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200129 cross20012909 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRB6 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 06:52 AM Date Notified 01/29/2020 Time Arrived 06:55 AM Date Arrived 01/29/2020 Crash Time 99:99 Crash Date 01/29/2020 Investigating Officer/Deputy DEPUTY KEVIN GILLIS Agency Crash Number 20012909 Primary Crash Document #Document Number Override 6VL0G5WRB6Additional InformationPHOTOS Photos ByDEPUTY GILLIS Reconstruction ByDiagram Description I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report. UNIT ONE WAS TRAVELING NORTH ON ROUND LAKE SCHOOL ROAD. UNIT ONE WENT OF THE ROAD AND HIT AN EMBANKMENT AT APPROXIMATELY 45 MPH. THE VEHICLE OVER TURNED AND CAME TO A REST ON THE DRIVER'S SIDE OF THE VEHICLE. THE DRIVER AND PASSENGER WERE ABLE TO GET OUT OF THE PASSENGER SIDE BACK DOOR. Crash Time 99:99 Crash Date 01/29/2020Wisconsin Motor Vehicle Crash Form DT4000 1 of 5 This report does not include any CJIS data. 20012909 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRB6 WISCONSIN MOTOR VEHICLE CRASH REPORT Structure Type Y Coordinate 5102234.5 X Coordinate 162102.96875 Longitude -91.363155417 Latitude 45.990325233 ON ROUND LAKE SCHOOL RD 0.48 MI S OF CTHB NB IN THE TOWN OF HAYWARD IN SAWYER COUNTY Location Special StudyAccess Control PARTIAL 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) CLOUDY Environment Factor(s) NONE Roadway Factor(s) NOT APPLICABLE Road Surface Condition(s) SNOW, ICE Light Condition DARK/UNLIT Manner of Collision NO COLLISION W/VEHICLE IN TRANSPORT First Harmful Event Location OFF ROADWAY, LOCATION UNKNOWN First Harmful Event EMBANKMENT 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 STRAIGHT Surface Type BLACKTOP (BITUMINOUS) Traffic Control Inoperative/Missing NO Traffic Control NO CONTROL Traffic Way TWO-WAY, NOT DIVIDED Emergency Motor Vehicle Use NON-EMERGENCY, TRANSPORT Special Function NO SPECIAL FUNCTION Most Harmful Event: Collision With EMBANKMENT Total Lanes 2 Speed Limit 45 Pre CrashTire Mark Direction Of Travel NORTHBOUND Insurance? YES Total HazMat Types 0 Total Trailers 0 Total # Citations Issued 1 Train/Bus # RecordedTotal Occs 2 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 MINOR DAMAGE Vehicle Damage 10--LEFT SIDE FRONT, 11--LEFT FRONT CORNER, 12--FRONT Initial Contact Point 12--FRONT Bus Use NOT A BUS Body Style UT - SPORT UTILITY VEHICLE Color BLU - BLUE Model ROGUE Year 2014 Make NISSAN Vehicle Identification Number 61210101 Country of Issuance UNITED STATES St WI Plate Type AUT - AUTOMOBILE License Plate Number Vehicle UNITVEHICLECrash Time 99:99 Crash Date 01/29/2020Wisconsin Motor Vehicle Crash Form DT4000 2 of 5 This report does not include any CJIS data. 20012909 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRB6 WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address HAYWARD, WI 54843 , US Owner Name 0101Driver Actions OTHER CONTRIBUTING ACTION Driver Prior Action Other Vehicle Factors NOT APPLICABLE What Driver Was Doing GOING STRAIGHT Vehicle Removed By ROADRUNNER TOWING Towed Due To Damage TOWED BUT NOT DUE TO DISABLING DAMAG VEHICLEUNIT Sequence Of Events Event MOTOR VEH IN TRANSPORT01 Event EMBANKMENT02 Event OVERTURN/ROLLOVER03 Event 04Individual Insurance Company PROGRESSIVE-CLASSIC-INS-CO Policy Holder UNITInjury Distracted By Distracted By Action OTHER ACTION (LOOKING AWAY FROM TASK ETC) Distracted By Source VEHICLE-INTEGRATED DEVICE 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-CURTAIN 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 Number STATE: WISCONSIN COUNTRY: UNITED STATES Address HAYWARD, WI 54843 , US Race INDIAN Date of Birth 01/04/ Sex FEMALE Citations Issued 1 Driver UN Individual Safety EquipmentITIDUALINDIV Crash Time 99:99 Crash Date 01/29/2020Wisconsin Motor Vehicle Crash Form DT4000 3 of 5 This report does not include any CJIS data. 20012909 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRB6 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 YES To/From SchoolAction Other Action Prior Action LocationStriking Unit #Non Motorist UNITINDIVIDUALInjury Distracted By LocationStriking Unit # Distracted By Action Distracted By Source Time of DeathDate of DeathHospital HAYWARD AREA MEM HOSP EMS Run #EMS Agency Identifier 6000954 Medical Transport EMS GROUND Trapped/Extricated NOT TRAPPED Ejection Path NOT EJECTED/NOT APPLICABLE Ejected NOT EJECTED Airbag DEPLOYED-CURTAIN Injury Severity SUSPECTED MINOR INJURY00201 Tint ComplianceEye Protection Helmet ComplianceHelmet Use Seat Position 3--FRONT SEAT-RIGHT SIDE (TRAIN ENGINEER 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 06/28/ Sex FEMALE Citations Issued 0 Passenger UN Individual Non Motorist Safety EquipmentITIDUALINDIV Crash Time 99:99 Crash Date 01/29/2020Wisconsin Motor Vehicle Crash Form DT4000 4 of 5 This report does not include any CJIS data. 20012909 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRB6 WISCONSIN MOTOR VEHICLE CRASH REPORT Drug & Alcohol Individual Condition EMOTIONAL (DEPRESSED, ANGRY, DISTURBED, ETC), UNDER THE INFLUENCE OF MEDICATIONS/DRUGS/ ALCOHOL Drug Type 00201Drug 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 UNITINDIVIDUAL Violations DescriptionVEHICLE OPERATOR FAIL/WEAR SEAT BELTStatute Number347.48(2m)(b)Issue To? 001 UTC Number BE65080901 Crash Time 99:99 Crash Date 01/29/2020Wisconsin Motor Vehicle Crash Form DT4000 5 of 5 This report does not include any CJIS data.