20160124 FredericksonAgency Accident Number
AC
C
I
D
E
N
T
#
PO
L
I
C
E
#
Police Number
GE
N
E
R
A
L
I
N
F
O
R
M
A
T
I
O
N
Reportable Accident On Emergency Amended GZDZNDV
DOT Document Number Document Override Number
16012401
16
0
1
2
4
0
1
16012401
16
0
1
2
4
0
1
01/24/2016
4 - Accident Date
0210
5 - Time of Accident (Military Time)
01
6 - Total Units
01
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County HAYWARD - 06, TOWN3 - Municipality INTERSECTION11 - Accident Location
14 - On Hwy No.
COMPANY LAKE RD
14 - On Street Name 14 - Bus/Frnt/Rmp 15 - Est. Distance 15 - Hwy. Dir
16 - Fr/At Hwy No.ZULASKI RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
46.034050
12 - Latitude -91.49723913 - Longitude
TREE80 - First Harmful Event NO COLLISION WITH MOTOR VEHICLE IN TRANSPORT93 - Manner of Collision
FULL CONTROL
112 - Access Control
CURVE
113 - Road Curvature
LEVEL/FLAT
113 - Road Terrain
CONCRETE - 1
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
E
R
A
T
O
R
/
P
E
D
E
S
T
R
I
A
N
Unit Status
TREE
81 - Most Harmful Event: Collision With
NORTH
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
WI
30 - State
2023
31 - Expiration Year 34 - On Duty Accident
FREDERICKSON
25 - Operator/Pedestrian Last Name
KYLE
25 - First Name
E
25 - Middle Initial 25 - Suffix
10/03/
32 - Date Of Birth
MALE
33 - Sex
26 - Address Street & Number 26 - PO Box
APPLETON
27 - City
WI
27 - State
54913
27 - Zip Code 28 - Telephone Number
FRONT-SEAT-LEFT-SIDE-(MC/BIKE DRIVER, TRAIN CONDUCTOR)
39 - Seat Position
RESTRAINT-USE-UNKNOWN
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
NEGOTIATING-CURVE
119 - What Driver Was Doing
NO-CONTROL
120 - Traffic Control 362 - No. of Citations Issued
346.63(1)(A)
64 - 1st Statute No.
346.57(3)
64 - 2nd Statute No.
346.70(1)
64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
SPEED-TOO-FAST-FOR-CONDITIONS
122 - Driver Factors
ABILITY IMPAIRED88 - Driver or Pedestrian Cond ALCOHOL-PRESENT
89 - Substance Presence
TEST REFUSED90 - Alcohol Test 90 - Alcohol Content TEST REFUSED91 - Drug Test
01
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDZNDV 1 4
VE
H
I
C
L
E
VE
H
O
W
N
E
R
Vehicle
Vehicle Owner
Insurance
School Bus
IN
S
91 - Drugs Reported
SNOW,-ICE,-OR-WET
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
962WXB
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2016
59 - Exp Year
0249
55 - Vehicle Identification Number
2014
50 - Year
MAZD
51 - Make
3 TOURING
52 - Model
4H - HATCHBACK 4
53 - Body Style
BLK
54 - Color
150100 - Skidmarks to Impact (Ft)
FRONT, FRONT DRIVER SIDE, FRONT PASSENGER SIDE, UNDERCARRIAGE, MIDDLE DRIVER SIDE, MIDDLE
PASSENGER SIDE
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
FREDERICKSON
46 - Vehicle Owner Last Name
KYLE
46 - First Name
E
46 - Middle Initial 46 - Suffix
10/03
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
APPLETON48 - City WI48 - State 5491348 - Zip Code 49 - Telephone Number
UNKNOWN63 - Liability Insurance Company Policy Holder Same As Owner60
FREDERICKSON
61 - Policy Holder Last Name
KYLE
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
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDZNDV 2 424
Fixed Objects Struck
PR
O
P
E
R
T
Y
O
W
N
E
R
Property
INDIVIDUAL
Organization Type
UNKNOWN
84 - Property Owner Last Name
UNKNOWN
84 - First Name 84 - Middle Initial 84 - Suffix
01
84 - Company Name Government Property Type
85 - Address Street & Number 85 - PO Box
HAYWARD
86 - City
WI
86 - State
54843
86 - Zip Code 87 - Telephone Number
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
DI
A
G
R
A
M
A
N
D
N
A
R
R
A
T
I
V
E
Diagram and Narrative
SGT. J. JOHNSON
ON 1/24/16, AT APPROXIMATELY 0210 HRS, UNIT 1 WAS TRAVELING NORTH ON COMPANY LAKE RD, NEARING ZULASKI RD IN
HAYWARD TWSP. THE DRIVER OF UNIT 1 (FREDERICKSON) WAS TRAVELING TOO FAST FOR CONDITIONS DUE TO THE ROAD
BEING SNOW COVERED AND SLIPPERY, AND HE WAS ALSO INTOXICATED. AS HE ATTEMPTED TO NEGOTIATE THE CURVE JUST
SOUTH OF ZULASKI RD, UNIT 1 BEGAN SKIDDING SIDWAYS. FREDERICKSON OVER-CORRECTED AND SLID OUT OF CONTROL,
LEAVING THE ROADWAY ON THE WEST SIDE OF COMPANY LAKE RD, ULTIMATELY STRIKING A TREE. STRIKING THE TREE SET OFF
ALL OF THE AIRBAGS IN THE VEHICLE, AND INJURED FREDERICKSON, WHO NEEDED TRANSPORT TO THE EMERGENCY ROOM. THE SKIDMARKS WERE APPROXIMATELY 150 IN LENGTH.
ON 1/24/16, AT APPROXIMATELY 0210 HRS, UNIT 1 WAS TRAVELING NORTH ON COMPANY LAKE RD, NEARING ZULASKI RD IN
HAYWARD TWSP. THE DRIVER OF UNIT 1 (FREDERICKSON) WAS TRAVELING TOO FAST FOR CONDITIONS DUE TO THE ROAD
BEING SNOW COVERED AND SLIPPERY, AND HE WAS ALSO INTOXICATED. AS HE ATTEMPTED TO NEGOTIATE THE CURVE JUST
SOUTH OF ZULASKI RD, UNIT 1 BEGAN SKIDDING SIDWAYS. FREDERICKSON OVER-CORRECTED AND SLID OUT OF CONTROL,
LEAVING THE ROADWAY ON THE WEST SIDE OF COMPANY LAKE RD, ULTIMATELY STRIKING A TREE. STRIKING THE TREE SET OFF
ALL OF THE AIRBAGS IN THE VEHICLE, AND INJURED FREDERICKSON, WHO NEEDED TRANSPORT TO THE EMERGENCY ROOM. THE SKIDMARKS WERE APPROXIMATELY 150 IN LENGTH.
Officer Information
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDZNDV 3 4
OF
F
I
C
E
R
I
N
F
O
R
M
A
T
I
O
N
125 - First Name 125 - Middle Initial
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
01/24/2016
132 - Date Notified 0213133 - Time Notified (Military Time)0220134 - Time Arrived (Military Time)
02/01/2016
135 - Date Of Report
16012401 16012401 19 - Special Study
18 - Agency Space
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDZNDV 4 4