20190803 quadererSAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0Z7RB05 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
11:50 PM
Date Notified
08/03/2019
Time Arrived
11:56 PM
Date Arrived
08/03/2019
Crash Time
11:40 PM
Crash Date
08/03/2019
Investigating Officer/Deputy
DEPUTY CALEB JORSTAD
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0Z7RB05Additional InformationPHOTOS
Photos ByDEPUTY CALEB JORSTAD
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
ON AUGUST 3RD, 2019 AT APPROXIMATELY 2350, I DEPUTY JORSTAD WITH THE SAWYER COUNTY SHERIFF'S OFFICE WAS DISPATCHED TO 13201
BACON STRIP IN THE TOWNSHIP OF HAYWARD FOR AN AUTOMOBILE ACCIDENT. I ARRIVED ON SCENE AT APPROXIMATELY 2356. WHILE
TRAVELLING ON BACON STRIP, I OBSERVED BROKEN PLASTIC ON THE WEST SIDE OF THE ROAD. I PULLED INTO THE DRIVEWAY, WHERE I
OBSERVED A GREEN SEDAN PARKED IN THE DRIVEWAY. I EXITED MY VEHICLE AND WAS APPROACHED BY TWO FEMALES.
THE DRIVER, IDENTIFIED AS () TOLD ME SHE WAS TRAVELLING SOUTHBOUND ON BACON STRIP RETURNING
HOME FROM WORK WHEN A VEHICLE THAT WAS TRAVELLING WESTBOUND ON WATERTOWER LANE DID NOT STOP FOR THE STOP SIGN LOCATED
AT WATERTOWER LANE AND BACON STRIP. A SAID SHE SWERVED TO THE LEFT TO AVOID THE VEHICLE HITTING THE DRIVER'S SIDE OF HER
VEHICLE. THE VEHICLE IMPACTED THE PASSENGER SIDE ON THE FRONT OF S VEHICLE. SAID THE VEHICLE SLOWED FOR A MOMENT
AND CONTINUED TRAVELLING ON BACON STRIP TOWARDS ROUND LAKE SCHOOL ROAD. KYRA TOLD ME SHE DID NOT KNOW WHAT KIND OF
VEHICLE IT WAS, ONLY THAT IT WAS A SMALL CAR.
Crash Time 11:40 PM
Crash Date 08/03/2019Wisconsin 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
6VL0Z7RB05 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
NO STRUCTURE
Y CoordinateX Coordinate
LongitudeLatitudeON BACON STRIP
0 FT W
OF WATERTOWER LANE
IN THE TOWN OF HAYWARD
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
DARK/UNLIT
Manner of Collision
06--SIDESWIPE/OPPOSITE DIRECTION
First Harmful Event Location
ON ROADWAY
First Harmful Event
MOTOR VEH IN TRANSPORT
Crash Scene
Intersection Type
L-INTERSECTION
Junction Location
INTERSECTION
Within Interchange Area
NO
Truck Bus or HazMat
NO
Road Grade
LEVEL
Road Curvature
UNKNOWN
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
20
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
PASSENGER CAR01 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITExtent Of Damage
FUNCTIONAL 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
4D - 4DR
Color
GRN - GREEN
Model
FUSION
Year
2006
Make
FORD
Vehicle Identification Number
43550101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
Vehicle
UNITVEHICLECrash Time 11:40 PM
Crash Date 08/03/2019Wisconsin 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
6VL0Z7RB05 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 By
OPERATOR
Towed Due To Damage
NOT TOWED
VEHICLEUNIT Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
MOTOR VEH IN TRANSPORT02
Event
03Event
04IndividualInsurance Company
LIBERTY-INS-CORP
Policy Holder
UNITInjury
Distracted By
Distracted By Action
UNKNOWN
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
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
INDIAN
Date of Birth
11/23/
Sex
FEMALE
Citations Issued
0
Driver
UN Individual
Safety EquipmentITIDUALINDIV
Crash Time 11:40 PM
Crash Date 08/03/2019Wisconsin 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
6VL0Z7RB05 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
LEVEL
Road Curvature
UNKNOWN
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 LimitPre CrashTire
Mark
Direction Of Travel
WESTBOUND
Insurance?
UNKNOWN
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # RecordedTotal Occs
1
Operating As EndorsementsVehicle Type
PASSENGER CAR02 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
HIT AND RUN
Unit Summary
UNITVehicle Removed By
OPERATOR
Towed Due To Damage
NOT TOWED
Extent Of Damage
VEHICLE NOT AT SCENE
Vehicle Damage
VEHICLE NOT AT SCENE
Initial Contact Point
VEHICLE NOT AT SCENE
Bus Use
NOT A BUS
Body StyleColor
ModelYearMakeVehicle Identification Number
0202Country of IssuanceStPlate TypeLicense Plate Number
Vehicle
UNITVEHICLECrash Time 11:40 PM
Crash Date 08/03/2019Wisconsin 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
6VL0Z7RB05 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
, ,
Owner Name
0202Driver Actions
FAILED TO YIELD RIGHT-OF-WAY, UNKNOWN
Driver Prior Action Other
Vehicle Factors
UNKNOWN
What Driver Was Doing
UNKNOWN
VEHICLEUNIT Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
02Event
03Event
04Injury
Distracted By
Prior Action
LocationStriking Unit #
Distracted By Action
Distracted By Source
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
Trapped/Extricated
NOT APPLICABLE
Ejection Path
NOT EJECTED/NOT APPLICABLE
Ejected
NOT APPLICABLE
Airbag
NOT APPLICABLE
Injury Severity
NO APPARENT INJURY00202 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY
Safety Equipment
RESTRAINT USE UNKNOWN
On Duty Crash
Driver License NumberAddress
, ,
RaceDate of Birth
SexCitations Issued
0
Driver
UN Individual
Non Motorist
Safety EquipmentITIDUALINDIV
Crash Time 11:40 PM
Crash Date 08/03/2019Wisconsin 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
6VL0Z7RB05 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 UseSuspected Alcohol Use
To/From SchoolAction Other
Action
UNITINDIVIDUALCrash Time 11:40 PM
Crash Date 08/03/2019Wisconsin Motor Vehicle Crash
Form DT4000 6 of 6
This report does not include any CJIS data.