20141215 Williams Groeschl RainvilleAgency Accident Number
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Reportable Accident On Emergency Amended GZDXX61
DOT Document Number Document Override Number
14121502
14
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1
5
0
2
380
38
0
12/15/2014
4 - Accident Date
1116
5 - Time of Accident (Military Time)
03
6 - Total Units
02
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County BASS LAKE - 01, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
027
14 - On Hwy No.
SB
14 - On Street Name 14 - Bus/Frnt/Rmp
0.43 MI15 - Est. Distance NORTH15 - Hwy. Dir
K16 - Fr/At Hwy No.16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.920471
12 - Latitude -91.49580513 - Longitude
MOTOR VEHICLE IN TRANSPORT80 - First Harmful Event SIDESWIPE. OPPOSITE DIRECTION93 - 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
ON-ROADWAY
117 - Relation To Roadway
DAYLIGHT114 - Light Condition DRY116 - Road Surface Condition FOG-SMOG-SMOKE118 - 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
1412151519779 - E M S Number
Operator/Pedestrian
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Unit Status
MOTOR VEHICLE IN TRANSPORT
81 - Most Harmful Event: Collision With
SOUTH
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
2016
31 - Expiration Year 34 - On Duty Accident
WILLIAMS
25 - Operator/Pedestrian Last Name
JOHN
25 - First Name
P
25 - Middle Initial 25 - Suffix
08/14/1
32 - Date Of Birth
MALE
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
NON-DEPLOYED
41 - Airbag
NOT-EJECTED
42 - Ejected 44
Medical Transport
NOT-TRAPPED
43 - Trapped/Extricated 92 - Pedestrian Location 92 - Pedestrian Action
OVERTAKING-ON-LEFT
119 - What Driver Was Doing
NO-CONTROL
120 - Traffic Control 0462 - No. of Citations Issued
346.13(1)
64 - 1st Statute No.
346.57(2)
64 - 2nd Statute No.
346.62(2)
64 - 3rd Statute No.
341.03(1)
64 - 4th Statute No.64 - 5th Statute No.
SPEED-TOO-FAST-FOR-CONDITIONS, IMPROPER-OVERTAKING, FAILURE-TO-HAVE-CONTROL
122 - Driver Factors
REDUCED ALERTNESS88 - Driver or Pedestrian Cond UNKNOWN
89 - Substance Presence
TEST GIVEN, ALCOHOL UNKNOWN90 - Alcohol Test 90 - Alcohol Content TEST GIVEN DRUGS UNKNOWN91 - Drug Test
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Vehicle Owner
Insurance
School Bus
IN
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91 - Drugs Reported
NOT-APPLICABLE
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
01
22 - Total Occupants
GX9608
56 - License Plate Number
LTK57 - Plate Type WI
58 - State
2014
59 - Exp Year
3788
55 - Vehicle Identification Number
2004
50 - Year
DODG
51 - Make
RAM 2500 Q
52 - Model
PK - PICKUP
53 - Body Style
WHI
54 - Color
00100 - Skidmarks to Impact (Ft)
FRONT, TOP OF VEHICLE, FRONT DRIVER SIDE, FRONT PASSENGER SIDE, MIDDLE PASSENGER SIDE, MIDDLE
DRIVER SIDE
94 - Vehicle Damage
VERY-SEVERE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
A-1 TOWING
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
WILLIAMS
46 - Vehicle Owner Last Name
JOHN
46 - First Name
P
46 - Middle Initial 46 - Suffix
08/14
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
AMICA-MUTUAL-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60
WILLIAMS
61 - Policy Holder Last Name
JOHN
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
Operator/Pedestrian
Unit Status
MOTOR VEHICLE IN TRANSPORT
81 - Most Harmful Event: Collision With
NORTH
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
2021
31 - Expiration Year 34 - On Duty Accident
GROESCHL
25 - Operator/Pedestrian Last Name
JEFFREY
25 - First Name
G
25 - Middle Initial 25 - Suffix
03/14/
32 - Date Of Birth
MALE
33 - Sex
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Insurance
OP
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IN
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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
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 0062 - No. of Citations Issued
64 - 1st Statute No.64 - 2nd Statute No.64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
NOT-APPLICABLE
122 - Driver Factors
APPEARED NORMAL88 - Driver or Pedestrian Cond UNKNOWN
89 - Substance Presence
TEST NOT GIVEN90 - Alcohol Test 90 - Alcohol Content TEST NOT GIVEN91 - Drug Test
91 - Drugs Reported
NOT-APPLICABLE
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
01
22 - Total Occupants
KR2849
56 - License Plate Number
LTK57 - Plate Type WI
58 - State
2015
59 - Exp Year
0322
55 - Vehicle Identification Number
2013
50 - Year
NISS
51 - Make
TITAN S/SV
52 - Model
PK - PICKUP
53 - Body Style
SIL
54 - Color
00100 - Skidmarks to Impact (Ft)
REAR DRIVER SIDE, REAR, MIDDLE DRIVER SIDE
94 - Vehicle Damage
SEVERE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
ROAD RUNNER TOWING
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
46 - Vehicle Owner Last Name 46 - First Name 46 - Middle Initial 46 - Suffix Date Of Birth
GROESCHL FORESTRY CONSULTING46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
AUTO-OWNERS-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60
61 - Policy Holder Last Name 61 - Policy Holder First Name
GROESCHL FORESTRY CONSULTING61 - Policy Holder Company
02
02
02
02
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School Bus
02
BU
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FromTo
Bus Travelling to/from School Name Body Make Seating Capacity
School District Contracted With
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Vehicle
Vehicle Owner
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Unit Status MOTOR VEHICLE IN TRANSPORT81 - Most Harmful Event: Collision With NORTH23 - Dir Of Travel 5524 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
29 - Driver's License Number WI30 - State 201831 - Expiration Year 34 - On Duty Accident
RAINVILLE
25 - Operator/Pedestrian Last Name
NANCY
25 - First Name
K
25 - Middle Initial 25 - Suffix
06/16/32 - Date Of Birth FEMALE33 - Sex
26 - Address Street & Number
253
26 - PO Box
STONE LAKE27 - City WI27 - State 5487627 - 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 INJURY38 - Injury Severity DEPLOYED41 - Airbag NOT-EJECTED42 - Ejected 44 Medical Transport
NOT-TRAPPED
43 - Trapped/Extricated 92 - Pedestrian Location 92 - Pedestrian Action
GOING-STRAIGHT119 - What Driver Was Doing NO-CONTROL120 - Traffic Control 0062 - No. of Citations Issued
64 - 1st Statute No.64 - 2nd Statute No.64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
NOT-APPLICABLE
122 - Driver Factors
APPEARED NORMAL88 - Driver or Pedestrian Cond UNKNOWN
89 - Substance Presence
TEST NOT GIVEN90 - Alcohol Test 90 - Alcohol Content
TEST NOT GIVEN
91 - Drug Test
91 - Drugs Reported
NOT-APPLICABLE
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
01
22 - Total Occupants
435MED56 - License Plate Number AUT57 - Plate Type WI58 - State 201559 - Exp Year 493155 - Vehicle Identification Number
2007
50 - Year
ACUR
51 - Make
TSX
52 - Model
4D - 4DR
53 - Body Style
GRN
54 - Color
00100 - Skidmarks to Impact (Ft)
REAR DRIVER SIDE, MIDDLE DRIVER SIDE, REAR
94 - Vehicle Damage
SEVERE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
A-1 TOWING
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
03
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45
Vehicle Owner Same As Operator
RAINVILLE
46 - Vehicle Owner Last Name
NANCY
46 - First Name
K
46 - Middle Initial 46 - Suffix
06/16/
Date Of Birth
46 - Company Name
47- Address Street & Number
253
47 - PO Box
STONE LAKE
48 - City
WI48 - State 54876
48 - Zip Code
49 - Telephone Number
PEKIN-INS-CO
63 - Liability Insurance Company
Policy Holder Same As Owner
60
RAINVILLE
61 - Policy Holder Last Name
NANCY
61 - Policy Holder First Name
61 - Policy Holder Company
03
03
03
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
105 - Photos By
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Diagram and Narrative
DEPUTY AMBER AL-MOGHRABI #340
ON DECEMBER 15TH, 2014 AT APPROXIMATELY 1119 AM I, DEPUTY MALCOLM HAAG, WAS CONTACTED BY DISPATCH TO RESPOND
TO STATE RD 27 NEAR CTH K FOR A THREE VEHICLE CRASH WITH POSSIBLE INJURIES. I ACTIVATED MY EMERGENCY LIGHTS AND
SIRENS AND RESPONDED TO THE SCENE. THERE WAS DENSE FOG WITH EXTREMELY
ON DECEMBER 15TH, 2014 AT APPROXIMATELY 1119 AM I, DEPUTY MALCOLM HAAG, WAS CONTACTED BY DISPATCH TO RESPOND
TO STATE RD 27 NEAR CTH K FOR A THREE VEHICLE CRASH WITH POSSIBLE INJURIES. I ACTIVATED MY EMERGENCY LIGHTS AND
SIRENS AND RESPONDED TO THE SCENE. THERE WAS DENSE FOG WITH EXTREMELY
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REDUCED VISIBILITY. I ARRIVED ON SCENE AT APPROXIMATELY 1121 AM AND OBSERVED TWO VEHICLES WITH DAMAGE ON THE
EAST SIDE OF THE ROADWAY AND ONE VEHICLE IN THE DITCH ON THE EAST SIDE. I SECURED THE SCENE AND BEGAN MAKING
CONTACT WITH THE DRIVERS. OTHER DEPUTIES ARRIVING ON SCENE STOPPED TRAFFIC ON THE ROADWAY. I ALERTED DISPATCH TO BEGIN EMS AND TOW TRUCKS TO BEGIN RESPONDING. I CONTACTED RESPONDING EMS WITH THE INVOLVED
DRIVER'S STATUSES. EMS ARRIVED ON SCENE AND TRANSPORTED THE DRIVER OF UNIT 01 AND UNIT 03 TO THE HOSPITAL. ALL
UNITS INVOLVED WERE REMOVED BY TOW. I RECEIVED WRITTEN STATEMENTS FROM OBSERVERS OF THE CRASH. I WAS
ALERTED THAT UNIT 01 WAS PASSING A VEHICLE WHILE SOUTHBOUND ON STATE RD 27. AS UNIT 01 WAS PASSING IT OBSERVED
ONCOMING HEADLIGHTS APPROACHING NORTHBOUND ON STATE RD 27. UNIT 01 QUICKLY RETURNED TO IT'S SOUTHBOUND
LANE AND THE PASSENGER SIDE TIRES LEFT THE ROADWAY. UNIT 01 LOST CONTROL AND CROSSED INTO THE NORTHBOUND LANE STRIKING UNIT 02 THEN UNIT 03. UNIT 01 ROLLED SIDEWAYS AND CAME TO REST. AFTER THE SCENE WAS SAFE I MET THE
DRIVER OF UNIT 03 AND UNIT 01 AT THE HOSPITAL. THE DRIVER OF UNIT 01 SAID THAT HE WAS TAKING NUMEROUS MEDICATIONS
AND SUBMITTED TO AN EVIDENTIARY BLOOD DRAW KIT. I SECURED THE KIT AND DEPARTED THE HOSPITAL AT APPROXIMATELY
1332 PM. SEE CASE 14121502
REDUCED VISIBILITY. I ARRIVED ON SCENE AT APPROXIMATELY 1121 AM AND OBSERVED TWO VEHICLES WITH DAMAGE ON THE
EAST SIDE OF THE ROADWAY AND ONE VEHICLE IN THE DITCH ON THE EAST SIDE. I SECURED THE SCENE AND BEGAN MAKING
CONTACT WITH THE DRIVERS. OTHER DEPUTIES ARRIVING ON SCENE STOPPED TRAFFIC ON THE ROADWAY. I ALERTED DISPATCH TO BEGIN EMS AND TOW TRUCKS TO BEGIN RESPONDING. I CONTACTED RESPONDING EMS WITH THE INVOLVED
DRIVER'S STATUSES. EMS ARRIVED ON SCENE AND TRANSPORTED THE DRIVER OF UNIT 01 AND UNIT 03 TO THE HOSPITAL. ALL
UNITS INVOLVED WERE REMOVED BY TOW. I RECEIVED WRITTEN STATEMENTS FROM OBSERVERS OF THE CRASH. I WAS
ALERTED THAT UNIT 01 WAS PASSING A VEHICLE WHILE SOUTHBOUND ON STATE RD 27. AS UNIT 01 WAS PASSING IT OBSERVED
ONCOMING HEADLIGHTS APPROACHING NORTHBOUND ON STATE RD 27. UNIT 01 QUICKLY RETURNED TO IT'S SOUTHBOUND
LANE AND THE PASSENGER SIDE TIRES LEFT THE ROADWAY. UNIT 01 LOST CONTROL AND CROSSED INTO THE NORTHBOUND LANE STRIKING UNIT 02 THEN UNIT 03. UNIT 01 ROLLED SIDEWAYS AND CAME TO REST. AFTER THE SCENE WAS SAFE I MET THE
DRIVER OF UNIT 03 AND UNIT 01 AT THE HOSPITAL. THE DRIVER OF UNIT 01 SAID THAT HE WAS TAKING NUMEROUS MEDICATIONS
AND SUBMITTED TO AN EVIDENTIARY BLOOD DRAW KIT. I SECURED THE KIT AND DEPARTED THE HOSPITAL AT APPROXIMATELY
1332 PM. SEE CASE 14121502
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Witness
PAQUIN107 - Witness Last Name JENNIFER107 - First Name L107 - Middle Initial
01
108 - Address Streeet & Number 108 - PO Box
7/29/
109 - Date of Birth
HAYWARD110 - City WIState 54843110 - Zip Code 111 - Telephone Number
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Witness
KARASZEWSKI
107 - Witness Last Name
CARLA
107 - First Name
R
107 - Middle Initial
02
108 - Address Streeet & Number 108 - PO Box 9/20/109 - Date of Birth
STONE LAKE
110 - City
WI
State
54876
110 - Zip Code
111 - Telephone Number
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125 - First Name 125 - Middle Initial
Officer Information
HAAG125 - Officer Last Name MALCOLM 380131 - 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
12/15/2014132 - Date Notified 1119133 - Time Notified (Military Time)1121134 - Time Arrived (Military Time)12/23/2014135 - Date Of Report
14121502 380 19 - Special Study
18 - Agency Space
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