20141017 AckerAgency Accident Number
AC
C
I
D
E
N
T
#
PO
L
I
C
E
#
Police Number
GE
N
E
R
A
L
I
N
F
O
R
M
A
T
I
O
N
Reportable Accident On Emergency Amended GZF43QW
DOT Document Number Document Override Number
14101702
14
1
0
1
7
0
2
10/17/2014
4 - Accident Date
0740
5 - Time of Accident (Military Time)
01
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County HUNTER - 07, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
CC
14 - On Hwy No.14 - On Street Name 14 - Bus/Frnt/Rmp
0.31 MI15 - Est. Distance NORTH15 - Hwy. Dir
16 - Fr/At Hwy No.WOODLAND DR16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.926314
12 - Latitude -91.19164013 - Longitude
DITCH80 - First Harmful Event NO COLLISION WITH MOTOR VEHICLE IN TRANSPORT93 - Manner of Collision
NO CONTROL
112 - Access Control
CURVE
113 - Road Curvature
HILL
113 - Road Terrain
BLACKTOP, BITUMINOUS, OR ASPHALT - 2
Surface Type
NOT-PHYSICALLY-DIVIDED-(2-WAY TRAFFIC)115 - Traffic Way
OUTSIDE-SHOULDER-LEFT
117 - Relation To Roadway
DAWN114 - Light Condition WET116 - Road Surface Condition RAIN118 - Weather
Hit and Run
9
Government Property
9
Fire
9
Photos Taken
9
Trailer or Towed
9
Truck, Bus, or Hazardous Materials
9
Load Spillage
9
Construction Zone
9
Names Exchanged
9
Supplemental Reports
101
Witness Statements
102
Measurements Taken
103 79 - E M S Number
Operator/Pedestrian
OP
E
R
A
T
O
R
/
P
E
D
E
S
T
R
I
A
N
Unit Status
DITCH
81 - Most Harmful Event: Collision With
NORTH
23 - Dir Of Travel
4524 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
29 - Driver's License Number
WI
30 - State
2014
31 - Expiration Year 34 - On Duty Accident
ACKER
25 - Operator/Pedestrian Last Name
ZAQARI
25 - First Name
B
25 - Middle Initial 25 - Suffix
11/28/
32 - Date Of Birth
MALE
33 - Sex
26 - PO Box
ELK MOUND
27 - City
WI
27 - State
54739
27 - Zip Code 28 - Telephone Number
FRONT-SEAT-LEFT-SIDE-(MC/BIKE DRIVER, TRAIN CONDUCTOR)
39 - Seat Position
SHOULDER-BELT-AND-LAP-BELT-USED
40 - Safety Equipment
N - NO APPARENT INJURY
38 - Injury Severity
NON-DEPLOYED
41 - Airbag
NOT-EJECTED
42 - Ejected 44
Medical Transport
NOT-TRAPPED
43 - Trapped/Extricated 92 - Pedestrian Location 92 - Pedestrian Action
NEGOTIATING-CURVE
119 - What Driver Was Doing
NO-CONTROL
120 - Traffic Control 162 - No. of Citations Issued
343.44(1)(A)
64 - 1st Statute No.64 - 2nd Statute No.64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
SPEED-TOO-FAST-FOR-CONDITIONS
122 - Driver Factors
APPEARED NORMAL88 - Driver or Pedestrian Cond NEITHER-ALCOHOL-NOR-DRUGS-PRESENT
89 - Substance Presence
TEST NOT GIVEN90 - Alcohol Test 90 - Alcohol Content TEST NOT GIVEN91 - Drug Test
01
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZF43QW 1 4
VE
H
I
C
L
E
VE
H
O
W
N
E
R
Vehicle
Vehicle Owner
Insurance
School Bus
IN
S
91 - Drugs Reported
SNOW,-ICE,-OR-WET
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
189VVA
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2015
59 - Exp Year
1642
55 - Vehicle Identification Number
2001
50 - Year
VOLK
51 - Make
JETTA
52 - Model
4D - 4DR
53 - Body Style
BLU
54 - Color
0100 - Skidmarks to Impact (Ft)
TOTAL (DAMAGE TO ALL AREAS)
94 - Vehicle Damage
SEVERE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96 97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
ACKER
46 - Vehicle Owner Last Name
ZAQARI
46 - First Name
B
46 - Middle Initial 46 - Suffix
11/28/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
ELK MOUND48 - City WI48 - State 5473948 - Zip Code 49 - Telephone Number
PROGRESSIVE-CLASSIC-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60
ACKER
61 - Policy Holder Last Name
ZAQARI
61 - Policy Holder First Name
61 - Policy Holder Company
01
01
01
01
BU
S
FromTo
Bus Travelling to/from School Name Body Make Seating Capacity
School District Contracted With
Trailer
01
TR
L
106 - Power Unit Number License Plate Number Plate Type State Expiration Year
Trailer Make Unit Type Vehicle Identification Number
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZF43QW 2 424
Fixed Objects Struck
PR
O
P
E
R
T
Y
O
W
N
E
R
Property
UNKNOWN
Organization Type 84 - Property Owner Last Name 84 - First Name 84 - Middle Initial 84 - Suffix
01
84 - Company Name Government Property Type
85 - Address Street & Number 85 - PO Box
86 - City 86 - State 86 - Zip Code 87 - Telephone Number
83 - Government Damage Tag Number
01
82 - Striking Unit
DITCH
82 - Object Struck 82 - Striking Unit 82 - Object Struck
82 - Striking Unit 82 - Object Struck 82 - Striking Unit 82 - Object Struck
82 - Striking Unit 82 - Object Struck 82 - Striking Unit 82 - Object Struck
105 - Photos By
DI
A
G
R
A
M
A
N
D
N
A
R
R
A
T
I
V
E
Diagram and Narrative
J GEISSLER
OPERATOR OF UNIT 1 WAS NB ON CR-CC AND NEGOTIATING A RIGHT HAND CURVE. AS HE CAME OUT OF THE CURVE HE
ENCOUNTERED A DEER IN THE ROADWAY AND CORRECTED HIS PATH IN ORDER TO AVOID THE DEER. AS HE DID SO HE
EXPLAINED THAT THE SLICK ROADWAY CAUSED HIM TO LOSE CONTROL AND HIS VEHICLE SPUN IN THE OPPOSITE DIRECTION
AFTER HIS TIRES GRABBED ON A LESS-SLICK PORTION OF THE ROAD. AFTER HIS VEHICLE SPUN HE LEFT THE ROADWAY TO THE
WEST AND HIS VEHICLE ROLLED 12 TIMES ON TO ITS TOP AND CAME TO A REST. HE ADMITTED TO GOING BETWEEN 45 AND 50
MPH WHILE NEGOTIATING THE CURVE, WHICH WAS CLEARLY TOO FAST FOR CONDITIONS IN THE RAINY WEATHER. THE RECOMMENDED SPEED IN THIS CORNER WAS 30 MPH
OPERATOR OF UNIT 1 WAS NB ON CR-CC AND NEGOTIATING A RIGHT HAND CURVE. AS HE CAME OUT OF THE CURVE HE
ENCOUNTERED A DEER IN THE ROADWAY AND CORRECTED HIS PATH IN ORDER TO AVOID THE DEER. AS HE DID SO HE
EXPLAINED THAT THE SLICK ROADWAY CAUSED HIM TO LOSE CONTROL AND HIS VEHICLE SPUN IN THE OPPOSITE DIRECTION
AFTER HIS TIRES GRABBED ON A LESS-SLICK PORTION OF THE ROAD. AFTER HIS VEHICLE SPUN HE LEFT THE ROADWAY TO THE
WEST AND HIS VEHICLE ROLLED 12 TIMES ON TO ITS TOP AND CAME TO A REST. HE ADMITTED TO GOING BETWEEN 45 AND 50
MPH WHILE NEGOTIATING THE CURVE, WHICH WAS CLEARLY TOO FAST FOR CONDITIONS IN THE RAINY WEATHER. THE RECOMMENDED SPEED IN THIS CORNER WAS 30 MPH
Officer Information
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZF43QW 3 4
OF
F
I
C
E
R
I
N
F
O
R
M
A
T
I
O
N
125 - First Name 125 - Middle Initial
GEISSLER
125 - Officer Last Name
JIM 366
131 - Officer ID
129 - Law Enforcement Agency No.
SAWYER COUNTY SHERIFFS DEPT
130 - Law Enforcement Agency Name
15880 EAST FIFTH STREET
126 - Law Enforcement Agency Address Street & Number
HAYWARD
127 - City
WI
127 - State
54843
127 - Zip Code
128 - Telephone Number
10/17/2014
132 - Date Notified 0750133 - Time Notified (Military Time)0815134 - Time Arrived (Military Time)
10/17/2014
135 - Date Of Report
14101702 19 - Special Study
18 - Agency Space
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZF43QW 4 4