20190628 ericksonSAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0Z7RB04 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
11:54 AM
Date Notified
06/28/2019
Time Arrived
12:09 PM
Date Arrived
06/28/2019
Crash Time
99:99
Crash Date
06/28/2019
Investigating Officer/Deputy
DEPUTY CALEB JORSTAD
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0Z7RB04Additional InformationPHOTOS
Photos ByDEPUTY JORSTAD
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
ON JUNE 28, 2019 AT APPROXIMATELY 11:54 A.M. I DEPUTY JORSTAD WITH THE SAWYER COUNTY SHERIFF'S OFFICE WAS DISPATCHED TO
HIGHWAY K IN THE TOWNSHIP OF BASS LAKE FOR A VEHICLE IN THE DITCH. I ARRIVED ON SCENE AT APPROXIMATELY 12:09 P.M. WHERE I MET
WITH THE CALLER, . ADVISED ME THAT HE HAD COME ACROSS THE VHEICLE, AND THERE WAS A FATHER AND SON
FISHING NEAR WHERE THE VEHICLE HAD CRASHED. THE WITNESS SAID THAT A FEMALE HAD EXITED THE VEHICLE AND GOT INTO ANOTHER
VEHICLE AND LEFT THE SCENE. I FOUND THAT THE REGISTERED OWNER HAD PROPERTIES IN SAWYER COUNTY. I PHOTOGRAPHED THE SCENE
AND CLEARED FROM THE SCENE WHEN THE VEHICLE WAS REMOVED BY ROADRUNNER TOWING.
Crash Time 99:99
Crash Date 06/28/2019Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0Z7RB04 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
NO STRUCTURE
Y Coordinate
5094233.5
X Coordinate
159062.859375
Longitude
-91.396602157
Latitude
45.917019425
ON CTHK WB
683 FT W
OF KIDD'S RD (1)
IN THE TOWN OF BASS LAKE
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
GUARDRAIL FACE
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 LEFT
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
GUARDRAIL FACE
Total Lanes
2
Speed Limit
35
Pre 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
UTILITY TRUCK/PICKUP TRUCK01 Unit Type
TRUCK
Vehicle Operating As Classification
D CLASS
Unit Status
HIT AND RUN
Unit Summary
UNITExtent Of Damage
DISABLING DAMAGE
Vehicle Damage
1--RIGHT FRONT CORNER, 11--LEFT FRONT CORNER, 12--FRONT,
UNDERCARRIAGE
Initial Contact Point
12--FRONT
Bus Use
NOT A BUS
Body Style
2D - 2DR
Color
WHI - WHITE
Model
F150
Year
1995
Make
FORD
Vehicle Identification Number
65270101 Country of Issuance
UNITED STATES
St
MN
Plate Type
LTK - LIGHT TRUCK
License Plate Number
Vehicle
UNITVEHICLECrash Time 99:99
Crash Date 06/28/2019Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0Z7RB04 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
AUSTIN, MN 55912 , US
Owner Name
0101Driver Actions
UNKNOWN
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
NEGOTIATING CURVE
Vehicle Removed By
OPERATOR
Towed Due To Damage
TOWED DUE TO DISABLING DAMAGE
VEHICLEUNIT Sequence Of Events
Event
GUARDRAIL FACE01
Event
DITCH02
Event
03Event
04Injury
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 APPLICABLE
Ejection Path
NOT EJECTED/NOT APPLICABLE
Ejected
NOT APPLICABLE
Airbag
NOT APPLICABLE
Injury Severity
NO APPARENT INJURY00101 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY
Safety Equipment
NONE USED - VEHICLE OCCUPANT
On Duty Crash
Driver License NumberAddress
, ,
RaceDate of Birth
SexCitations Issued
0
Driver
UNKNOWN
UN Individual
Non Motorist
Safety EquipmentITIDUALINDIV
Crash Time 99:99
Crash Date 06/28/2019Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0Z7RB04 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
NOT OBSERVED
Drug Type
00101Drug 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
Prior Action
UNITINDIVIDUALHAYWARD, WI 54843 , US
PROPOWNER01Fixed Objects Struck
Property Owner
Damage Tag NumberStructure NumberStruck Object
GUARDRAIL FACE
Striking Unit
0101
Crash Time 99:99
Crash Date 06/28/2019Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.