20121804 taylor20121804
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0F7HWRM 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
02:20 AM
Date Notified
12/18/2020
Time Arrived
02:27 AM
Date Arrived
12/18/2020
Crash Time
02:15 AM
Crash Date
12/18/2020
Investigating Officer/Deputy
DEPUTY AMBER OSHEA DORN
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0F7HWRMAdditional InformationPHOTOS
Photos ByAMBER O'SHEA DORN 322
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
WAS TRAVELING NORTHBOUND ON TREPANIA ROAD WHEN HIS VEHICLE LEFT THE ROADWAY HITTING THE NORTHBOUND DITCH, THEN A
TREE AND ROLLING IN THE AIR. THE VEHICLE CAME TO REST IN THE NORTHBOUND DITCH/ROADWAY LANE ON ITS WHEELS. SUFFERED INJURY
FROM CRASH AND WAS TAKEN TO THE HAYWARD HOSPITAL FOR EVALUATION. WAS ALERT AND CONSCIOUS UPON MY ARRIVAL ON
SCENE. IS REVOKED OUT OF MINNESOTA. THE VEHICLE WAS TOWED BY AMERICAN TOWING COMPANY DUE TO DISABLING DAMAGE.
Crash Time 02:15 AM
Crash Date 12/18/2020Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
20121804
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0F7HWRM WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
Y Coordinate
5097602
X Coordinate
162313.59375
Longitude
-91.357176071
Latitude
45.948852861
ON TREPANIA RD
0.52 MI S
OF ROUND LAKE SCHOOL 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)
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
Time Scene Cleared
03:37 AM
Date Scene Cleared
12/18/2020
Time All Lanes Open
03:37 AM
Date All Lanes Open
12/18/2020
Time Initial Lane/Rd Closed
03:25 AM
Date Initial Lane/Rd Closed
12/18/2020
Reasons for Closure
TOW TRUCK
Closure Type
FULL CLOSURE
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
DITCH
Total Lanes
2
Speed Limit
25
Pre CrashTire
Mark
Direction Of Travel
NORTHBOUND
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
UNITModel
I35
Year
2004
Make
INFINITI
Vehicle Identification Number
26900101 Country of Issuance
UNITED STATES
St
MN
Plate Type
AUT - AUTOMOBILE
License Plate Number
Vehicle
Crash Time 02:15 AM
Crash Date 12/18/2020Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
20121804
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0F7HWRM WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
PRIOR LAKE, MN 55372 , US
Owner Name
0101Driver Actions
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
Extent Of Damage
DISABLING DAMAGE
Vehicle Damage
15 - ALL AREAS
Initial Contact Point
13 - TOP
Bus UseBody Style
4D - 4DR
Color
SIL - SILVER (ALUMINUM)VEHICLEUNITUNITVEHICLE Sequence Of Events
Event
DITCH01
Event
TREE02
Event
OVERTURN/ROLLOVER03
Event
04Individual
Insurance Company
PROGRESSIVE-CLASSIC-INS-CO
Policy Holder
UNITInjury
EMS Run #
6453
EMS Agency Identifier
6000954
Medical Transport
EMS GROUND
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABLE
Ejected
NOT EJECTED
Airbag
DEPLOYED-COMBINATION
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: MINNESOTA COUNTRY: UNITED STATES
Address
HAYWARD, WI 54843 , US
Race
INDIAN
Date of Birth
11/05/
Sex
MALE
Citations Issued
0
Driver
ITSafety Equipment
Individual
UNINDIVIDUALCrash Time 02:15 AM
Crash Date 12/18/2020Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
20121804
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0F7HWRM WISCONSIN MOTOR VEHICLE
CRASH REPORT
Distracted By
Drug & Alcohol
Individual Condition
CONFUSED OR DISORIENTED (NON LUCID)
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
LocationStriking Unit #
Distracted By Action
UNKNOWN
Distracted By Source
UNKNOWN
Time of DeathDate of DeathHospital
HAYWARD AREA MEM HOSP
UNITNon Motorist
INDIVIDUALCrash Time 02:15 AM
Crash Date 12/18/2020Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.