200107 klais20010703
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0Z6J8VT 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
01
Total Units
01
Time Notified
06:30 AM
Date Notified
01/08/2020
Time Arrived
07:30 AM
Date Arrived
01/08/2020
Crash Time
99:99
Crash Date
01/07/2020
Investigating Officer/Deputy
DEPUTY AMBER O'SHEA DORN
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0Z6J8VTAdditional InformationPHOTOS
Photos ByDEPUTY O'SHEA DORN
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 VEHICLE THAT HAD GONE INTO THE DITCH ON POTTERS ROAD OFF OF DESMITH LANE, NOTIFIED BY THE OWNER/OPERATOR
OF THE VEHICLE WHO WAS WALKING ON THE ROADWAY. THE OPERATOR OF THE VEHICLE SLID THROUGH THE INTERSECTION AND WENT INTO
THE DITCH. WHILE THE OPERATOR ATTEMPTED TO GET THE VEHICLE OUT OF THE DITCH, THE OPERATOR STATED THE VEHICLE CAUGHT FIRE AND
BURNED UP. THE OPERATOR STATED HE BELIEVES HE LEFT HIS FRIENDS HOUSE AROUND 10:30 PM, BUT WAS UNSURE. THE OPERATOR ADMITTED
TO CONSUMING ALCOHOL BUT WAS NOT INTOXICATED AT THE TIME OF CONTACT WITH OPERATOR. THE OPERATOR/OWNER OF THE VEHICLE WAS
FOUND HITCHHIKING ON HIGHWAY 70 AT APPROXIMATELY 6:30 AM. THE OPERATOR HAD A SMALL AMOUNT OF MARIJUANA RESIDUE IN A
PRESCRIPTION PILL BOTTLE LOCATED IN HIS JACKET POCKET. THE OPERATOR WAS TRANSPORTED BY LAW ENFORCEMENT TO OJIBWA
AMBULANCE GARAGE FOR MINOR INJURIES THAT OCCURRED WHILE HITCHHIKING. THE OPERATOR WAS TRANSPORTED BACK TO HIS RESIDENCE
BY LAW ENFORCEMENT. THE VEHICLE WAS REMOVED AND TOWED TO ROADRUNNER TOWING IMPOUND LOT.
Crash Time 99:99
Crash Date 01/07/2020Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
20010703
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0Z6J8VT WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
Y Coordinate
5076539
X Coordinate
171483.34375
Longitude
-91.224822106
Latitude
45.764240309
ON POTTERS RD
47 FT E
OF DESMITH LN (2)
IN THE TOWN OF RADISSON
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)
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
ROADSIDE
First Harmful Event
DITCH
Crash Scene
Intersection Type
FOUR-WAY INTERSECTION
Junction Location
INTERSECTION
Within Interchange Area
NO
Truck Bus or HazMat
NO
Road Grade
LEVEL
Road Curvature
CURVE RIGHT
Surface Type
BLACKTOP (BITUMINOUS)
Traffic Control Inoperative/Missing
UNKNOWN
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
DITCH
Total Lanes
2
Speed Limit
25
Pre CrashTire
Mark
Direction Of Travel
UNKNOWN
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
DISABLING DAMAGE
Vehicle Damage
1--RIGHT FRONT CORNER, 2--RIGHT SIDE FRONT, 3--RIGHT SIDE MIDDLE, 4--
RIGHT SIDE REAR, 5--RIGHT REAR CORNER, 6--REAR
Initial Contact Point
12--FRONT
Bus Use
NOT A BUS
Body Style
MV - MINI VAN
Color
BLU - BLUE
Model
TOWN & COU
Year
2005
Make
CHRYSLER
Vehicle Identification Number
329960101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
Vehicle
UNITVEHICLECrash Time 99:99
Crash Date 01/07/2020Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
20010703
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0Z6J8VT WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
RADISSON, WI 54867 , US
Owner Name
0101Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
UNKNOWN
What Driver Was Doing
LEFT TURN
Vehicle Removed ByTowed Due To Damage
TOWED DUE TO DISABLING DAMAGE
VEHICLEUNIT Sequence Of Events
Event
DITCH01
Event
FIRE/EXPLOSION02
Event
03Event
04IndividualInsurance Company
GEICO-GENERAL-INS-CO
Policy Holder
UNITInjury
Distracted By
Distracted By Action
UNKNOWN
Distracted By Source
UNKNOWN
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
SUSPECTED MINOR INJURY00101 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY
Safety Equipment
NOT APPLICABLE
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
RADISSON, WI 54867 , US
Race
WHITE
Date of Birth
12/17/
Sex
MALE
Citations Issued
0
Driver
UN Individual
Safety EquipmentITIDUALINDIV
Crash Time 99:99
Crash Date 01/07/2020Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
20010703
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0Z6J8VT WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
UNDER THE INFLUENCE OF MEDICATIONS/DRUGS/ ALCOHOL
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
YES
Suspected Alcohol Use
YES
To/From SchoolAction Other
Action
Prior Action
LocationStriking Unit #Non Motorist
UNITINDIVIDUALCrash Time 99:99
Crash Date 01/07/2020Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.