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20112333 martin20112333 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0GNQ6ND 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 11:39 PM Date Notified 11/23/2020 Time Arrived 11:42 PM Date Arrived 11/23/2020 Crash Time 11:39 PM Crash Date 11/23/2020 Investigating Officer/Deputy DEPUTY MICHAEL SIMPSON Agency Crash NumberPrimary Crash Document #Document Number Override 6VL0GNQ6NDAdditional InformationNONE, PHOTOS Photos ByDEPUTY SIMPSON#357 Reconstruction ByDiagram Description I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report. FRONT SEAT PASSENGER CALLED AND REPORTED THE ACCIDENT AND THAT THE DRIVER HAD A POSSIBLE BROKEN RIGHT LEG. DEPUTY ARRIVED AND FOUND ALL OCCUPANTS OUT OF THE VEHICLE AND THE DRIVER SITTING DOWN COMPLAINING OF RIGHT LEGT PAIN. ROADWAY WAS ICE COVERED. THE ROADWAY CURVED TO THE RIGHT. VEHICLE LOST CONTROL ON ICE SPUN APPROXIMATELY 180 DEGREES AND HIT A TREE OFF OF THE ROADWAY. IMPACTING ON THE FRONT PASSENGER SIDE. Crash Time 11:39 PM Crash Date 11/23/2020Wisconsin Motor Vehicle Crash Form DT4000 1 of 6 This report does not include any CJIS data. 20112333 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0GNQ6ND WISCONSIN MOTOR VEHICLE CRASH REPORT Structure Type NO STRUCTURE Y Coordinate 5103781.5 X Coordinate 157720.1875 Longitude -91.420686873 Latitude 46.002033455 ON CHIPPEWA TRL 0.57 MI E OF BENDER RD IN THE TOWN OF HAYWARD 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) WEATHER CONDITIONS Roadway Factor(s) ROAD SURFACE CONDITION (WET, ICY, SNOW, SLUSH, ETC) Road Surface Condition(s) WET, ICE Light Condition DARK/UNLIT Manner of Collision 00 - NO COLLISION W/VEHICLE IN TRANSPORT First Harmful Event Location SHOULDER LEFT 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 DOWNHILL Road Curvature CURVE RIGHT 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 45 Pre CrashTire Mark Direction Of Travel WESTBOUND Insurance? NO Total HazMat Types 0 Total Trailers 0 Total # Citations Issued 0 Train/Bus # RecordedTotal Occs 3 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 01 - RIGHT FRONT CORNER, 02 - RIGHT SIDE FRONT, 03 - RIGHT SIDE MIDDLE, 12 - FRONT Initial Contact Point 02 - RIGHT SIDE FRONT Bus UseBody Style UT - SPORT UTILITY VEHICLE Color SIL - SILVER (ALUMINUM) Model ESCAPE Year 2007 Make FORD Vehicle Identification Number 81210101 Country of Issuance UNITED STATES St WI Plate Type AUT - AUTOMOBILE License Plate Number VEHICLEUNIT Vehicle Crash Time 11:39 PM Crash Date 11/23/2020Wisconsin Motor Vehicle Crash Form DT4000 2 of 6 This report does not include any CJIS data. 20112333 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0GNQ6ND WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address COUDERAY, WI 54828 , US Owner Name 0101Driver Actions NO CONTRIBUTING ACTION Driver Prior Action Other Vehicle Factors NOT APPLICABLE What Driver Was Doing NEGOTIATING CURVE Vehicle Removed ByTowed 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 NOT DISTRACTED Distracted By Source NOT APPLICABLE (NOT DISTRACTED) Time of DeathDate of DeathHospital HAYWARD AREA MEM HOSP EMS Run #EMS Agency Identifier 6000954 Medical Transport EMS GROUND Trapped/Extricated NOT TRAPPED Ejection Path NOT EJECTED/NOT APPLICABLE Ejected NOT EJECTED Airbag DEPLOYED-FRONT 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 COUDERAY, WI 54828 , US RaceDate of Birth 12/20/ Sex FEMALE Citations Issued 0 Driver ITSafety Equipment Non Motorist Individual UNINDIVIDUALCrash Time 11:39 PM Crash Date 11/23/2020Wisconsin Motor Vehicle Crash Form DT4000 3 of 6 This report does not include any CJIS data. 20112333 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0GNQ6ND WISCONSIN MOTOR VEHICLE CRASH REPORT 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 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 DEPLOYED-FRONT Injury Severity NO APPARENT INJURY00201 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 HAYWARD, WI 54843 , US RaceDate of Birth 09/28/ Sex FEMALE Citations Issued 0 Passenger ITSafety Equipment Non Motorist Individual UNINDIVIDUALCrash Time 11:39 PM Crash Date 11/23/2020Wisconsin Motor Vehicle Crash Form DT4000 4 of 6 This report does not include any CJIS data. 20112333 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0GNQ6ND 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 NON DEPLOYED Injury Severity NO APPARENT INJURY00301 Tint ComplianceEye Protection Helmet ComplianceHelmet Use Seat Position 09 - RIGHT Row 02 - SECOND ROW Safety Equipment SHOULDER & LAP BELT On Duty Crash Driver License Number STATE: WISCONSIN COUNTRY: UNITED STATES Address HAYWARD, WI 54843 , US RaceDate of Birth 05/15/ Sex MALE Citations Issued 0 Passenger ITSafety Equipment Non Motorist Individual UNINDIVIDUALCrash Time 11:39 PM Crash Date 11/23/2020Wisconsin Motor Vehicle Crash Form DT4000 5 of 6 This report does not include any CJIS data. 20112333 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0GNQ6ND 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 UNITINDIVIDUALCrash Time 11:39 PM Crash Date 11/23/2020Wisconsin Motor Vehicle Crash Form DT4000 6 of 6 This report does not include any CJIS data.