20141105 WhiteAgency Accident Number
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Reportable Accident On Emergency Amended GZF72MJ
DOT Document Number Document Override Number
14110501
14
1
1
0
5
0
1
11/05/2014
4 - Accident Date
0630
5 - Time of Accident (Military Time)
01
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County OJIBWA - 11, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
G
14 - On Hwy No.14 - On Street Name 14 - Bus/Frnt/Rmp
832 FT15 - Est. Distance WEST15 - Hwy. Dir
16 - Fr/At Hwy No.DAM RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.848687
12 - Latitude -91.08253013 - Longitude
OVERTURN80 - First Harmful Event NO COLLISION WITH MOTOR VEHICLE IN TRANSPORT93 - Manner of Collision
NO CONTROL
112 - Access Control
CURVE
113 - Road Curvature
LEVEL/FLAT
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 DRY116 - Road Surface Condition CLOUDY118 - 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
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U - UNKNOWN
Unit Status
OVERTURN
81 - Most Harmful Event: Collision With
EAST
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 30 - State 31 - Expiration Year 34 - On Duty Accident
25 - Operator/Pedestrian Last Name 25 - First Name 25 - Middle Initial 25 - Suffix
32 - Date Of Birth 33 - Sex
26 - Address Street & Number 26 - PO Box
27 - City 27 - State
54835
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
MAKING-RIGHT-TURN
119 - What Driver Was Doing
NO-CONTROL
120 - Traffic Control 62 - No. of Citations Issued
64 - 1st Statute No.64 - 2nd Statute No.64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
INATTENTIVE-DRIVING
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
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Vehicle
Vehicle Owner
Insurance
School Bus
IN
S
91 - Drugs Reported
NOT-APPLICABLE
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
340WMP
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2015
59 - Exp Year
6256
55 - Vehicle Identification Number
50 - Year
CHEV
51 - Make
BLAZER
52 - Model
4D - 4DR
53 - Body Style
BLK
54 - Color
200100 - Skidmarks to Impact (Ft)
FRONT, FRONT PASSENGER SIDE, REAR, TOP OF VEHICLE, REAR PASSENGER SIDE, MIDDLE PASSENGER SIDE,
REAR DRIVER SIDE, MIDDLE DRIVER SIDE, FRONT DRIVER SIDE
94 - Vehicle Damage
VERY-SEVERE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
DENENNY'S SERVICE TOW
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
WHITE
46 - Vehicle Owner Last Name
CORBIN
46 - First Name
R
46 - Middle Initial 46 - Suffix
08/11
Date Of Birth
46 - Company Name
47 - PO Box
EXELAND48 - City WI48 - State 5483548 - Zip Code 49 - Telephone Number
NORTHWOODS63 - Liability Insurance Company Policy Holder Same As Owner60
WHITE
61 - Policy Holder Last Name
CORBIN
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
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MV4000e 01/2005
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Wisconsin Motor Vehicle
Accident Report
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Wisconsin Motor Vehicle GZF72MJ 2 323
105 - Photos By
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Diagram and Narrative
UNIT 1 WAS TRAVELING NORTH BOUND ON CTH G, UNIT 1 APPROACHED A 90 DEGREE CORNER TRAVELING TOO FAST FOR THE
CORNER. UNIT 1 LOST CONTROL AND ROLLED IN THE DITCH LINE.
UNIT 1 WAS TRAVELING NORTH BOUND ON CTH G, UNIT 1 APPROACHED A 90 DEGREE CORNER TRAVELING TOO FAST FOR THE
CORNER. UNIT 1 LOST CONTROL AND ROLLED IN THE DITCH LINE.
OF
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125 - First Name 125 - Middle Initial
Officer Information
LEVERTON125 - Officer Last Name CHRIS 318131 - Officer ID
129 - Law Enforcement Agency No.
SAWYER COUNTY SHERIFFS DEPT
130 - Law Enforcement Agency Name
15880 EAST FIFTH STREET126 - Law Enforcement Agency Address Street & Number
HAYWARD
127 - City
WI
127 - State
54843
127 - Zip Code
(715) 634-4858 EXT.
128 - Telephone Number
11/05/2014132 - Date Notified 0709133 - Time Notified (Military Time)0740134 - Time Arrived (Military Time)11/05/2014135 - Date Of Report
14110501 19 - Special Study
18 - Agency Space
Accident Report
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZF72MJ 3 3