20141201 McdermottAgency Accident Number
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Reportable Accident On Emergency Amended GZFFQMF
DOT Document Number Document Override Number
14120102
14
1
2
0
1
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2
12/01/2014
4 - Accident Date
0142
5 - Time of Accident (Military Time)
01
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County HAYWARD - 06, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
14 - On Hwy No.
TWIN LAKE RD 6
14 - On Street Name 14 - Bus/Frnt/Rmp
1251 FT15 - Est. Distance WEST15 - Hwy. Dir
16 - Fr/At Hwy No.BETHEL RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
46.041312
12 - Latitude -91.32195013 - Longitude
DITCH80 - 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
SHOULDER-(OTHER THAN SHOULDER WITHIN MEDIAN OR GORE)
117 - Relation To Roadway
DARK-NOT-LIGHTED114 - Light Condition SNOW/SLUSH116 - Road Surface Condition CLEAR118 - 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
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Unit Status
DITCH
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
M2366786136601
29 - Driver's License Number
WI
30 - State
2020
31 - Expiration Year 34 - On Duty Accident
MCDERMOTT
25 - Operator/Pedestrian Last Name
PATRICK
25 - First Name
M
25 - Middle Initial 25 - Suffix
10/06/1
32 - Date Of Birth
MALE
33 - Sex
26 - Address Street & Number 26 - PO Box
MILWAUKEE
27 - City
WI
27 - State
53226
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
GOING-STRAIGHT
119 - What Driver Was Doing
NO-CONTROL
120 - Traffic Control 0262 - No. of Citations Issued
346.57(2)
64 - 1st Statute No.
346.57(3)
64 - 2nd Statute No.64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
SPEED-TOO-FAST-FOR-CONDITIONS, FAILURE-TO-HAVE-CONTROL, DRIVER-CONDITION
122 - Driver Factors
ABILITY IMPAIRED88 - Driver or Pedestrian Cond ALCOHOL-PRESENT
89 - Substance Presence
TEST NOT GIVEN90 - Alcohol Test 90 - Alcohol Content TEST NOT GIVEN91 - Drug Test
01
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZFFQMF 1 4
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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
01
22 - Total Occupants
JJ5560
56 - License Plate Number
LTK57 - Plate Type WI
58 - State
2015
59 - Exp Year
1258
55 - Vehicle Identification Number
2001
50 - Year
DODG
51 - Make
RAM
52 - Model
2D - 2DR
53 - Body Style
WHI
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT DRIVER SIDE, MIDDLE DRIVER SIDE, REAR DRIVER SIDE, REAR, TOP OF VEHICLE, FRONT
94 - Vehicle Damage
MODERATE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
ROADRUNNER TOWING
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
MCDERMOTT
46 - Vehicle Owner Last Name
PATRICK
46 - First Name
M
46 - Middle Initial 46 - Suffix
10/06/1
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
MILWAUKEE48 - City WI48 - State 5322648 - Zip Code ( 49 - Telephone Number
ESURANCE-INSURANCE-COMPANY63 - Liability Insurance Company Policy Holder Same As Owner60
MCDERMOTT
61 - Policy Holder Last Name
PATRICK
61 - Policy Holder First Name
61 - Policy Holder Company
01
01
01
01
BU
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FromTo
Bus Travelling to/from School Name Body Make Seating Capacity
School District Contracted With
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
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Wisconsin Motor Vehicle
Accident Report
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZFFQMF 2 424
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
15880 5TH AVE
85 - Address Street & Number 85 - PO Box
HAYWARD
86 - City
WI
86 - State
54843
86 - Zip Code 87 - Telephone Number
0000
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
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Diagram and Narrative
UNIT 1 WAS TRAVELING EAST BOUND ON TWIN LAKES ROAD. UNIT 1 LEFT THE ROAD WAY STRIKING THE DITCH, UNIT 1 CAME TO
REST ON ITS DRIVER'S SIDE PARTIALLY IN THE ROAD WAY.
UNIT 1 WAS TRAVELING EAST BOUND ON TWIN LAKES ROAD. UNIT 1 LEFT THE ROAD WAY STRIKING THE DITCH, UNIT 1 CAME TO
REST ON ITS DRIVER'S SIDE PARTIALLY IN THE ROAD WAY.
Officer Information
Accident Report
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZFFQMF 3 4
OF
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125 - First Name 125 - Middle Initial
CULHANE
125 - Officer Last Name
CASEY 327
131 - Officer ID
206
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
12/01/2014
132 - Date Notified 0137133 - Time Notified (Military Time)0142134 - Time Arrived (Military Time)
12/02/2014
135 - Date Of Report
14120102 19 - Special Study
18 - Agency Space
Accident Report
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZFFQMF 4 4