200306 schrock20030609
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5K0 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
08:15 AM
Date Notified
03/06/2020
Time Arrived
08:25 AM
Date Arrived
03/06/2020
Crash Time
08:14 AM
Crash Date
03/06/2020
Investigating Officer/Deputy
DEPUTY AMANDA REED
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0GMH5K0Additional InformationPHOTOS
Photos ByDEPUTY AMANDA REED
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
ON MARCH 6TH, 2020, I, DEPUTY REED RESPONDED TO A REPORT OF A VAN IN THE DITCH ON STH 77 EAST OF HATCHERY ROAD. I ARRIVED ON SCENE AND
MET WITH THE DRIVER, WHO WAS TRAVELING E/B ON STH 77 WHEN HER REAR END KICKED OUT ON THE ICE COVERED ROADS AND
CAUSED HER TO GO INTO THE DITCH CRASHING INTO A LARGE TRAFFIC SIGN. VEHICLE HAD A BUSTED OUT REAR WINDOW FROM THE
INCIDENT.
Crash Time 08:14 AM
Crash Date 03/06/2020Wisconsin Motor Vehicle Crash
Form DT4000 1 of 9
This report does not include any CJIS data.
20030609
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5K0 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
NO STRUCTURE
Y Coordinate
5105946
X Coordinate
159442.390625
Longitude
-91.400053471
Latitude
46.022314375
ON STH77 EB
0.27 MI E
OF O BRIEN HILL RD
IN THE TOWN OF HAYWARD
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)
WEATHER CONDITIONS
Roadway Factor(s)
NONE
Road Surface Condition(s)
ICE
Light Condition
DAYLIGHT
Manner of Collision
00 - NO COLLISION W/VEHICLE IN TRANSPORT
First Harmful Event Location
ON ROADWAY
First Harmful Event
DITCH
Crash Scene
Intersection Type
NOT AN INTERSECTION
Junction Location
NON-JUNCTION
Within Interchange Area
NO
Truck Bus or HazMat
NO
Road Grade
UPHILL
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
55
Pre CrashTire
Mark
Direction Of Travel
EASTBOUND
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # RecordedTotal Occs
6
Operating As EndorsementsVehicle Type
PASSENGER VAN01 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITExtent Of Damage
MINOR DAMAGE
Vehicle Damage
06 - REAR
Initial Contact Point
06 - REAR
Bus UseBody Style
4D - 4DR
Color
WHI - WHITE
Model
VAN
Year
2007
Make
CHEVROLET
Vehicle Identification Number
16230101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
VEHICLEUNIT Vehicle
Crash Time 08:14 AM
Crash Date 03/06/2020Wisconsin Motor Vehicle Crash
Form DT4000 2 of 9
This report does not include any CJIS data.
20030609
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5K0 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
HAYWARD, WI 54843 , US
Owner Name
0101Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
GOING STRAIGHT
Vehicle Removed By
OWNER
Towed Due To Damage
NOT TOWED
UNITVEHICLE Sequence Of Events
Event
RUN OFF ROADWAY RIGHT01
Event
02Event
03Event
04Individual
Insurance Company
AMERICAN-FAMILY-INS-CO
Policy Holder
UNITDistracted By
Injury
Distracted By Action
NOT DISTRACTED
Distracted By Source
NOT APPLICABLE (NOT DISTRACTED)
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
07 - LEFT
Row
01 - FRONT ROW
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
HAYWARD, WI 54843 , US
Race
WHITE
Date of Birth
09/17/
Sex
FEMALE
Citations Issued
0
Driver
ITSafety Equipment
Individual
UNINDIVIDUALCrash Time 08:14 AM
Crash Date 03/06/2020Wisconsin Motor Vehicle Crash
Form DT4000 3 of 9
This report does not include any CJIS data.
20030609
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5K0 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 #UNITNon Motorist
INDIVIDUALDistracted By
Injury
LocationStriking Unit #
Distracted By Action
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
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00201 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
10 - UNKNOWN SE
Row
06 -UNKNOWN ROW
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
Driver License NumberAddress
, ,
RaceDate of Birth
SexCitations Issued
0
Passenger
ITSafety Equipment
Non Motorist
Individual
UNINDIVIDUALCrash Time 08:14 AM
Crash Date 03/06/2020Wisconsin Motor Vehicle Crash
Form DT4000 4 of 9
This report does not include any CJIS data.
20030609
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5K0 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL
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
UNITINDIVIDUALDistracted By
Injury
Prior Action
LocationStriking Unit #
Distracted By Action
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
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00301 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
10 - UNKNOWN SE
Row
02 - SECOND ROW
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
Driver License NumberAddress
, ,
RaceDate of Birth
SexCitations Issued
0
Passenger
ITSafety Equipment
Non Motorist
Individual
UNINDIVIDUALCrash Time 08:14 AM
Crash Date 03/06/2020Wisconsin Motor Vehicle Crash
Form DT4000 5 of 9
This report does not include any CJIS data.
20030609
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5K0 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00301Drug 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
UNITINDIVIDUALDistracted By
Injury
Prior Action
LocationStriking Unit #
Distracted By Action
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
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00401 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
10 - UNKNOWN SE
Row
02 - SECOND ROW
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
Driver License NumberAddress
, ,
RaceDate of Birth
SexCitations Issued
0
Passenger
ITSafety Equipment
Non Motorist
Individual
UNINDIVIDUALCrash Time 08:14 AM
Crash Date 03/06/2020Wisconsin Motor Vehicle Crash
Form DT4000 6 of 9
This report does not include any CJIS data.
20030609
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5K0 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00401Drug 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
UNITINDIVIDUALDistracted By
Injury
Prior Action
LocationStriking Unit #
Distracted By Action
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
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00501 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
10 - UNKNOWN SE
Row
06 -UNKNOWN ROW
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
Driver License NumberAddress
, ,
RaceDate of Birth
SexCitations Issued
0
Passenger
ITSafety Equipment
Non Motorist
Individual
UNINDIVIDUALCrash Time 08:14 AM
Crash Date 03/06/2020Wisconsin Motor Vehicle Crash
Form DT4000 7 of 9
This report does not include any CJIS data.
20030609
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5K0 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00501Drug 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
UNITINDIVIDUALDistracted By
Injury
Prior Action
LocationStriking Unit #
Distracted By Action
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
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00601 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
10 - UNKNOWN SE
Row
06 -UNKNOWN ROW
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
Driver License NumberAddress
, ,
RaceDate of Birth
SexCitations Issued
0
Passenger
ITSafety Equipment
Non Motorist
Individual
UNINDIVIDUALCrash Time 08:14 AM
Crash Date 03/06/2020Wisconsin Motor Vehicle Crash
Form DT4000 8 of 9
This report does not include any CJIS data.
20030609
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5K0 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00601Drug 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
UNITINDIVIDUALHAYWARD, WI 54843 , US
GovernmentSAWYER COUNTY
(715) 634-2691
PROPOWNER01Fixed Objects Struck
Property Owner
Damage Tag Number
01111
Structure NumberStruck Object
TRAFFIC SIGN POST
Striking Unit
0101
Crash Time 08:14 AM
Crash Date 03/06/2020Wisconsin Motor Vehicle Crash
Form DT4000 9 of 9
This report does not include any CJIS data.