20160127 Heinemann AndersonAgency Accident Number
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Reportable Accident On Emergency Amended GZDLK32
DOT Document Number Document Override Number
16012703
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116012703
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01/27/2016
4 - Accident Date
0851
5 - Time of Accident (Military Time)
02
6 - Total Units
01
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County HAYWARD - 53, CITY3 - Municipality INTERSECTION11 - Accident Location
077
14 - On Hwy No.
WB
14 - On Street Name 14 - Bus/Frnt/Rmp 15 - Est. Distance 15 - Hwy. Dir
06316 - Fr/At Hwy No.16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
46.018700
12 - Latitude -91.47587413 - Longitude
MOTOR VEHICLE IN TRANSPORT80 - First Harmful Event SIDESWIPE. SAME 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
DIVIDED-HIGHWAY-MEDIAN-STRIP-WITHOUT-TRAFFIC-BARRIER115 - Traffic Way
ON-ROADWAY
117 - Relation To Roadway
DAYLIGHT114 - Light Condition WET116 - Road Surface Condition CLOUDY118 - 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
SOUTH
23 - Dir Of Travel
3524 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
Number
WI
30 - State
2021
31 - Expiration Year 34 - On Duty Accident
HEINEMANN
25 - Operator/Pedestrian Last Name
TOMMYE
25 - First Name
IRIS
25 - Middle Initial 25 - Suffix
08/22/
32 - Date Of Birth
FEMALE
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
MAKING-LEFT-TURN
119 - What Driver Was Doing
TRAFFIC-SIGNAL-OPERATING
120 - Traffic Control 162 - No. of Citations Issued
346.18(2)
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 NEITHER-ALCOHOL-NOR-DRUGS-PRESENT
89 - Substance Presence
TEST NOT GIVEN90 - Alcohol Test 90 - Alcohol Content TEST NOT GIVEN91 - Drug Test
01
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Vehicle
Vehicle Owner
Insurance
School Bus
IN
S
91 - Drugs Reported
NOT-APPLICABLE
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
804TXH
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2016
59 - Exp Year
90472
55 - Vehicle Identification Number
1999
50 - Year
LEXS
51 - Make
RX 300
52 - Model
UT - SPORT UTILITY
53 - Body Style
RED
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT PASSENGER SIDE
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
FOLTOS
46 - Vehicle Owner Last Name
BARRY
46 - First Name
C
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 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
Operator/Pedestrian
Unit Status
MOTOR VEHICLE IN TRANSPORT
81 - Most Harmful Event: Collision With
EAST
23 - Dir Of Travel
3524 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
WI
30 - State
2023
31 - Expiration Year 34 - On Duty Accident
ANDERSON
25 - Operator/Pedestrian Last Name
ELIZABETH
25 - First Name
EMILY
25 - Middle Initial 25 - Suffix
04/29/
32 - Date Of Birth
FEMALE
33 - Sex
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Wisconsin Motor Vehicle GZDLK32 2 525
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Vehicle
Vehicle Owner
Insurance
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IN
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26 - Address Street & Number 26 - PO Box
LAKE NEBAGAMON
27 - City
WI
27 - State
54849
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
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
TRAFFIC-SIGNAL-OPERATING
120 - Traffic Control 062 - 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 NEITHER-ALCOHOL-NOR-DRUGS-PRESENT
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
1
22 - Total Occupants
892WWU
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2016
59 - Exp Year
7301
55 - Vehicle Identification Number
2001
50 - Year
TOYT
51 - Make
COROLLA
52 - Model
4D - 4DR
53 - Body Style
BLK
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT DRIVER SIDE, FRONT, FRONT PASSENGER SIDE
94 - Vehicle Damage
VERY-SEVERE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
A1 TOWING
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
ANDERSON
46 - Vehicle Owner Last Name
ELIZABETH
46 - First Name
EMILY
46 - Middle Initial 46 - Suffix
04/29/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
LAKE NEBAGAMON48 - City WI48 - State 5484948 - Zip Code .49 - Telephone Number
UNITRIN-DIRECT-PROPERTY-&-CASUALTY-CO63 - Liability Insurance Company Policy Holder Same As Owner60
ANDERSON
61 - Policy Holder Last Name
ELIZABETH
61 - Policy Holder First Name
61 - 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
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
SGT NICK ALMOGHRABI
I, SGT. NICK AL-MOGHRABI, WAS DISPATCHED TO A TWO VEHICLE PROPERTY DAMAGE CRASH IN THE INTERSECTION OF USH 63 AND STH 77 ON 01/27/15 AT 08:54. UPON ARRIVAL AT 08:59, I OBSERVED A RED LEXUS SUV PARKED IN THE MEDIAN ON THE SOUTH
SIDE OF THE INTERSECTION BETWEEN THE USH 63 LANES. I FURTHER OBSERVED A BLACK TOYOTA CAR PARKED IN THE MIDDLE
OF THE EAST BOUND LANES OF STH 77 IN THE INTERSECTION. I MET WITH THE TWO OPERATORS WHO IDENTIFIED THEMSELVES
BY WI DL AS TOMMYE HEINEMANN OF HAYWARD OPERATING THE LEXUS AND ELIZABETH ANDERSON OF LAKE NEBAGAMON
OPERATING THE TOYOTA. BOTH STATED THEY WERE NOT INJURED. I OBSERVED A SCRATCH AND RED MARK NEAR THE HAIRLINE
ON ANDERSON'S FOREHEAD. UPON ASKING HER ABOUT IT, ANDERSON DIDN'T KNOW SHE HAD BEEN INJURED. I REQUESTED EMS NON-EMERGENT AS WELL AS TWO WRECKER SERVICES, ONE BEING ROADRUNNER TOWING AS REQUESTED BY HEINEMANN. I
ADVISED THE OPERATORS THAT I WOULD BE TAKING PHOTOGRAPHS OF THE INCIDENT AND ASKED THEM IF THEY COULD
COMPLETE WRITTEN STATEMENTS. BOTH AGREED TO AND HEINEMANN OFFERED ANDERSON A SEAT IN HER VEHICLE TO STAY
WARM. I OBSERVED MODERATE DAMAGE TO THE FRONT PASSENGER SIDE OF HEINEMANN'S VEHICLE AND VERY SEVERE
DAMAGE TO THE FRONT OF ANDERSON'S VEHICLE INCLUDING AIR BAG DEPLOYMENT OF BOTH THE DRIVER'S AND PASSENGER
SIDE AIRBAGS. UPON THE ARRIVAL OF EMS, I WAS ADVISED THEY WERE TRANSPORTING ANDERSON NON-EMERGENT TO
HAYWARD AREA MEMORIAL HOSPITAL. ONCE PHOTOGRAPHS WERE COMPLETED, I MET WITH HEINEMANN AND REVIEWED HER WRITTEN STATEMENT. UPON ASKING WHAT HAPPENED, HEINEMANN TOLD ME SHE HAD BEEN TRAVELING WEST ON STH 77 AND
WAS TURNING SOUTH ONTO USH 63. HEINEMANN ADVISED SHE HAD A GREEN LIGHT BUT NOT A GREEN ARROW. HEINEMANN
FURTHER STATED SHE THOUGHT SHE HAD ENOUGH TIME TO TURN LEFT BEFORE ANDERSON ENTERED THE INTERSECTION.
UPON MEETING WITH ANDERSON AT THE HOSPITAL, SHE PROVIDED THE SAME ACCOUNT OF THE INCIDENT.
SEE CASE REPORT FOR FULL NARRATIVE.
I, SGT. NICK AL-MOGHRABI, WAS DISPATCHED TO A TWO VEHICLE PROPERTY DAMAGE CRASH IN THE INTERSECTION OF USH 63 AND STH 77 ON 01/27/15 AT 08:54. UPON ARRIVAL AT 08:59, I OBSERVED A RED LEXUS SUV PARKED IN THE MEDIAN ON THE SOUTH
SIDE OF THE INTERSECTION BETWEEN THE USH 63 LANES. I FURTHER OBSERVED A BLACK TOYOTA CAR PARKED IN THE MIDDLE
OF THE EAST BOUND LANES OF STH 77 IN THE INTERSECTION. I MET WITH THE TWO OPERATORS WHO IDENTIFIED THEMSELVES
BY WI DL AS TOMMYE HEINEMANN OF HAYWARD OPERATING THE LEXUS AND ELIZABETH ANDERSON OF LAKE NEBAGAMON
OPERATING THE TOYOTA. BOTH STATED THEY WERE NOT INJURED. I OBSERVED A SCRATCH AND RED MARK NEAR THE HAIRLINE
ON ANDERSON'S FOREHEAD. UPON ASKING HER ABOUT IT, ANDERSON DIDN'T KNOW SHE HAD BEEN INJURED. I REQUESTED EMS NON-EMERGENT AS WELL AS TWO WRECKER SERVICES, ONE BEING ROADRUNNER TOWING AS REQUESTED BY HEINEMANN. I
ADVISED THE OPERATORS THAT I WOULD BE TAKING PHOTOGRAPHS OF THE INCIDENT AND ASKED THEM IF THEY COULD
COMPLETE WRITTEN STATEMENTS. BOTH AGREED TO AND HEINEMANN OFFERED ANDERSON A SEAT IN HER VEHICLE TO STAY
WARM. I OBSERVED MODERATE DAMAGE TO THE FRONT PASSENGER SIDE OF HEINEMANN'S VEHICLE AND VERY SEVERE
DAMAGE TO THE FRONT OF ANDERSON'S VEHICLE INCLUDING AIR BAG DEPLOYMENT OF BOTH THE DRIVER'S AND PASSENGER
SIDE AIRBAGS. UPON THE ARRIVAL OF EMS, I WAS ADVISED THEY WERE TRANSPORTING ANDERSON NON-EMERGENT TO
HAYWARD AREA MEMORIAL HOSPITAL. ONCE PHOTOGRAPHS WERE COMPLETED, I MET WITH HEINEMANN AND REVIEWED HER WRITTEN STATEMENT. UPON ASKING WHAT HAPPENED, HEINEMANN TOLD ME SHE HAD BEEN TRAVELING WEST ON STH 77 AND
WAS TURNING SOUTH ONTO USH 63. HEINEMANN ADVISED SHE HAD A GREEN LIGHT BUT NOT A GREEN ARROW. HEINEMANN
FURTHER STATED SHE THOUGHT SHE HAD ENOUGH TIME TO TURN LEFT BEFORE ANDERSON ENTERED THE INTERSECTION.
UPON MEETING WITH ANDERSON AT THE HOSPITAL, SHE PROVIDED THE SAME ACCOUNT OF THE INCIDENT.
SEE CASE REPORT FOR FULL NARRATIVE.
Officer Information
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125 - First Name 125 - Middle Initial
ALMOGHRABI
125 - Officer Last Name
NICK 392
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
01/27/2016
132 - Date Notified 0854133 - Time Notified (Military Time)0859134 - Time Arrived (Military Time)
01/27/2016
135 - Date Of Report
16012703 116012703 19 - Special Study
18 - Agency Space
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