20071013 rowe20071013
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FZQKRW 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
02
Time Notified
09:26 AM
Date Notified
07/10/2020
Time Arrived
09:39 AM
Date Arrived
07/10/2020
Crash Time
09:24 AM
Crash Date
07/10/2020
Investigating Officer/Deputy
DEPUTY AMBER ALMOGHRABI
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0FZQKRWAdditional InformationPHOTOS
Photos ByDEPUTY AMBER AL-MOGHRABI
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
ON JULY 10, 2020, I, DEPUTY AMBER AL-MOGHRABI, WAS WORKING PATROL FOR THE SAWYER COUNTY SHERIFF'S DEPARTMENT. AT APPROXIMATELY 9:26
AM, I WAS ADVISED BY DISPATCH TO RESPOND TO STATE HWY 77 AT THE STATE HWY 27 INTERSECTION FOR A TWO VEHICLE ACCIDENT WITH INJURY. I
ACTIVATED MY EMERGENCY LIGHTS AND SIREN AND ADVISED DISPATCH THAT I WOULD BE ENROUTE. UPON ARRIVAL AT 9:39, I MET WITH OFFICER PETERS
FROM THE HAYWARD POLICE DEPARTMENT WHO WAS ALREADY ON SCENE. HE STATED THAT HE HAD RUN BOTH VEHICLES THROUGH DISPATCH ALREADY,
BUT HAS NOT SPOKEN WITH THE DRIVER OF THE PICK UP. I ASKED WHERE THE DRIVER WAS AND HE STATED HE BELIEVED HE WAS IN THE AMBULANCE. I
ASKED WHERE THE DRIVER OF THE SEMI WAS AND HE STATED HE WAS STILL IN HIS TRUCK PARKED UP THE ROAD, BUT WAS NOT INJURED. OFFICER
PETERS PROVIDED ME WITH THE INSURANCE CARD FROM THE DRIVER OF THE SEMI, WHICH I TOOK A PICTURE OF AND WILL ATTACH TO MY REPORT.
OFFICER PETERS ADVISED THAT THE SEMI DRIVER STATED THAT HE WAS TRAVELING WESTBOUND ON STATE HWY 77, WHEN THE PICK UP TRUCK SWERVED
INTO HIS LANE ALMOST HEAD ON. THE SEMI DRIVER STATED THAT HE QUICKLY SWERVED HIS VEHICLE AND ENDED UP BEING SIDE SWIPED BY THE PICK UP
TRUCK. I ASKED OFFICER PETERS TO SPEAK WITH TWO INDIVIDUALS STANDING BY THE AMBULANCE WHO STATED THAT THEY WERE WITNESSES TO WHAT
HAPPENED AND HAVE THEM FILL OUT VOLUNTARY STATEMENTS. HE STATED HE WOULD AS I TALKED TO THE INJURED SUBJECT IN THE AMBULANCE. I GOT
INTO THE AMBULANCE AND ASKED THE MALE FOR HIS IDENTIFICATION. HE IDENTIFIED HIMSELF AS . HE STATED HE WAS TRAVELING
Crash Time 09:24 AM
Crash Date 07/10/2020Wisconsin Motor Vehicle Crash
Form DT4000 1 of 6
This report does not include any CJIS data.
20071013
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FZQKRW WISCONSIN MOTOR VEHICLE
CRASH REPORT
EASTBOUND ON STATE HWY 77 AND MUST HAVE DOZED OFF AND CROSSED OVER THE WHITE LINE INTO THE OTHER LANE. HE STATED THAT HE HEARD THE
SEMI DRIVER HONK HIS HORN AND TRIED TO CORRECT HIS VEHICLE TO GO BACK INTO HIS LANE, BUT IT WAS TOO LATE. HE STATED THEY SIDE SWIPED
VEHICLES. ADVISED ME THAT HE WAS TRAVELING APPROXIMATELY 65 MILES PER HOUR AND THAT HE WAS WEARING HIS SEATBELT. SEE REPORT
FOR MORE INFO.
Structure Type
NO STRUCTURE
Y Coordinate
5110132.5
X Coordinate
150930.6875
Longitude
-91.512748078
Latitude
46.055593967
ON STH77 WB
553 FT E
OF MEADOW LANE RD
IN THE TOWN OF LENROOT
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)
NONE
Road Surface Condition(s)
DRY
Light Condition
DAYLIGHT
Manner of Collision
06 - SIDESWIPE/OPPOSITE DIRECTION
First Harmful Event Location
ON ROADWAY
First Harmful Event
MOTOR VEH IN TRANSPORT
Crash Scene
Intersection Type
NOT AN INTERSECTION
Junction Location
NON-JUNCTION
Within Interchange Area
NO
Truck Bus or HazMat
TRUCK OR TRUCK COMBINATION > 10,000LBS GVWR/GCWR
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
MOTOR VEH IN TRANSPORT
Total Lanes
2
Speed Limit
55
Pre CrashTire
Mark
Direction Of Travel
WESTBOUND
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # RecordedTotal Occs
1
Operating As EndorsementsVehicle Type
TRUCK TRACTOR (NOT ATTACHED)01Unit Type
TRUCK
Vehicle Operating As Classification
B CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITInitial Contact Point
08 - LEFT SIDE REAR
Bus UseBody Style
SE - SEMI-TRAILER
Color
RED - RED
Model
TRUCK TRAC
Year
2016
Make
VOLVO
Vehicle Identification Number
33680101 Country of Issuance
UNITED STATES
St
WI
Plate Type
APO - APPORTIONED
License Plate Number
Vehicle
Crash Time 09:24 AM
Crash Date 07/10/2020Wisconsin Motor Vehicle Crash
Form DT4000 2 of 6
This report does not include any CJIS data.
20071013
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FZQKRW WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
SUPERIOR, WI 54880 , 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
OPERATOR
Towed Due To Damage
NOT TOWED
Extent Of Damage
FUNCTIONAL DAMAGE
Vehicle Damage
08 - LEFT SIDE REAR
VEHICLEUNITUNITVEHICLE Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
02Event
03Event
04Organization/Company
JEFF FOSTER TRUCKING INC
Insurance Company
TRAVELERS-INDEMNITY-CO-OF-CONNECTICUT
Policy Holder
UNITInjury
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: MINNESOTA COUNTRY: UNITED STATES
Address
PENGILLY, MN 55775 , US
Race
WHITE
Date of Birth
09/16/
Sex
MALE
Citations Issued
0
Driver
ITSafety Equipment
Individual
UNINDIVIDUALCrash Time 09:24 AM
Crash Date 07/10/2020Wisconsin Motor Vehicle Crash
Form DT4000 3 of 6
This report does not include any CJIS data.
20071013
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FZQKRW WISCONSIN MOTOR VEHICLE
CRASH REPORT
Distracted By
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 #
Distracted By Action
NOT DISTRACTED
Distracted By Source
NOT APPLICABLE (NOT DISTRACTED)UNITNon Motorist
INDIVIDUALMeasured WeightMeasured WidthMeasured LengthMeasured Height
Escort Vehicle PresentEscort Vehicle Required
By Permit
Permitted Vehicle On
Permitted Route
WI Permit NumberOS/OW Load
Permitted Load
NOT APPLICABLE
Carrier Type
OTHER OPERATION/NOT SPECIFIED
US DOT #
Cargo Body Type
NO CARGO BODY - (BOBTAIL, LIGHT MOTO
Vehicle Configuration
SINGLE-UNIT TRUCK (2-AXLE AND GVWR MORE THA
GVWR
MORE THAN 26,000 LB01 Address
, US
Name
JEFF FOSTER TRUCKING INC01 Source
DRIVERUse Vehicle Owner Same as Carrier
Carrier
CKBUSUNITTRUEmergency Motor Vehicle Use
NOT APPLICABLE
Special Function
NO SPECIAL FUNCTION
Most Harmful Event: Collision With
MOTOR VEH IN TRANSPORT
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
1
Operating As EndorsementsVehicle Type
UTILITY TRUCK/PICKUP TRUCK02 Unit Type
TRUCK
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITCrash Time 09:24 AM
Crash Date 07/10/2020Wisconsin Motor Vehicle Crash
Form DT4000 4 of 6
This report does not include any CJIS data.
20071013
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FZQKRW WISCONSIN MOTOR VEHICLE
CRASH REPORT
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
Owner Address
SUPERIOR, WI 54880 , US
Owner Name
0202Driver Actions
FAILED TO KEEP IN DESIGNATED LANE, OTHER CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
GOING STRAIGHT
Vehicle Removed By
A-1 TOWING
Towed Due To Damage
TOWED DUE TO DISABLING DAMAGE
Extent Of Damage
DISABLING DAMAGE
Vehicle Damage
07 - LEFT REAR CORNER, 08 - LEFT SIDE REAR, 09 - LEFT SIDE MIDDLE, 10 -
LEFT SIDE FRONT
Initial Contact Point
10 - LEFT SIDE FRONT
Bus UseBody Style
PK - PICKUP
Color
GRY - GRAY
Model
F150
Year
2019
Make
FORD
Vehicle Identification Number
38870202 Country of Issuance
UNITED STATES
St
WI
Plate Type
LTK - LIGHT TRUCK
License Plate Number
VEHICLEUNIT Vehicle
UNITVEHICLE Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
02Event
03Event
04IndividualInsurance Company
STATE-FARM-GENERAL-INS-CO
Policy Holder
UNITSeat PositionRow
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
SUPERIOR, WI 54880 , US
Race
HISPANIC
Date of Birth
10/11/
Sex
MALE
Citations Issued
0
Driver
ITSafety Equipment
Individual
UNINDIVIDUALCrash Time 09:24 AM
Crash Date 07/10/2020Wisconsin Motor Vehicle Crash
Form DT4000 5 of 6
This report does not include any CJIS data.
20071013
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FZQKRW WISCONSIN MOTOR VEHICLE
CRASH REPORT
Distracted By
Injury
Drug & Alcohol
Individual Condition
ASLEEP OR FATIGUED
Drug Type
00202Drug 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 #
Distracted By Action
OTHER ACTION (LOOKING AWAY FROM TASK ETC)
Distracted By Source
OTHER DISTRACTION (ANIMAL, FOOD, GROOMING)
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-COMBINATION
Injury Severity
POSSIBLE INJURY00202 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
07 - LEFT01 - FRONT ROW
Safety Equipment
SHOULDER & LAP BELT
UNITNon Motorist
INDIVIDUALCrash Time 09:24 AM
Crash Date 07/10/2020Wisconsin Motor Vehicle Crash
Form DT4000 6 of 6
This report does not include any CJIS data.