20141229 JohnstonAgency Accident Number
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Police Number
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Reportable Accident On Emergency Amended GZDXX62
DOT Document Number Document Override Number
12/29/2014
4 - Accident Date
0022
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.
PENINSULA RD
14 - On Street Name 14 - Bus/Frnt/Rmp
0.32 MI15 - Est. Distance WEST15 - Hwy. Dir
K16 - Fr/At Hwy No.16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
46.011613
12 - Latitude -91.39035613 - 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 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 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
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
UNKNOWN
25 - Operator/Pedestrian Last Name
UNKNOWN
25 - First Name 25 - Middle Initial 25 - Suffix
32 - Date Of Birth
MALE
33 - Sex
UNKNOWN
26 - Address Street & Number 26 - PO Box
HAYWARD
27 - City
WI
27 - State
54843
27 - Zip Code 28 - Telephone Number
UNKNOWN
39 - Seat Position
RESTRAINT-USE-UNKNOWN
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.
INATTENTIVE-DRIVING, SPEED-TOO-FAST-FOR-CONDITIONS
122 - Driver Factors
NOT OBSERVED88 - Driver or Pedestrian Cond UNKNOWN
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
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PK2012
Wisconsin Motor Vehicle GZDXX62 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
994VGX
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2015
59 - Exp Year
4968
55 - Vehicle Identification Number
1998
50 - Year
CHEV
51 - Make
MALBU
52 - Model
4D - 4DR
53 - Body Style
MAR
54 - Color 100 - Skidmarks to Impact (Ft)
MIDDLE PASSENGER SIDE, FRONT PASSENGER SIDE, TOP OF VEHICLE, FRONT, FRONT 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
JOHNSTON
46 - Vehicle Owner Last Name
DENISE
46 - First Name
M
46 - Middle Initial 46 - Suffix
10/19/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
WINTER48 - City WI48 - State 5489648 - Zip Code 49 - Telephone Number
UNKNOWN63 - Liability Insurance Company Policy Holder Same As Owner60
61 - Policy Holder Last Name 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
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MV4000e 01/2005
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Wisconsin Motor Vehicle
Accident Report
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZDXX62 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 E 5TH ST
85 - Address Street & Number 85 - PO Box
HAYWARD
86 - City
WI
86 - State
54843
86 - Zip Code 87 - Telephone Number
000
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 PENINSULA RD. UNIT 1 LOST CONTROL COLLIDING WITH THE SOUTH DITCH, ROLLING AT
LEAST ONE TIME. UNIT 1 CAME TO REST ON IT'S TIRES FACING WEST. THE DRIVER AND ANY OTHER OCCUPANTS ON SCENE
WERE GONE PRIOR TO ARRIVAL.
UNIT 1 WAS TRAVELING EAST BOUND ON PENINSULA RD. UNIT 1 LOST CONTROL COLLIDING WITH THE SOUTH DITCH, ROLLING AT
LEAST ONE TIME. UNIT 1 CAME TO REST ON IT'S TIRES FACING WEST. THE DRIVER AND ANY OTHER OCCUPANTS ON SCENE
WERE GONE PRIOR TO ARRIVAL.
Officer Information
Accident Report
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZDXX62 3 4
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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
12/29/2014
132 - Date Notified 0022133 - Time Notified (Military Time)0026134 - Time Arrived (Military Time)
01/04/2015
135 - Date Of Report
19 - Special Study
18 - Agency Space
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDXX62 4 4