20110109 taylor20110109
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0F1BQ6X 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
01:42 AM
Date Notified
11/01/2020
Time Arrived
01:42 AM
Date Arrived
11/01/2020
Crash Time
01:42 AM
Crash Date
11/01/2020
Investigating Officer/Deputy
DEPUTY SEAN ANDERSON
Agency Crash Number
20110109
Primary Crash Document #Document Number Override
6VL0F1BQ6XAdditional InformationNONE
Photos By
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
UNIT 1 WAS TRAVELING SOUTH ON COUNTY HWY NN. UNIT 1 TRUCK A LARGE TREE THAT WAS ON ROAD COMPLETELY BLOCKING ROAD. IT WAS DARK
ENOUGH DRIVER OF UNIT 1 WAS UNABLE TO SEE TREE IN TIME TO STOP.
Crash Time 01:42 AM
Crash Date 11/01/2020Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
20110109
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0F1BQ6X WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
NO STRUCTURE
Y Coordinate
5094589
X Coordinate
164922.109375
Longitude
-91.321510947
Latitude
45.923090944
ON CTHNN SB
0.27 MI S
OF DREAM CATCHER RD
IN THE TOWN OF HAYWARD
IN SAWYER COUNTY
Location
Special StudyAccess Control
NO CONTROL
Tribal Land
LAC COURTE OREILLES BAND
Crash Classification - Jurisdiction
INDIAN RESERVATION/TRUST
Crash Classification - Location
TRIBAL LAND
Relation To Trafficway
TRAFFICWAY - ON ROAD
Animal Type
Weather Condition(s)
CLOUDY
Environment Factor(s)
OTHER
Roadway Factor(s)
OBSTRUCTION IN ROADWAY
Road Surface Condition(s)
WET
Light Condition
DARK/UNLIT
Manner of Collision
00 - NO COLLISION W/VEHICLE IN TRANSPORT
First Harmful Event Location
ON ROADWAY
First Harmful Event
TREE
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
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
TREE
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 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
SD - SEDAN
Color
RED - RED
Model
GRAND PRIX
Year
2003
Make
PONTIAC
Vehicle Identification Number
81530101 Country of Issuance
UNITED STATES
St
WI
Plate Type
LCO - LAC COURTE OREI
License Plate Number
VEHICLEUNIT Vehicle
Crash Time 01:42 AM
Crash Date 11/01/2020Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
20110109
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0F1BQ6X WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
13189 W STATE ROAD 27 70
COUDERAY, WI 54828 , US
Owner Name
DOUGLAS CHARLES QUAGON
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
TOWED DUE TO DISABLING DAMAGE
UNITVEHICLE Sequence Of Events
Event
TREE01
Event
02Event
03Event
04Distracted By
Injury
LocationStriking Unit #
Distracted By Action
UNKNOWN
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
DEPLOYED-FRONT
Injury Severity
NO APPARENT INJURY00101 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
07 - LEFT
Row
01 - FRONT ROW
Safety Equipment
RESTRAINT USE UNKNOWN
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
HAYWARD, WI 54843 , US
Race
INDIAN
Date of Birth
02/16/
Sex
FEMALE
Citations Issued
0
Driver
ITSafety Equipment
Non Motorist
Individual
UNINDIVIDUALCrash Time 01:42 AM
Crash Date 11/01/2020Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
20110109
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0F1BQ6X WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
NOT OBSERVED
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
UNITINDIVIDUALCrash Time 01:42 AM
Crash Date 11/01/2020Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.