20110207 jefson20110207
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0J3XHKN WISCONSIN MOTOR VEHICLE
CRASH REPORT
Secondary
CrashAmendedCrash Type
NON-DOMESTICATED ANIMAL W/ NO INJURYReportable
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
04:35 AM
Date Notified
11/02/2020
Time ArrivedDate ArrivedCrash Time
04:30 AM
Crash Date
11/02/2020
Investigating Officer/Deputy
SERGEANT NICK ALMOGHRABI
Agency Crash Number
20110207
Primary Crash Document #Document Number Override
6VL0J3XHKNI, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
Structure Type
NO STRUCTURE
Y Coordinate
5086390
X Coordinate
150045.921875
Longitude
-91.506816465
Latitude
45.842115868
ON SAND LAKE RD
218 FT W
OF WARTEMON LN
IN THE TOWN OF SAND LAKE
IN SAWYER COUNTY
Location
Special StudyAccess ControlTribal Land
Crash Classification - Jurisdiction
NO SPECIAL JURISDICTION
Crash Classification - Location
PUBLIC PROPERTY
Relation To Trafficway
TRAFFICWAY - ON ROAD
Animal Type
DEER
Weather Condition(s)
Environment Factor(s)
Roadway Factor(s)Road Surface Condition(s)
Light ConditionManner of Collision
00 - NO COLLISION W/VEHICLE IN TRANSPORT
First Harmful Event Location
ON ROADWAY
First Harmful Event
NON DOMESTICATED ANIMAL (ALIVE)
Crash Scene
Road GradeRoad CurvatureSurface Type
Traffic Control Inoperative/MissingTraffic ControlTraffic Way
Emergency Motor Vehicle Use
NOT APPLICABLE
Special Function
POLICE
Most Harmful Event: Collision With
NON DOMESTICATED ANIMAL (ALIVE)
Total LanesSpeed LimitPre 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
PASSENGER CAR01 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITCrash Time 04:30 AM
Crash Date 11/02/2020Wisconsin Motor Vehicle Crash
Form DT4000 1 of 3
This report does not include any CJIS data.
20110207
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0J3XHKN WISCONSIN MOTOR VEHICLE
CRASH REPORT
Truck Bus or HazMat
Owner AddressOwner Name
0101Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle FactorsWhat Driver Was Doing
Vehicle Removed By
OPERATOR
Towed Due To Damage
NOT TOWED
Extent Of Damage
MINOR DAMAGE
Vehicle Damage
01 - RIGHT FRONT CORNER, 12 - FRONT
Initial Contact Point
12 - FRONT
Bus UseBody Style
SD - SEDAN
Color
BLK - BLACK
Model
TAURUS
Year
2017
Make
FORD
Vehicle Identification Number
7390101 Country of Issuance
UNITED STATES
St
WI
Plate Type
OFF - MUNICIPAL OFFICI
License Plate Number
VEHICLEUNIT Vehicle
UNITVEHICLEGovernment
SAWYER COUNTY
Insurance Company
WISCONSIN-COUNTY-MUTUAL-INS-CORP
Policy Holder
UNITInjury
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
Trapped/ExtricatedEjection PathEjected
AirbagInjury Severity
NO APPARENT INJURY00101 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat PositionRow
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
POLICE
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
HAYWARD, WI 54843 , US
Race
WHITE
Date of Birth
05/09/
Sex
MALE
Citations Issued
0
Driver
ITSafety Equipment
Individual
UNINDIVIDUALCrash Time 04:30 AM
Crash Date 11/02/2020Wisconsin Motor Vehicle Crash
Form DT4000 2 of 3
This report does not include any CJIS data.
20110207
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0J3XHKN 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
Distracted By Source
UNITNon Motorist
INDIVIDUALCrash Time 04:30 AM
Crash Date 11/02/2020Wisconsin Motor Vehicle Crash
Form DT4000 3 of 3
This report does not include any CJIS data.