20160130 MeltonAgency Accident Number
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Police Number
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Reportable Accident On Emergency Amended GZDTZ9M
DOT Document Number Document Override Number
16013001
16
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1
16013001158
16
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5
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01/30/2016
4 - Accident Date
0744
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 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.BENDER RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.998000
12 - Latitude -91.43273413 - Longitude
TREE80 - First Harmful Event NO COLLISION WITH MOTOR VEHICLE IN TRANSPORT93 - 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
OUTSIDE-SHOULDER-LEFT
117 - Relation To Roadway
DAYLIGHT114 - Light Condition SNOW/SLUSH116 - 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
OP
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Unit Status
TREE
81 - Most Harmful Event: Collision With
WEST
23 - Dir Of Travel
5524 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
Number
ND
30 - State
2019
31 - Expiration Year 34 - On Duty Accident
MELTON
25 - Operator/Pedestrian Last Name
JENNY
25 - First Name
L
25 - Middle Initial 25 - Suffix
06/12/
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-ONLY-USED
40 - Safety Equipment
N - NO APPARENT 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 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
01
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDTZ9M 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
1
22 - Total Occupants
406TCJ
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2016
59 - Exp Year
9476
55 - Vehicle Identification Number
2013
50 - Year
CHEV
51 - Make
EQUINOX
52 - Model
UT - SPORT UTILITY
53 - Body Style
BLU
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT DRIVER SIDE, FRONT, FRONT PASSENGER SIDE
94 - Vehicle Damage
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
MELTON
46 - Vehicle Owner Last Name
LYNN
46 - First Name
A
46 - Middle Initial 46 - Suffix
03/16/1
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code .49 - Telephone Number
PROGRESSIVE-CASUALTY-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60
MELTON
61 - Policy Holder Last Name
LYNN
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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Wisconsin Motor Vehicle GZDTZ9M 2 424
Fixed Objects Struck
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Property
UNKNOWN
Organization Type 84 - Property Owner Last Name 84 - First Name 84 - Middle Initial 84 - Suffix
01
84 - Company Name Government Property Type
85 - Address Street & Number 85 - PO Box
86 - City 86 - State 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
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Diagram and Narrative
DEPUTY HOUSE
UNIT 1 WAS TRAVELLING WESTBOUND ON HIGHWAY B TOWARDS HAYWARD. WHEN UNIT1 CAME OVER A HILL, UNIT 1 DRIVER
TAPPED BRAKES TO SLOWER TRAFFIC AHEAD. WHILE DOING SO, VEHICLES REAR END GAVE OUT AND STARTED TO SWAY LEFT
AND RIGHT. UNIT 1 DRIVER LOST CONTROL AND VEHICLE PROCEEDED TO LEFT SHOULDER AND INTO THE DITCH..UNIT 1 THEN
STRUCK A TREE CAUSING SEVERE DAMAGE..ICE AND SLUSH COVERED ROADS WERE A FACTOR IN THIS INCIDENT. DRIVER OF
UNIT 1 WAS TRANSPORTED TO HOSPITAL BY PRIVATE CARRIER. ROADRUNNER TOWING REMOVED VEHICLE
UNIT 1 WAS TRAVELLING WESTBOUND ON HIGHWAY B TOWARDS HAYWARD. WHEN UNIT1 CAME OVER A HILL, UNIT 1 DRIVER
TAPPED BRAKES TO SLOWER TRAFFIC AHEAD. WHILE DOING SO, VEHICLES REAR END GAVE OUT AND STARTED TO SWAY LEFT
AND RIGHT. UNIT 1 DRIVER LOST CONTROL AND VEHICLE PROCEEDED TO LEFT SHOULDER AND INTO THE DITCH..UNIT 1 THEN
STRUCK A TREE CAUSING SEVERE DAMAGE..ICE AND SLUSH COVERED ROADS WERE A FACTOR IN THIS INCIDENT. DRIVER OF
UNIT 1 WAS TRANSPORTED TO HOSPITAL BY PRIVATE CARRIER. ROADRUNNER TOWING REMOVED VEHICLE
Officer Information
Accident Report
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MV4000e 01/2005
Page
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Wisconsin Motor Vehicle GZDTZ9M 3 4
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125 - First Name 125 - Middle Initial
HOUSE
125 - Officer Last Name
ROB 317
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
01/30/2016
132 - Date Notified 0744133 - Time Notified (Military Time)0747134 - Time Arrived (Military Time)
02/01/2016
135 - Date Of Report
16013001 16013001158 19 - Special Study
18 - Agency Space
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDTZ9M 4 4