20091027 balko20091027
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0HPL4FM WISCONSIN MOTOR VEHICLE
CRASH REPORT
Secondary
CrashAmendedCrash Type
DT4000 (STANDARD CRASH)Reportable
TagsSchool Bus Related
YES, SCHOOL BUS DIRECActive School ZoneGovernment
Property
Reporting
ThresholdTrailer or TowedWork ZoneLane ClosureHit and RunOn Emergency
Total Killed
01
Total Injured
03
Total Units
02
Time Notified
06:34 PM
Date Notified
09/10/2020
Time Arrived
06:45 PM
Date Arrived
09/10/2020
Crash Time
06:34 PM
Crash Date
09/10/2020
Investigating Officer/Deputy
DEPUTY DENNIS NELSON
Agency Crash Number
20091027
Primary Crash Document #Document Number Override
6VL0HPL4FMAdditional InformationCMV INSPECTION, FATAL CRASH
SUPPLEMENT, PHOTOS,
RECONSTRUCTION, WITNESS
STATEMENTS
Photos ByDEPUTY NELSON
Reconstruction ByWISCONSIN STATE PATROL
NWR/SPO
Diagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
DRIVER OF UNIT 1 WAS TRAVELING NORTHBOUND ON STH 40, IN THE PROCESS OF TURNING LEFT ONTO STH 48. DRIVER OF UNIT 2 WAS TRAVELING
SOUTHBOUND ON STH 40. THE DRIVER OF UNIT 1 FAILED TO YIELD THE RIGHT OF WAY TO UNIT 2. BOTH UNITS COLLIDED IN AN OFFSET HEAD-ON
COLLISION. .
Crash Time 06:34 PM
Crash Date 09/10/2020Wisconsin Motor Vehicle Crash
Form DT4000 1 of 10
This report does not include any CJIS data.
20091027
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0HPL4FM WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
Y Coordinate
5065809.5
X Coordinate
171674.890625
Longitude
-91.215105023
Latitude
45.668017385
ON STH40 SB
12 FT S
OF CTHD WB
IN THE TOWN OF WEIRGOR
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)
GLARE
Roadway Factor(s)
NONE
Road Surface Condition(s)
DRY
Light Condition
DAYLIGHT
Manner of Collision
02 - FRONT TO FRONT
First Harmful Event Location
ON ROADWAY
First Harmful Event
MOTOR VEH IN TRANSPORT
Crash Scene
Intersection Type
FOUR-WAY INTERSECTION
Junction Location
INTERSECTION-RELATED
Within Interchange Area
NO
Truck Bus or HazMat
VEHICLE DESIGNED TO CARRY 9 OR MORE PPL, INCLUDING DRIVER
Road Grade
SAG(BOTTOM)
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
NORTHBOUND
Insurance?
UNKNOWN
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # Recorded
5
Total Occs
5
Operating As Endorsements
S - SCHOOL BUS
Vehicle Type
SCHOOL BUS01 Unit Type
BUS
Vehicle Operating As Classification
C CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITExtent Of Damage
DISABLING DAMAGE
Vehicle Damage
12 - FRONT
Initial Contact Point
12 - FRONT
Bus Use
SCHOOL
Body Style
BU - BUS
Color
YEL - YELLOW
Model
SCHOOL BUS
Year
2015
Make
ICBU
Vehicle Identification Number
57190101 Country of Issuance
UNITED STATES
St
WI
Plate Type
BUS - BUS
License Plate Number
VEHICLEUNIT Vehicle
Crash Time 06:34 PM
Crash Date 09/10/2020Wisconsin Motor Vehicle Crash
Form DT4000 2 of 10
This report does not include any CJIS data.
20091027
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0HPL4FM WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
BRUCE, WI 54819 , US
Owner Name
0101Driver Actions
FAILED TO YIELD RIGHT-OF-WAY
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
LEFT TURN
Vehicle Removed By
S&R TOWING
Towed Due To Damage
TOWED DUE TO DISABLING DAMAGE
UNITVEHICLE Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
02Event
03Event
04Distracted By
Injury
LocationStriking Unit #
Distracted By Action
NOT DISTRACTED
Distracted By Source
NOT APPLICABLE (NOT DISTRACTED)
Time of DeathDate of DeathHospital
LAKEVIEW MEDICAL CENTER
EMS Run #
5318
EMS Agency Identifier
6000954
Medical Transport
EMS GROUND
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABLE
Ejected
NOT EJECTED
Airbag
NON DEPLOYED
Injury Severity
POSSIBLE 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
EXELAND, WI 54835 , US
Race
WHITE
Date of Birth
05/06/
Sex
FEMALE
Citations Issued
0
Driver
ITSafety Equipment
Non Motorist
Individual
UNINDIVIDUALCrash Time 06:34 PM
Crash Date 09/10/2020Wisconsin Motor Vehicle Crash
Form DT4000 3 of 10
This report does not include any CJIS data.
20091027
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0HPL4FM WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00101Drug Test Results
PENDING
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
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
NOT APPLICABLE
Injury Severity
SUSPECTED MINOR INJURY00201 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
08 - MIDDLE
Row
06 -UNKNOWN ROW
Safety Equipment
NOT APPLICABLE
On Duty Crash
Driver License NumberAddress
EXELAND, WI 54835 , US
Race
WHITE
Date of Birth
04/20/
Sex
FEMALE
Citations Issued
0
Passenger
ITSafety Equipment
Non Motorist
Individual
UNINDIVIDUALCrash Time 06:34 PM
Crash Date 09/10/2020Wisconsin Motor Vehicle Crash
Form DT4000 4 of 10
This report does not include any CJIS data.
20091027
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0HPL4FM 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
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
NOT APPLICABLE
Injury Severity
SUSPECTED MINOR INJURY00301 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
09 - RIGHT
Row
06 -UNKNOWN ROW
Safety Equipment
OTHER
On Duty Crash
Driver License NumberAddress
, ,
Race
HISPANIC
Date of Birth
06/23/
Sex
MALE
Citations Issued
0
Passenger
ITSafety Equipment
Non Motorist
Individual
UNINDIVIDUALCrash Time 06:34 PM
Crash Date 09/10/2020Wisconsin Motor Vehicle Crash
Form DT4000 5 of 10
This report does not include any CJIS data.
20091027
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0HPL4FM 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
NOT APPLICABLE
Injury Severity
NO APPARENT INJURY00501 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
10 - UNKNOWN SE
Row
06 -UNKNOWN ROW
Safety Equipment
NOT APPLICABLE
On Duty Crash
Driver License NumberAddress
, ,
Race
WHITE
Date of Birth
06/17/
Sex
FEMALE
Citations Issued
0
Passenger
ITSafety Equipment
Non Motorist
Individual
UNINDIVIDUALCrash Time 06:34 PM
Crash Date 09/10/2020Wisconsin Motor Vehicle Crash
Form DT4000 6 of 10
This report does not include any CJIS data.
20091027
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0HPL4FM 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
NOT APPLICABLE
Injury Severity
NO APPARENT INJURY00601 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat PositionRow
99 - UNKNOWN
Safety Equipment
NOT APPLICABLE
On Duty Crash
Driver License NumberAddress
, AL , US
Race
WHITE
Date of Birth
04/19/
Sex
MALE
Citations Issued
0
Passenger
ITSafety Equipment
Non Motorist
Individual
UNINDIVIDUALCrash Time 06:34 PM
Crash Date 09/10/2020Wisconsin Motor Vehicle Crash
Form DT4000 7 of 10
This report does not include any CJIS data.
20091027
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0HPL4FM 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
UNITINDIVIDUALMeasured 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
NOT IN COMMERCE/OTHER TRUCK
US DOT #
Cargo Body Type
BUS (SEATS FOR MORE THAN 15 OCCUPAN
Vehicle Configuration
BUS(SEATS FOR MORE THAN 15 OCCUPANTS, INCL
GVWR
10,001-26,000 LBS01 Address
104 W WASHINGTON AVE
BRUCE, WI 54819 , US
Name
BRUCE SCHOOL01 Source
DRIVERUse Vehicle Owner Same as Carrier
Carrier
CKBUSUNITTRUTruck Bus or HazMat
NO
Road Grade
DOWNHILL
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
SOUTHBOUND
Insurance?
UNKNOWN
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # RecordedTotal Occs
1
Operating As EndorsementsVehicle Type
PASSENGER CAR02 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNIT Vehicle
Crash Time 06:34 PM
Crash Date 09/10/2020Wisconsin Motor Vehicle Crash
Form DT4000 8 of 10
This report does not include any CJIS data.
20091027
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0HPL4FM WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
BRUCE, WI 54819 , US
Owner Name
0202Driver Actions
UNKNOWN
Driver Prior Action Other
Vehicle Factors
UNKNOWN
What Driver Was Doing
GOING STRAIGHT
Vehicle Removed By
ROADRUNNER TOWING
Towed Due To Damage
TOWED DUE TO DISABLING DAMAGE
Extent Of Damage
DISABLING DAMAGE
Vehicle Damage
12 - FRONT
Initial Contact Point
12 - FRONT
Bus UseBody Style
4D - 4DR
Color
ONG - ORANGE
Model
NITRO
Year
2007
Make
DODGE
Vehicle Identification Number
0202Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
VEHICLEUNITUNITVEHICLE Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
02Event
03Event
04Injury
Trapped/Extricated
TRAPPED/EXTRICATED
Ejection Path
NOT EJECTED/NOT APPLICABLE
Ejected
NOT EJECTED
Airbag
DEPLOYED-FRONT
Injury Severity
FATAL INJURY00402 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
07 - LEFT
Row
01 - FRONT ROW
Safety Equipment
NONE USED - VEHICLE OCCUPANT
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
BRUCE, WI 54819 , US
Race
WHITE
Date of Birth
09/16/
Sex
FEMALE
Citations Issued
0
Driver
ITSafety Equipment
Individual
UNINDIVIDUALCrash Time 06:34 PM
Crash Date 09/10/2020Wisconsin Motor Vehicle Crash
Form DT4000 9 of 10
This report does not include any CJIS data.
20091027
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0HPL4FM WISCONSIN MOTOR VEHICLE
CRASH REPORT
Distracted By
Drug & Alcohol
Individual Condition
NOT OBSERVED
Drug Type
00402Drug Test Results
PENDING
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
NO
Suspected Alcohol Use
NO
To/From SchoolAction Other
Action
Prior Action
LocationStriking Unit #
Distracted By Action
UNKNOWN
Distracted By Source
Time of Death
18:55
Date of Death
09/10/2020
Hospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
UNITNon Motorist
INDIVIDUALDate of Birth
12/04/1953EXELAND, WI 54835 , US01Witness
WITNESSCrash Time 06:34 PM
Crash Date 09/10/2020Wisconsin Motor Vehicle Crash
Form DT4000 10 of 10
This report does not include any CJIS data.