20112904 tom20112904
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0F7HWRK 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
02:00 AM
Date Notified
11/29/2020
Time Arrived
02:29 AM
Date Arrived
11/29/2020
Crash Time
01:45 AM
Crash Date
11/29/2020
Investigating Officer/Deputy
DEPUTY AMBER OSHEA DORN
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0F7HWRKAdditional InformationPHOTOS
Photos ByDEPUTY O'SHEA DORN
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
WAS WESTBOUND TRAVELING ON STATE HIGHWAY 70 NEAR BROWNS ROAD WHEN HIS VEHICLE LEFT THE ROADWAY NEAR THE WESTBOUND
DITCH LINE. THE VEHICLE TRAVELED FOR APPROXIMATELY 40-50 YARDS ROLLING OVER AS IT TRAVELED, HITTING TREES AND BRANCHES. THE VEHICLE
CAME TO A REST ON ITS ROOF AND STARTED ON FIRE. THE VEHICLE FIRE WAS PUT OUT WITH ONLY THE FRAME REMAINING. HAS A
SUSPENDED DRIVER'S LICENSE AND ALSO FAILED TO REPORT THE ACCIDENT, CITATIONS WERE ISSUED.
Crash Time 01:45 AM
Crash Date 11/29/2020Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
20112904
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0F7HWRK WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
Y Coordinate
5088605
X Coordinate
196326.28125
Longitude
-90.91371294
Latitude
45.883945134
ON STH70 WB
0.46 MI W
OF BROWNS RD
IN THE TOWN OF DRAPER
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
DITCH
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
DITCH
Total Lanes
2
Speed Limit
55
Pre CrashTire
Mark
Direction Of Travel
WESTBOUND
Insurance?
NO
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
2
Train/Bus # RecordedTotal Occs
1
Operating As EndorsementsVehicle Type
(SPORT) UTILITY VEHICLE01 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
13 - TOP
Bus UseBody Style
4D - 4DR
Color
BLK - BLACK
Model
TAHOE
Year
1995
Make
CHEVROLET
Vehicle Identification Number
95080101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
VEHICLEUNIT Vehicle
Crash Time 01:45 AM
Crash Date 11/29/2020Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
20112904
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0F7HWRK WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
N7594 RATHKE ROAD
WINTER, WI 54896 , US
Owner Name
DAVID A TOM
0101Driver Actions
UNKNOWN
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
GOING STRAIGHT
Vehicle Removed ByTowed Due To Damage
TOWED DUE TO DISABLING DAMAGE
UNITVEHICLE Sequence Of Events
Event
DITCH01
Event
OVERTURN/ROLLOVER02
Event
FIRE/EXPLOSION03
Event
04Distracted By
Injury
LocationStriking Unit #
Distracted By Action
UNKNOWN
Distracted By Source
UNKNOWN
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
Trapped/Extricated
NOT TRAPPED
Ejection Path
UNKNOWN
Ejected
UNKNOWN
Airbag
UNKNOWN
Injury Severity
SUSPECTED MINOR INJURY00101 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
07 - LEFT
Row
01 - FRONT ROW
Safety Equipment
RESTRAINT USED - TYPE UNKNOWN
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
WINTER, WI 54896 , US
Race
WHITE
Date of Birth
05/25/
Sex
MALE
Citations Issued
2
Driver
ITSafety Equipment
Non Motorist
Individual
UNINDIVIDUALCrash Time 01:45 AM
Crash Date 11/29/2020Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
20112904
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0F7HWRK 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
YES
To/From SchoolAction Other
Action
Prior Action
UNITINDIVIDUAL Violations
DescriptionOPERATING WHILE SUSPENDEDStatute Number343.44(1)(a)Issue To?
001
UTC Number
BE65041501
DescriptionFAILURE OF OPERATOR TO NOTIFY POLICE OF ACCIDENT (2ND+)Statute Number346.70(1)Issue To?
001
UTC Number
BE65041602
Crash Time 01:45 AM
Crash Date 11/29/2020Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.