.807321608
ON STH70 EB
0.92 MI W
OF KOEPPLOR RD
IN THE TOWN OF OJIBWA
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)
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 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
STRAIGHT
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
EMBANKMENT
Total Lanes
2
Speed Limit
55
Pre CrashTire
Mark
Direction Of Travel
EASTBOUND
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 TRUCK01 Unit Type
TRUCK
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, 12--FRONT
Initial Contact Point
12--FRONT
Bus Use
NOT A BUS
Body Style
PK - PICKUP
Color
BLU - BLUE
Model
RAM 1500
Year
2013
Make
DODGE
Vehicle Identification Number
40940101 Country of Issuance
UNITED STATES
St
SD
Plate Type
LTK - LIGHT TRUCK
License Plate Number
Vehicle
UNITVEHICLECrash Time 06:52 PM
Crash Date 08/10/2019Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
19081029
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FB0004 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
BOX ELDER, SD 57719 , 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
DITCH01
Event
EMBANKMENT02
Event
CULVERT03
Event
04IndividualInsurance Company
AMERICAN-FAMILY-MUTUAL-INS-CO
Policy Holder
UNITInjury
Distracted By
Distracted By Action
OTHER ACTION (LOOKING AWAY FROM TASK ETC)
Distracted By Source
OTHER DISTRACTION (ANIMAL, FOOD, GROOMING)
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: SOUTH DAKOTA COUNTRY: UNITED STATES
Address
BOX ELDER, SD 57719 , US
Race
WHITE
Date of Birth
10/08/
Sex
MALE
Citations Issued
0
Driver
UN Individual
Safety EquipmentITIDUALINDIV
Crash Time 06:52 PM
Crash Date 08/10/2019Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
19081029
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FB0004 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 06:52 PM
Crash Date 08/10/2019Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.