20190719 kenney JULY 19, 2019, I, DEPUTY AMBER AL-MOGHRABI WAS WORKING PATROL FOR THE SAWYER COUNTY SHERIFF'S DEPARTMENT. AT APPROXIMATELY
16:26, I WAS ADVISED BY DISPATCH TO RESPOND TO MEADOW LANE ROAD JUST OFF OF COMPANY LAKE ROAD FOR A VEHICLE THAT HAD HIT A
TREE. DISPATCH ADVISED ME THAT THERE WERE NO INJURIES AND NO ROAD BLOCKAGE. I WENT EN ROUTE TO THE ACCIDENT AND ARRIVED ON
SCENE AT 16:35. UPON ARRIVAL I NOTICED A SILVER CHEVY IMPALA THAT WAS POINTED SOUTHBOUND AND THE FRONT END HAD HIT THE TREE.
DUE TO THE BAD THUNDERSTORM WE WERE IN THE MIDDLE OF OUR COMPUTER SYSTEMS WERE NOT WORKING, SO I WAS UNABLE TO RUN THE
LICENSE PLATE ON THE VEHICLE, BUT I ASKED DISPATCH TO LOG IT IN THE CAD SYSTEM. I WALKED UP TO THE DRIVER SIDE OF THE VEHICLE AND
KNOCKED ON THE WINDOW FOR THE DRIVER TO ROLL IT DOWN. THE MALE DRIVER ROLLED DOWN THE WINDOW TO SPEAK TO ME. I ASKED IF HE
WAS OK. HE STATED HE WAS OK. I ASKED THE MALE DRIVER IF HE THOUGHT HE NEEDED AN AMBULANCE AT ALL OR AN EMT TO COME CHECK
HIM OUT AND HE STATED HE DID NOT. I ASKED THE MALE DRIVER FOR HIS DRIVER'S LICENSE AND HE STATED HE DID NOT HAVE IT ON HIM. I
ASKED HIM FOR HIS NAME AND DATE OF BIRTH, WHICH HE INFORMED ME WAS WITH A BIRTH DATE OF . I
ASKED WHAT HAD HAPPENED. HE STATED HE WAS TRAVELING SOUTHBOUND ON MEADOW LANE ROAD AND WAS PLAYING WITH
19071922
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FZQKRK 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
04:26 PM
Date Notified
07/19/2019
Time Arrived
04:35 PM
Date Arrived
07/19/2019
Crash Time
04:24 PM
Crash Date
07/19/2019
Investigating Officer/Deputy
DEPUTY AMBER ALMOGHRABI
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0FZQKRKAdditional InformationPHOTOS
Photos ByDEPUTY AMBER AL-MOGHRABI
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
Crash Time 04:24 PM
Crash Date 07/19/2019Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
HIS TRACTION CONTROL AROUND THE CORNERS OF THE GRAVEL ROAD. HE STATED HE WAS GOING APPROXIMATELY 30 MILES PER HOUR AND
AS HE WAS NEGOTIATING A CURVE HE TURNED OFF HIS TRACTION CONTROL AND LOST CONTROL OF HIS VEHICLE. STATED HE
WAS WEARING HIS SEATBELT AND THAT HE HAD NOT BEEN DRINKING OR ON ANY DRUGS TODAY. I ASKED WHO HE WANTED TO
TOW THE VEHICLE. HE STATED HE WAS NOT SURE BUT THAT HE HAD STATE FARM FOR INSURANCE. I ADVISED HIM THAT
IS PRETTY GOOD AT TAKING MOST INSURANCES IF HE WANTED ME TO CALL FOR THEM. HE STATED THAT WAS FINE. SEE REPORT FOR MORE
19071922
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FZQKRK WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
NO STRUCTURE
Y Coordinate
5108979
X Coordinate
151204.421875
Longitude
-91.508376342
Latitude
46.04538309
ON MEADOW LANE RD
1061 FT N
OF COMPANY LAKE 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)
CLOUDY, RAIN
Environment Factor(s)
WEATHER CONDITIONS
Roadway Factor(s)
NONE
Road Surface Condition(s)
WET
Light Condition
DAYLIGHT
Manner of Collision
NO COLLISION W/VEHICLE IN TRANSPORT
First Harmful Event Location
SHOULDER RIGHT
First Harmful Event
TREE
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 - UNKNOWN DIRECTION
Surface Type
SLAG, GRAVEL, OR STONE
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
TREE
Total Lanes
2
Speed Limit
45
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
UNITBus Use
NOT A BUS
Body Style
4D - 4DR
Color
SIL - SILVER (ALUMINUM)
Model
IMPALA
Year
2013
Make
CHEVROLET
Vehicle Identification Number
47580101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
Vehicle
Crash Time 04:24 PM
Crash Date 07/19/2019Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
19071922
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FZQKRK WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
MINONG, WI 54859 , US
Owner Name
0101Driver Actions
FAILURE TO CONTROL, OTHER 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
Extent Of Damage
DISABLING DAMAGE
Vehicle Damage
1--RIGHT FRONT CORNER, 11--LEFT FRONT CORNER, 12--FRONT
Initial Contact Point
12--FRONT
VEHICLEUNITUNITVEHICLE Sequence Of Events
Event
TREE01
Event
02Event
03Event
04IndividualInsurance Company
STATE-FARM-GENERAL-INS-CO
Policy Holder
UNITInjury
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
MINONG, WI 54859 , US
Race
WHITE
Date of Birth
02/05/
Sex
MALE
Citations Issued
0
Driver
UN Individual
Safety EquipmentITIDUALINDIV
Crash Time 04:24 PM
Crash Date 07/19/2019Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
19071922
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FZQKRK WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Distracted By
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 #
Distracted By Action
NOT DISTRACTED
Distracted By Source
NOT APPLICABLE (NOT DISTRACTED)
Non Motorist
UNITINDIVIDUALCrash Time 04:24 PM
Crash Date 07/19/2019Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.