20112927 oates20112927
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0J3XHKQ 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
09:36 PM
Date Notified
11/29/2020
Time Arrived
09:46 PM
Date Arrived
11/29/2020
Crash Time
09:30 PM
Crash Date
11/29/2020
Investigating Officer/Deputy
SERGEANT NICK ALMOGHRABI
Agency Crash Number
20112927
Primary Crash Document #Document Number Override
6VL0J3XHKQAdditional InformationPHOTOS, OTHER DOCUMENTS
Photos BySGT ALMOGHRABI
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
I, SGT. NICK AL-MOGHRABI, WAS ON DUTY FOR THE SAWYER COUNTY SHERIFF'S DEPARTMENT ON 11/29/20. AT 2136 I WAS DISPATCHED TO A RESIDENCE ON
BOULDER COURT IN THE TOWNSHIP OF HAYWARD FOR A PROPERTY DAMAGE CRASH. I WAS ADVISED THE OPERATOR SIDE SWIPED A TREE ON BOULDER
COURT AND TO USE CAUTION AS THE ROADWAY WAS ICE COVERED. UPON MY ARRIVAL IN THE AREA, I OBSERVED THE ROAD SURFACE WAS ALMOST 100%
ICE COVERED. I OBSERVED TRACKS LEADING INTO THE RIGHT SIDE DITCH STRIKING A TREE THEN LEAVING THE DITCH BACK TO THE ROADWAY. I ARRIVED
AND MET WITH THE OPERATOR WHO WAS NOT INJURED. THE OPERATOR ADVISED SHE WAS WEARING A SEAT BELT AND TRAVELING AROUND 15 MPH WHEN
SHE SPUN OUT INTO THE DITCH STRIKING THE TREE. I OBSERVED DAMAGE TO THE MAJORITY OF THE PASSENGER SIDE OF HER 2005 CHEVY ENVOY
BEGINNING WITH THE MIRROR. BOTH PASSENGER SIDE DOORS WERE CAVED IN AND UNABLE TO OPEN. I PHOTOGRAPHED THE DAMAGE AS WELL AS THE
TRACKS AND TREE SHE STRUCK. THE OPERATOR WAS JUST LEVELING OUT AFTER COMING DOWN A SMALL HILL WHEN SHE LEFT THE ROADWAY. NO
CITATIONS WERE ISSUED.
Crash Time 09:30 PM
Crash Date 11/29/2020Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
20112927
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0J3XHKQ WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
NO STRUCTURE
Y Coordinate
5104809
X Coordinate
150754.140625
Longitude
-91.511127653
Latitude
46.007741397
ON BOULDER CT
831 FT E
OF LEIN 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 - ON ROAD
Animal Type
Weather Condition(s)
CLOUDY
Environment Factor(s)
NONE
Roadway Factor(s)
ROAD SURFACE CONDITION (WET, ICY, SNOW, SLUSH,
ETC)
Road Surface Condition(s)
ICE
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
DOWNHILL
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
N/A
Pre CrashTire
Mark
Direction Of Travel
SOUTHBOUND
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
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
FUNCTIONAL DAMAGE
Vehicle Damage
02 - RIGHT SIDE FRONT, 03 - RIGHT SIDE MIDDLE, 04 - RIGHT SIDE REAR
Initial Contact Point
02 - RIGHT SIDE FRONT
Bus UseBody Style
UT - SPORT UTILITY VEHICLE
Color
BLK - BLACK
Model
ENVOY
Year
2005
Make
GENERAL MOTORS COR
Vehicle Identification Number
89760101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
VEHICLEUNIT Vehicle
Crash Time 09:30 PM
Crash Date 11/29/2020Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
20112927
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0J3XHKQ WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
HAYWARD, WI 54843 , US
Owner Name
0101Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
GOING STRAIGHT
Vehicle Removed By
OPERATOR
Towed Due To Damage
NOT TOWED
UNITVEHICLE Sequence Of Events
Event
DITCH01
Event
TREE02
Event
03Event
04IndividualInsurance Company
PROGRESSIVE-CASUALTY-INS-CO
Policy Holder
UNITDistracted By
Injury
Distracted By Action
NOT DISTRACTED
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
NON DEPLOYED
Injury Severity
NO APPARENT 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
HAYWARD, WI 54843 , US
Race
WHITE
Date of Birth
07/10/
Sex
FEMALE
Citations Issued
0
Driver
ITSafety Equipment
Individual
UNINDIVIDUALCrash Time 09:30 PM
Crash Date 11/29/2020Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
20112927
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0J3XHKQ 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
LocationStriking Unit #UNITNon Motorist
INDIVIDUALCrash Time 09:30 PM
Crash Date 11/29/2020Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.