20090216 adair20090216
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0J3XHKF 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
08:28 PM
Date Notified
09/02/2020
Time Arrived
08:35 PM
Date Arrived
09/02/2020
Crash Time
08:27 PM
Crash Date
09/02/2020
Investigating Officer/Deputy
SERGEANT NICK ALMOGHRABI
Agency Crash Number
20090216
Primary Crash Document #Document Number Override
6VL0J3XHKFAdditional InformationPHOTOS, OTHER DOCUMENTS
Photos BySGT ALMOGHRABI
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
I, SGT. NICK AL-MOGHRABI, WAS ON DUTY FOR THE SAWYER COUNTY SHERIFF'S DEPARTMENT ON 09/02/20. AT 2028 I HEARD A PAGE FOR EMS TO RESPOND
TO A ONE VEHICLE ROLLOVER WITH AN UNCONSCIOUS DRIVER STILL INSIDE ON RAY'S ROAD NEAR UPON ARRIVING IN THE AREA, SAWYER
DISPATCH ADVISED IT WAS QUITE SOME DISTANCE PAST THAT ADDRESS. SAWYER DISPATCH ADVISED ALL RESPONDERS THAT THE OPERATOR WAS NOW
ALERT AND OUT OF THE VEHICLE. I ARRIVED ON SCENE AT 2035 AND FOUND THE CRASH TO BE ON KELLNER ROAD JUST NORTH OF METCALF ROAD IN THE
TOWNSHIP OF BASS LAKE. I OBSERVED A CHEVY SILVERADO WITH THE FRONT PASSENGER SIDE UP AGAINST A TREE AND TWO MALES STANDING OUTSIDE.
I APPROACHED AND MET WITH THE MALES ASKING WHO WAS THE DRIVER. . ADVISED HE WAS. I OBSERVED A LARGE SWOLLEN LUMP ON HIS
FOREHEAD ABOVE HIS RIGHT EYE HALFWAY BETWEEN THE EYE AND HAIR LINE. THE OTHER MALE WAS IDENTIFIED AS HIS BROTHER WHO WAS THE CALLER
AND WITNESS, ADVISED HIS BROTHER WAS UNCONSCIOUS FOR AT LEAST A MINUTE IN THE VEHICLE. I ASKED
TO REST AGAINST HIS TRUCK UNTIL PARAMEDICS ARRIVED. WHEN ASKED WHAT HAPPENED, ADVISED HE HAD BEEN UP FOR OVER 24 HOURS
AND WAS TRYING TO MAKE IT HOME HOWEVER FELL ASLEEP AND HIT THE TREE. THE VEHICLE DID HAD CROSSED OVER THE ROADWAY LEAVING IT
SIDEWAYS BEFORE STRIKING THE TREE HOWEVER HAD NOT ROLLED OVER. ADVISED ASIDE FROM HIS HEAD, HIS NECK HURT AS WELL.
Crash Time 08:27 PM
Crash Date 09/02/2020Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
20090216
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0J3XHKF WISCONSIN MOTOR VEHICLE
CRASH REPORT
ADVISED THAT HE WAS WEARING HIS SEAT BELT AT THE TIME OF THE CRASH. I CANCELED RESPONDING FIRE AND LAW ENFORCEMENT BUT
REQUESTED EMS CONTINUE.
UPON THE ARRIVAL OF PARAMEDICS, THEY MET AND ASSESSED WHILE OBTAINED THE INSURANCE INFORMATION FOR THE 2016
CHEVY SILVERADO BEARING WI REGISTRATION REFUSED EMS TRANSPORT; DAMAGE TO THE FRONT PASSENGER SIDE; NO IMPAIRMENT
INDICATED OR CITATIONS ISSUED.
Structure Type
NO STRUCTURE
Y Coordinate
5091371
X Coordinate
149124.96875
Longitude
-91.522269373
Latitude
45.886340296
ON KELLNER RD
699 FT N
OF METCALF RD
IN THE TOWN OF BASS 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 - ON ROAD
Animal Type
Weather Condition(s)
CLEAR
Environment Factor(s)
NONE
Roadway Factor(s)
NONE
Road Surface Condition(s)
DRY
Light Condition
DUSK
Manner of Collision
00 - NO COLLISION W/VEHICLE IN TRANSPORT
First Harmful Event Location
OUTSIDE RIGHT-OF-WAY (TRAFFICWAY)
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
LEVEL
Road Curvature
STRAIGHT
Surface Type
SLAG, GRAVEL, OR STONE
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
TREE
Total Lanes
2
Speed Limit
35
Pre CrashTire
Mark
Direction Of Travel
NORTHBOUND
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 TRUCK01 Unit Type
TRUCK
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITBus UseBody Style
PK - PICKUP
Color
BLK - BLACK
Model
SILVERADO
Year
2016
Make
CHEVROLET
Vehicle Identification Number
243670101 Country of Issuance
UNITED STATES
St
WI
Plate Type
LTK - LIGHT TRUCK
License Plate Number
Vehicle
Crash Time 08:27 PM
Crash Date 09/02/2020Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
20090216
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0J3XHKF WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
HAYWARD, WI 54843 , US
Owner Name
0101Driver Actions
FAILURE TO CONTROL, OTHER 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
DISABLING DAMAGE
Vehicle Damage
02 - RIGHT SIDE FRONT, 03 - RIGHT SIDE MIDDLE
Initial Contact Point
02 - RIGHT SIDE FRONT
VEHICLEUNITUNITVEHICLE Sequence Of Events
Event
DITCH01
Event
TREE02
Event
03Event
04IndividualInsurance Company
AMERICAN-FAMILY-INS-CO
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
SUSPECTED MINOR 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
02/09/
Sex
MALE
Citations Issued
0
Driver
ITSafety Equipment
Individual
UNINDIVIDUALCrash Time 08:27 PM
Crash Date 09/02/2020Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
20090216
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0J3XHKF WISCONSIN MOTOR VEHICLE
CRASH REPORT
Distracted By
Drug & Alcohol
Individual Condition
ASLEEP OR FATIGUED
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
INDIVIDUALCrash Time 08:27 PM
Crash Date 09/02/2020Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.