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Agency Accident Number
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Police Number
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Reportable Accident On Emergency Amended GZFF0DQ
DOT Document Number Document Override Number
14110601
14
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1
0
6
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1
11/06/2014
4 - Accident Date
0148
5 - Time of Accident (Military Time)
01
6 - Total Units
02
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County BASS LAKE - 01, TOWN3 - Municipality INTERSECTION11 - Accident Location
K
14 - On Hwy No.14 - On Street Name 14 - Bus/Frnt/Rmp 15 - Est. Distance 15 - Hwy. Dir
16 - Fr/At Hwy No.HIGHLINE RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.914765
12 - Latitude -91.45955813 - Longitude
TREE80 - First Harmful Event NO COLLISION WITH MOTOR VEHICLE IN TRANSPORT93 - Manner of Collision
NO CONTROL
112 - Access Control
STRAIGHT
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-RIGHT
117 - Relation To Roadway
DARK-NOT-LIGHTED114 - Light Condition SNOW/SLUSH116 - 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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Unit Status
TREE
81 - Most Harmful Event: Collision With
EAST
23 - Dir Of Travel
5524 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
29 - Driver's License Number
WI
30 - State
2020
31 - Expiration Year 34 - On Duty Accident
CROSS
25 - Operator/Pedestrian Last Name
LISA
25 - First Name
M
25 - Middle Initial 25 - Suffix
01/04/
32 - Date Of Birth
FEMALE
33 - Sex
26 - Address Street & Number 26 - PO Box
HAYWARD
27 - City
WI
27 - State
54843
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
B - NON-INCAPACITATING INJURY
38 - Injury Severity
DEPLOYED
41 - Airbag
NOT-EJECTED
42 - Ejected 44
Medical Transport
NOT-TRAPPED
43 - Trapped/Extricated 92 - Pedestrian Location 92 - Pedestrian Action
GOING-STRAIGHT
119 - What Driver Was Doing
NO-CONTROL
120 - Traffic Control 162 - No. of Citations Issued
346.63(2)(A)1
64 - 1st Statute No.64 - 2nd Statute No.64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
DRIVER-CONDITION
122 - Driver Factors
ABILITY IMPAIRED88 - Driver or Pedestrian Cond ALCOHOL-PRESENT
89 - Substance Presence
TEST GIVEN, ALCOHOL UNKNOWN90 - Alcohol Test 90 - Alcohol Content TEST NOT GIVEN91 - Drug Test
01
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Vehicle
Vehicle Owner
Insurance
School Bus
IN
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91 - Drugs Reported
SNOW,-ICE,-OR-WET
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
2
22 - Total Occupants
480UWY
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2015
59 - Exp Year
2045
55 - Vehicle Identification Number
2014
50 - Year
CHEV
51 - Make
CRUZE
52 - Model
4D - 4DR
53 - Body Style
BLK
54 - Color
100100 - Skidmarks to Impact (Ft)
TOTAL (DAMAGE TO ALL AREAS)
94 - Vehicle Damage
VERY-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
CROSS
46 - Vehicle Owner Last Name
LISA
46 - First Name
M
46 - Middle Initial 46 - Suffix
01/04/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
GEICO-CASUALTY-CO63 - Liability Insurance Company Policy Holder Same As Owner60
CROSS
61 - Policy Holder Last Name
LISA
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
Occupant
Address Same As Operator
OC
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01
65 - Unit No
WOLFE
66 - Occupant Last Name
BRANDON
66 - First Name
P
66 - Middle Initial 66 - Suffix
01
68 - Address Street & Number 68 - PO Box
BIRCHWOOD
68 - City
WI
68 - State
54817
68 - Zip Code
06/0467 - Date of Birth M69 - Sex
UNKNOWN
71 - Seat Position
NONE-USED-VEHICLE-DRIVER/OCCUPANT
72 - Safety Equipment
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A - INCAPACITATING INJURY
70 - Injury Severity
DEPLOYED
73 - Airbag
NOT-EJECTED
75 - Ejected
Medical Transport
77
NOT-TRAPPED
76 - Trapped/Extricated 78 - Agency Space
Trailer
01
TR
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106 - Power Unit Number License Plate Number Plate Type State Expiration Year
Trailer Make Unit Type Vehicle Identification Number
Fixed Objects Struck
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Property
GOVERNMENT
Organization Type 84 - Property Owner Last Name 84 - First Name 84 - Middle Initial 84 - Suffix
01
SAWYER COUNTY
84 - Company Name
COUNTY/MUNICIPAL
Government Property Type
85 - Address Street & Number 85 - PO Box
HAYWARD
86 - City
WI
86 - State
54843
86 - Zip Code 87 - Telephone Number
1
83 - Government Damage Tag Number
01
82 - Striking Unit
TREE
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
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Diagram and Narrative
DEPUTY C. LEVERTON
ON 11614, AT 0149 HRS, I WAS DISPATCHED TO THE INTERSECTION OF CTH K AND HIGHLINE RD IN BASS LAKE TWSP FOR A ONE
VEH CRASH. UPON ARRIVAL, I OBSERVED A VEHICLE THAT, BASED OFF THE TRACKS IN THE SNOW, HAD BEEN TRAVELING EAST
ON CTH K, WAS IN THE SOUTH DITCH, NOW FACING WEST, WITH THE REAR END OF THE VEHICLE AGAINST A TREE. WHEN I WALKED DOWN TO THE VEHICLE, I SPOKE WITH THE DRIVER, WHO WAS
ON 11614, AT 0149 HRS, I WAS DISPATCHED TO THE INTERSECTION OF CTH K AND HIGHLINE RD IN BASS LAKE TWSP FOR A ONE
VEH CRASH. UPON ARRIVAL, I OBSERVED A VEHICLE THAT, BASED OFF THE TRACKS IN THE SNOW, HAD BEEN TRAVELING EAST
ON CTH K, WAS IN THE SOUTH DITCH, NOW FACING WEST, WITH THE REAR END OF THE VEHICLE AGAINST A TREE. WHEN I WALKED DOWN TO THE VEHICLE, I SPOKE WITH THE DRIVER, WHO WAS
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UNINJURED, AND THE PASSENGER, WHO WAS LATER TAKEN TO THE HOSPITAL BY AMBULANCE. I COULD SEE THAT THE VEHICLE HAD BEEN TRAVELING EAST, LEFT THE ROADWAY INTO THE SOUTH DITCH, JUMPED A DRIVEWAY, LANDED FACING WEST, AND
CRASHED INTO A TREE.
THE DRIVER WAS SUBSEQUENTLY ARRESTED FOR OMVWI AND POSSESSION OF THC AND DRUG PARAPHERNALIA. THE AIRBAGS
OF THE VEHICLE WERE DEPLOYED, AND THE DAMAGE WAS VERY MAJOR.
SAWYER COUNTY SHERIFF'S OFFICE CASE 14110601
UNINJURED, AND THE PASSENGER, WHO WAS LATER TAKEN TO THE HOSPITAL BY AMBULANCE. I COULD SEE THAT THE VEHICLE HAD BEEN TRAVELING EAST, LEFT THE ROADWAY INTO THE SOUTH DITCH, JUMPED A DRIVEWAY, LANDED FACING WEST, AND
CRASHED INTO A TREE.
THE DRIVER WAS SUBSEQUENTLY ARRESTED FOR OMVWI AND POSSESSION OF THC AND DRUG PARAPHERNALIA. THE AIRBAGS
OF THE VEHICLE WERE DEPLOYED, AND THE DAMAGE WAS VERY MAJOR.
SAWYER COUNTY SHERIFF'S OFFICE CASE 14110601
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125 - First Name 125 - Middle Initial
Officer Information
JOHNSON
125 - Officer Last Name
JEFF 322
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
(715) 634-4858 EXT.
128 - Telephone Number
11/06/2014
132 - Date Notified 0149133 - Time Notified (Military Time)0154134 - Time Arrived (Military Time)
11/12/2014
135 - Date Of Report
14110601 19 - Special Study
18 - Agency Space
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