20160126 Miller TurnbullAgency Accident Number
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Reportable Accident On Emergency Amended GZDWFR5
DOT Document Number Document Override Number
16012602
16
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1
2
6
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01/26/2016
4 - Accident Date
0811
5 - Time of Accident (Military Time)
02
6 - Total Units
01
7 - Total Injured 8 - Total Killed
SAWYER - 572 - County HUNTER - 07, TOWN3 - Municipality INTERSECTION11 - Accident Location
B
14 - On Hwy No.14 - On Street Name 14 - Bus/Frnt/Rmp 15 - Est. Distance 15 - Hwy. Dir
16 - Fr/At Hwy No.PINES RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.982193
12 - Latitude -91.19351813 - Longitude
MOTOR VEHICLE IN TRANSPORT80 - First Harmful Event ANGLE93 - Manner of Collision
NO CONTROL
112 - Access Control
STRAIGHT
113 - Road Curvature
HILL
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 SNOW/SLUSH116 - Road Surface Condition SNOW118 - 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
MOTOR VEHICLE IN TRANSPORT
81 - Most Harmful Event: Collision With
NORTH
23 - Dir Of Travel
N/A24 - Speed Limit
C CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
29 - Driver's License Number
WI
30 - State
2018
31 - Expiration Year
WINTER-HWY-MAINTENANCE
34 - On Duty Accident
MILLER
25 - Operator/Pedestrian Last Name
REID
25 - First Name
JOSEPH
25 - Middle Initial 25 - Suffix
12/29/
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
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
BACKING-MANEUVER
119 - What Driver Was Doing
STOP-SIGN
120 - Traffic Control 162 - No. of Citations Issued
346.18(3)
64 - 1st Statute No.64 - 2nd Statute No.64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
FAIL-TO-YIELD-RIGHT-OF-WAY
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
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Accident Report
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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
TRUCK
21 - Unit Type
STRAIGHT-TRUCK-(INSERT TRUCK)
Vehicle Type
1
22 - Total Occupants
86754
56 - License Plate Number
MUN57 - Plate Type WI
58 - State 59 - Exp Year
4414
55 - Vehicle Identification Number
2014
50 - Year
INTL
51 - Make
7400
52 - Model
DP - DUMP TRUCK
53 - Body Style
ONG
54 - Color 100 - Skidmarks to Impact (Ft)
UNDERCARRIAGE
94 - Vehicle Damage
MODERATE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
OPERATOR
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
TOWN OF HUNTER46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
RURAL-MUTUAL-INS-CO-(ATTN:-CLAIMS-DEPT)63 - Liability Insurance Company Policy Holder Same As Owner60
61 - Policy Holder Last Name 61 - Policy Holder First Name
TOWN OF HUNTER61 - 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
Operator/Pedestrian
Unit Status
MOTOR VEHICLE IN TRANSPORT
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
2018
31 - Expiration Year 34 - On Duty Accident
TURNBULL
25 - Operator/Pedestrian Last Name
ROBERT
25 - First Name
L
25 - Middle Initial 25 - Suffix
02/01
32 - Date Of Birth
MALE
33 - Sex
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 GZDWFR5 2 525
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Insurance
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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
A - 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 62 - No. of Citations Issued
64 - 1st Statute No.64 - 2nd Statute No.64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
SPEED-TOO-FAST-FOR-CONDITIONS
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
SNOW,-ICE,-OR-WET
124 - Highway Factors
TRUCK
21 - Unit Type
PICKUP/UTILITY-TRUCK
Vehicle Type
1
22 - Total Occupants
AG2849
56 - License Plate Number
LTK57 - Plate Type WI
58 - State
2016
59 - Exp Year
6540
55 - Vehicle Identification Number
1994
50 - Year
FORD
51 - Make 52 - Model
PK - PICKUP
53 - Body Style
MUL
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT
94 - Vehicle Damage
VERY-SEVERE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
A-1 TOWING
97 - Vehicle Removed By
TIRES
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
TURNBULL
46 - Vehicle Owner Last Name
ROBERT
46 - First Name
L
46 - Middle Initial 46 - Suffix
02/01/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code (715) 462-9979 EXT.49 - Telephone Number
ALLSTATE63 - Liability Insurance Company Policy Holder Same As Owner60
TURNBULL
61 - Policy Holder Last Name
ROBERT
61 - Policy Holder First Name
61 - Policy Holder Company
02
02
02
02
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZDWFR5 3 5
School Bus
02
BU
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FromTo
Bus Travelling to/from School Name Body Make Seating Capacity
School District Contracted With
Trailer
01
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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 JEFF CAIN
UNIT ONE WAS CLEARING SNOW AT THE INTERSECTION OF HWY B AND PINES LANE WHEN IT BACKED INTO THE EASTBOUND LANE OF HWY B IN PREPARATION TO PLOW PINES LANE. UNIT TWO WAS APPROACHING FROM THE WEST ON HWY BAND
COLLIDED WITH THE RIGHT REAR OF UNIT ONE.
UNIT ONE WAS CLEARING SNOW AT THE INTERSECTION OF HWY B AND PINES LANE WHEN IT BACKED INTO THE EASTBOUND LANE OF HWY B IN PREPARATION TO PLOW PINES LANE. UNIT TWO WAS APPROACHING FROM THE WEST ON HWY BAND
COLLIDED WITH THE RIGHT REAR OF UNIT ONE.
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125 - First Name 125 - Middle Initial
Officer Information
CAIN
125 - Officer Last Name
JEFF 314
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
01/26/2016
132 - Date Notified 0811133 - Time Notified (Military Time)0819134 - Time Arrived (Military Time)
01/26/2016
135 - Date Of Report
16012602 19 - Special Study
18 - Agency Space
Truck and Bus
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Wisconsin Motor Vehicle GZDWFR5 4 5
136
136
136 136
136 A truck or truck combination > 10,000 lbs
GVWR/GCWR
Any vehicle displaying a hazardous materials
placard
01
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A vehicle designed to carry 9 or more people, including the driver
136
Fatal Injury Medical Transport
One or more vehicles towed from the scene due to disabling damage
01
Unit Number
137 - Hazardous Materials Class Numbers
137 - Hazardous Materials "UN" Nos.
HazMat Placard Displayed Hazardous Cargo Was Released
137 - Name Of Hazardous Materials in this Load 137 - Name Of Hazardous Materials Released
Interstate Carrier
138 140 - US DOT No.140 - ICC MC No.LC No.IC No.
VEHICLE-SIDE
141 - Source
TOWN OF HUNTER
139 - Carrier Name
9316N HWY CC
142 - Carrier Address
HAYWARD
City
WI
State
54843
Zip Code
143 - GVWR (Lbs)
2
144 - Total No. of Axles
SINGLE-UNIT-VEHICLE
145 - Vehicle Configuration
DUMP
147 - Cargo Body Type
COLLISION-INVOLVING-MOTOR-VEHICLE-IN-TRANSPOR
146 - First Event
BLANK
146 - Second Event
BLANK
146 - Third Event
BLANK
146 - Fourth Event
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZDWFR5 5 5