20191122 johnson19112218
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0F03P3F 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
07:17 PM
Date Notified
11/22/2019
Time Arrived
07:17 PM
Date Arrived
11/22/2019
Crash Time
07:00 PM
Crash Date
11/22/2019
Investigating Officer/Deputy
DEPUTY LUCAS SHEPARD
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0F03P3FAdditional InformationNONE
Photos By
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
ON NOVEMBER 22ND DEPUTY SHEPARD WAS REQUESTED TO CALL ABOUT A ONE VEHICLE CRASH THAT HAD OCCURRED
EARLIER IN THE DAY. ADVISED THAT THE CRASH HAD OCCURRED AT APPROXIMATELY 7:00PM AND THAT SHE WAS NOW AT HOME AND
THAT THE VEHICLE WAS BEING TOWED AS WE SPOKE. SHE STATED THAT THE CRASH OCCURRED APPROXIMATELY ONE MILE NORTH OF THE
DEAD END ON MARSH LAKE RD. SHE STATED THAT SHE WAS TRAVELING NORTH ON THAT ROAD FOLLOWING HER HUSBANDS VEHICLE. SHE
ADVISED THAT THE ROADWAY WAS COVERED IN PACKED DOWN SNOW AND ICE AND SHE BEGAN TO SLIDE AND WAS UNABLE TO REGAIN
CONTROL OF HER VEHICLE. THE VEHICLE SLID TO THE WEST SIDE OF THE ROAD AND THE REAR DRIVERS SIDE CORNER OF THE VEHICLE LEFT
THE ROADWAY. SHE STATED THAT WHEN THE VEHICLE LEFT THE ROAD AT THAT ANGLE IT ROLLED ONTO THE DRIVER'S SIDE IN A SWAMPY DITCH
AREA ON THE SIDE OF THE ROAD. THE AIRBAGS REPORTEDLY DEPLOYED. SHE WAS UNINJURED AND HER HUSBAND CAME BACK AND HELPED HER
OUT OF THE VEHICLE. THEY MADE THEIR OWN ARRANGEMENTS TO GET THE VEHICLE REMOVED BY A TOW TRUCK AND BROUGHT TO TIMBER
FORD DEALERSHIP IN HAYWARD WI.
Crash Time 07:00 PM
Crash Date 11/22/2019Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
19112218
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0F03P3F WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
Y Coordinate
5078785.5
X Coordinate
154046.265625
Longitude
-91.450008604
Latitude
45.775896381
ON MARSH LAKE RD S
0.37 MI S
OF RIGHT OF WAY RD
IN THE TOWN OF SAND 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)
CLOUDY
Environment Factor(s)
NONE
Roadway Factor(s)
ROAD SURFACE CONDITION (WET, ICY, SNOW, SLUSH,
ETC)
Road Surface Condition(s)
ICE
Light Condition
DARK/UNLIT
Manner of Collision
NO COLLISION W/VEHICLE IN TRANSPORT
First Harmful Event Location
SHOULDER LEFT
First Harmful Event
DITCH
Crash Scene
Intersection Type
NOT AN INTERSECTION
Junction Location
NON-JUNCTION
Within Interchange Area
UNKNOWN
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
DITCH
Total Lanes
2
Speed Limit
35
Pre CrashTire
Mark
Direction Of Travel
NORTHBOUND
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # RecordedTotal Occs
1
Operating As EndorsementsVehicle Type
(SPORT) UTILITY VEHICLE01 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITExtent Of Damage
DISABLING DAMAGE
Vehicle Damage
7--LEFT REAR CORNER, 8--LEFT SIDE REAR, 9--LEFT SIDE MIDDLE, 10--LEFT
SIDE FRONT, 11--LEFT FRONT CORNER
Initial Contact Point
7--LEFT REAR CORNER
Bus Use
NOT A BUS
Body Style
4H - HATCHBACK 4 DOOR
Color
GRY - GRAY
Model
EXPEDITION
Year
2018
Make
FORD
Vehicle Identification Number
64570101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
Vehicle
UNITVEHICLECrash Time 07:00 PM
Crash Date 11/22/2019Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
19112218
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0F03P3F WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
HAYWARD, WI 54843 , US
Owner Name
0101Driver Actions
UNKNOWN
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
OVERTURN/ROLLOVER02
Event
03Event
04IndividualInsurance Company
PROGRESSIVE-CLASSIC-INS-CO
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-COMBINATION
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
HISPANIC
Date of Birth
09/17/
Sex
FEMALE
Citations Issued
0
Driver
UN Individual
Safety EquipmentITIDUALINDIV
Crash Time 07:00 PM
Crash Date 11/22/2019Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
19112218
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0F03P3F 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 07:00 PM
Crash Date 11/22/2019Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.