20112806 wahlstrom20112806
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FB000F 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
02
Time Notified
03:42 AM
Date Notified
11/28/2020
Time Arrived
04:57 AM
Date Arrived
11/28/2020
Crash Time
03:42 AM
Crash Date
11/28/2020
Investigating Officer/Deputy
DEPUTY MATTHEW JEFSON
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0FB000FAdditional InformationPHOTOS
Photos ByM JEFSON
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
I WAS DISPATCHED TO A VEHICLE ROLL OVER CRASH ON STH 27 NEAR THE RUSK COUNTY LINE. DUE TO BEING TIED UP ON ANOTHER CALL WE HAD RUSK
COUNTY RESPOND. WHILE EN ROUTE WE LEARNED IT WAS A TWO VEHICLE ACCIDENT AND THAT ONE OF THE DRIVERS WAS NOW AT THE HOSPITAL IN
LADYSMITH WITH INJURIES. AFTER GETTING ON SCENE AND SEARCHING FOR A POSSIBLE SECOND DRIVER WE REALIZED THAT THE SECOND VEHICLE
STRUCK WAS A DISABLED VEHICLE THAT WAS TAGGED BY STATE PATROL FOR REMOVAL AT 10PM ON 11-27. THE OTHER VEHICLE WAS LOCATED 450 FT
SOUTH AND ABOUT 40 YARDS INTO THE WOODLINE. PHOTOGRAPHS AND MEASUREMENTS WERE TAKEN AND JERRY'S AMOCO ARRIVED AND REMOVED
VEHICLES. DRIVER OF UNIT 1 WAS READ THE INFORMING THE ACCUSED AND BLOOD WAS DRAWN. DRIVER ALSO WAS CITED FOR OWI 1ST AND OPERATING
LEFT OF CENTER.
Crash Time 03:42 AM
Crash Date 11/28/2020Wisconsin Motor Vehicle Crash
Form DT4000 1 of 5
This report does not include any CJIS data.
20112806
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FB000F WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
Y Coordinate
5063158
X Coordinate
179594.265625
Longitude
-91.111956188
Latitude
45.647915858
ON STH27 SB
1.39 MI S
OF HAJDASZ RD
IN THE TOWN OF MEADOW BROOK
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)
NONE
Roadway Factor(s)
NONE
Road Surface Condition(s)
DRY
Light Condition
DARK/UNLIT
Manner of Collision
00 - NO COLLISION W/VEHICLE IN TRANSPORT
First Harmful Event Location
SHOULDER RIGHT
First Harmful Event
PARKED MOTOR VEHICLE
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
DIVIDED HWY W/O TRAFFIC BARRIER
Emergency Motor Vehicle Use
NOT APPLICABLE
Special Function
NO SPECIAL FUNCTION
Most Harmful Event: Collision With
PARKED MOTOR VEHICLE
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
2
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
15 - ALL AREAS
Initial Contact Point
11 - LEFT FRONT CORNER
Bus UseBody Style
4D - 4DR
Color
SIL - SILVER (ALUMINUM)
Model
C
Year
2003
Make
MERCEDES BENZ
Vehicle Identification Number
60140101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
VEHICLEUNIT Vehicle
Crash Time 03:42 AM
Crash Date 11/28/2020Wisconsin Motor Vehicle Crash
Form DT4000 2 of 5
This report does not include any CJIS data.
20112806
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FB000F WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
725 4TH ST
CHETEK, WI 54728 , US
Owner Name
TYLER J WAHLSTROM
(715) 491-55430101Driver Actions
FAILED TO KEEP IN DESIGNATED LANE
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
GOING STRAIGHT
Vehicle Removed By
JERRY'S AMOCO
Towed Due To Damage
TOWED DUE TO DISABLING DAMAGE
UNITVEHICLE Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
CROSS CENTERLINE02
Event
PARKED MOTOR VEHICLE03
Event
RUN OFF ROADWAY LEFT04
Distracted By
Injury
LocationStriking Unit #
Distracted By Action
UNKNOWN
Distracted By Source
UNKNOWN
Time of DeathDate of DeathHospital
MARSHFIELD MEDICAL CENTER - LADYSMITH
EMS Run #EMS Agency IdentifierMedical Transport
OTHER
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
RESTRAINT USE UNKNOWN
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
CHETEK, WI 54728 , US
Race
WHITE
Date of Birth
08/09/
Sex
MALE
Citations Issued
2
Driver
ITSafety Equipment
Non Motorist
Individual
UNINDIVIDUALCrash Time 03:42 AM
Crash Date 11/28/2020Wisconsin Motor Vehicle Crash
Form DT4000 3 of 5
This report does not include any CJIS data.
20112806
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FB000F WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
NOT OBSERVED
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
YES
To/From SchoolAction Other
Action
Prior Action
UNITINDIVIDUAL Violations
DescriptionOPERATING WHILE UNDER THE INFLUENCEStatute Number346.63(1)(A)Issue To?
001
UTC Number
BE60831301
DescriptionOPERATING LEFT OF CENTERStatute Number346.05(1)Issue To?
001
UTC Number
BE60831402
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
DIVIDED HWY W/O TRAFFIC BARRIER
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
NOT ON ROADWAY
Insurance?
UNKNOWN
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # RecordedTotal Occs
0
Operating As EndorsementsVehicle Type
PASSENGER CAR02 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
LEGALLY PARKED
Unit Summary
UNITInitial Contact Point
11 - LEFT FRONT CORNER
Bus UseBody Style
CP - COUPE
Color
BLK - BLACK
Model
GRAND PRIX
Year
2002
Make
PONTIAC
Vehicle Identification Number
76690202 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
Vehicle
Crash Time 03:42 AM
Crash Date 11/28/2020Wisconsin Motor Vehicle Crash
Form DT4000 4 of 5
This report does not include any CJIS data.
20112806
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FB000F WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
EXELAND, WI 54835 , US
Owner Name
0202Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
LEGALLY PARKED
Vehicle Removed By
JERRY'S AMOCO
Towed Due To Damage
TOWED DUE TO DISABLING DAMAGE
Extent Of Damage
DISABLING DAMAGE
Vehicle Damage
08 - LEFT SIDE REAR, 09 - LEFT SIDE MIDDLE, 10 - LEFT SIDE FRONT, 11 -
LEFT FRONT CORNER, 12 - FRONT
VEHICLEUNITUNITVEHICLE Sequence Of Events
Event
PARKED MOTOR VEHICLE01
Event
MOTOR VEH IN TRANSPORT02
Event
DITCH03
Event
04Crash Time 03:42 AM
Crash Date 11/28/2020Wisconsin Motor Vehicle Crash
Form DT4000 5 of 5
This report does not include any CJIS data.