20072501 quaderer20072501
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0HPL4FL 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
02
Total Units
01
Time Notified
12:18 AM
Date Notified
07/25/2020
Time Arrived
12:33 AM
Date Arrived
07/25/2020
Crash Time
12:18 AM
Crash Date
07/25/2020
Investigating Officer/Deputy
DEPUTY DENNIS NELSON
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0HPL4FLAdditional InformationNONE, PHOTOS
Photos ByDEPUTY NELSON
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
ON 7-25-20 AT 0018 DEPUTY NELSON WAS DISPATCHED TO A ONE VEHICLE ACCIDENT AT THE INTERSECTION OF SAND LAKE RD AND CTH F. CALLER
ADVISED THAT TWO PEOPLE WERE INJURED. DEPUTY NELSON ARRIVED ONSCENE AND OBSERVED DEPUTY SIMPSON AND EMS PERSONAL WERE TENDING
TO THE SUBJECTS. DEPUTY NELSON OBSERVED A BLACK IMPALA HAD GONE THROUGH THE INTERSECTION IMPACTING INTO THE DITCH. DEPUTY NELSON
LOOKED AT THE INTERSECTION AND DID NOT OBSERVE ANY BRAKE MARKS PRIOR TO CRASHING INTO THE DITCH. THE FRONT PASSENGER WAS
OUT OF THE VEHICLE LAYING IN THE DITCH. THE DRIVER WAS STUCK IN THE DRIVER SEAT. DEPUTY NELSON SPOKE WITH AND HE
ADVISED THAT THEY WERE COMING FROM A BAR AND WERE HEADED HOME WHEN THE CRASHED. EMS STAFF REMOVED FORM THE VEHICLE. A
BLOOD DRAW WAS DONE ON THE WHILE WAITING FOR THE HELICOPTER TO LAND. BOTH SUBJECTS WERE FLOWN TO A UNKNOWN HOSPITAL.
Crash Time 12:18 AM
Crash Date 07/25/2020Wisconsin Motor Vehicle Crash
Form DT4000 1 of 5
This report does not include any CJIS data.
20072501
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0HPL4FL WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
NO STRUCTURE
Y Coordinate
5086216.5
X Coordinate
152639.21875
Longitude
-91.473397578
Latitude
45.84187118
ON SAND LAKE RD
9 FT W
OF CTHF EB
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)
CLEAR
Environment Factor(s)
NONE
Roadway Factor(s)
NONE
Road Surface Condition(s)
DRY
Light Condition
DARK/UNLIT
Manner of Collision
00 - NO COLLISION W/VEHICLE IN TRANSPORT
First Harmful Event Location
SHOULDER RIGHT
First Harmful Event
EMBANKMENT
Crash Scene
Intersection Type
T-INTERSECTION
Junction Location
INTERSECTION
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
NOT APPLICABLE
Special Function
NO SPECIAL FUNCTION
Most Harmful Event: Collision With
EMBANKMENT
Total Lanes
1
Speed Limit
45
Pre CrashTire
Mark
Direction Of Travel
EASTBOUND
Insurance?
UNKNOWN
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # RecordedTotal Occs
2
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
12 - FRONT
Initial Contact Point
12 - FRONT
Bus UseBody Style
4D - 4DR
Color
BLK - BLACK
Model
IMPALA
Year
2011
Make
CHEVROLET
Vehicle Identification Number
35350101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
VEHICLEUNIT Vehicle
Crash Time 12:18 AM
Crash Date 07/25/2020Wisconsin Motor Vehicle Crash
Form DT4000 2 of 5
This report does not include any CJIS data.
20072501
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0HPL4FL WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
STONE LAKE, WI 54876 , US
Owner Name
0101Driver Actions
DISREGARDED STOP SIGN
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
UNITVEHICLE Sequence Of Events
Event
EMBANKMENT01
Event
02Event
03Event
04Distracted By
Injury
LocationStriking Unit #
Distracted By Action
UNKNOWN
Distracted By Source
NOT APPLICABLE (NOT DISTRACTED)
Time of DeathDate of DeathHospital
OTHER WISCONSIN FACILITY
EMS Run #EMS Agency Identifier
6000954
Medical Transport
EMS AIR
Trapped/Extricated
TRAPPED/NOT EXTRICATED
Ejection Path
NOT EJECTED/NOT APPLICABLE
Ejected
NOT EJECTED
Airbag
DEPLOYED-FRONT
Injury Severity
SUSPECTED SERIOUS INJUR00101 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
INDIAN
Date of Birth
09/14/
Sex
MALE
Citations Issued
0
Driver
ITSafety Equipment
Non Motorist
Individual
UNINDIVIDUALCrash Time 12:18 AM
Crash Date 07/25/2020Wisconsin Motor Vehicle Crash
Form DT4000 3 of 5
This report does not include any CJIS data.
20072501
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0HPL4FL WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
UNDER THE INFLUENCE OF MEDICATIONS/DRUGS/ ALCOHOL
Drug Type
00101Drug Test Results
CANCELLED PER POSITIVE ALCOHOL RESULT
Drug Test Type
BLOOD
Drug Test Given
TEST GIVEN
Alcohol Test Results
PENDING
Alcohol Test Type
BLOOD
Alcohol Test Given
TEST GIVEN
Suspected Drug Use
YES
Suspected Alcohol Use
YES
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
OTHER MINNESOTA FACILITY
EMS Run #EMS Agency Identifier
6000954
Medical Transport
EMS AIR
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABLE
Ejected
NOT EJECTED
Airbag
DEPLOYED-FRONT
Injury Severity
SUSPECTED SERIOUS INJUR00201 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
09 - RIGHT
Row
01 - FRONT ROW
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
STONE LAKE, WI 54876 , US
Race
INDIAN
Date of Birth
10/27/
Sex
MALE
Citations Issued
0
Passenger
ITSafety Equipment
Non Motorist
Individual
UNINDIVIDUALCrash Time 12:18 AM
Crash Date 07/25/2020Wisconsin Motor Vehicle Crash
Form DT4000 4 of 5
This report does not include any CJIS data.
20072501
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0HPL4FL WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL, 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
UNITINDIVIDUALCrash Time 12:18 AM
Crash Date 07/25/2020Wisconsin Motor Vehicle Crash
Form DT4000 5 of 5
This report does not include any CJIS data.