20160207 EytchesonAgency Accident Number
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Reportable Accident On Emergency Amended GZDVPJN
DOT Document Number Document Override Number
16020701502
16
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2
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7
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1
5
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16020705
16
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2
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7
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5
02/07/2016
4 - Accident Date
1927
5 - Time of Accident (Military Time)
01
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County WINTER - 17, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
B
14 - On Hwy No.14 - On Street Name 14 - Bus/Frnt/Rmp
1.03 MI15 - Est. Distance WEST15 - Hwy. Dir
16 - Fr/At Hwy No.W BARBER RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.901436
12 - Latitude -90.99670613 - Longitude
CULVERT80 - First Harmful Event NO COLLISION WITH MOTOR VEHICLE IN TRANSPORT93 - Manner of Collision
NO CONTROL
112 - Access Control
CURVE
113 - Road Curvature
LEVEL/FLAT
113 - Road Terrain
BLACKTOP, BITUMINOUS, OR ASPHALT - 2
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 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
OP
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Unit Status
CULVERT
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
29 - Driver's License Number
WI
30 - State
2017
31 - Expiration Year 34 - On Duty Accident
EYTCHESON
25 - Operator/Pedestrian Last Name
SUSAN
25 - First Name
JOAN
25 - Middle Initial 25 - Suffix
05/26
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
NEGOTIATING-CURVE
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.
FAILURE-TO-HAVE-CONTROL
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
01
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Wisconsin Motor Vehicle GZDVPJN 1 5
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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
5
22 - Total Occupants
512CCL
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2016
59 - Exp Year
1648
55 - Vehicle Identification Number
2009
50 - Year
CHEV
51 - Make
SUBURBAN
52 - Model
UT - SPORT UTILITY
53 - Body Style
GLD
54 - Color
0100 - Skidmarks to Impact (Ft)
FRONT PASSENGER SIDE, MIDDLE PASSENGER SIDE, FRONT
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
EYTCHESON
46 - Vehicle Owner Last Name
SUSAN
46 - First Name
JOAN
46 - Middle Initial 46 - Suffix
05/26/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
USAA-CASUALTY-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60
EYTCHESON
61 - Policy Holder Last Name
SUSAN
61 - Policy Holder First Name
61 - 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
Occupant
Address Same As Operator
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65 - Unit No
GAJEWSKI
66 - Occupant Last Name
JILL
66 - First Name
R
66 - Middle Initial 66 - Suffix
01
68 - Address Street & Number 68 - PO Box
HAYWARD
68 - City
WI
68 - State
54843
68 - Zip Code
10/26/67 - Date of Birth F69 - Sex
FRONT-SEAT-RIGHT-SIDE-(TRAIN ENGINEER)
71 - Seat Position
SHOULDER-BELT-AND-LAP-BELT-USED
72 - Safety Equipment
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Wisconsin Motor Vehicle
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Wisconsin Motor Vehicle GZDVPJN 2 525
N - NO APPARENT INJURY
70 - Injury Severity
NON-DEPLOYED
73 - Airbag
NOT-EJECTED
75 - Ejected
Medical Transport
77
NOT-TRAPPED
76 - Trapped/Extricated 78 - Agency Space
Occupant
Address Same As Operator
OC
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65 - Unit No
REFUSED
66 - Occupant Last Name 66 - First Name 66 - Middle Initial 66 - Suffix
02
68 - Address Street & Number 68 - PO Box
68 - City 68 - State 68 - Zip Code
67 - Date of Birth 69 - Sex
SECOND-SEAT-LEFT-SIDE-(MC/BIKE PASSENGER, TRAIN BREAKMA
71 - Seat Position
SHOULDER-BELT-AND-LAP-BELT-USED
72 - Safety Equipment
N - NO APPARENT INJURY
70 - Injury Severity
NON-DEPLOYED
73 - Airbag
NOT-EJECTED
75 - Ejected
Medical Transport
77
NOT-TRAPPED
76 - Trapped/Extricated 78 - Agency Space
Occupant
Address Same As Operator
OC
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A
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01
65 - Unit No
REFUSED
66 - Occupant Last Name 66 - First Name 66 - Middle Initial 66 - Suffix
03
68 - Address Street & Number 68 - PO Box
68 - City 68 - State 68 - Zip Code
67 - Date of Birth 69 - Sex
SECOND-SEAT-RIGHT
71 - Seat Position
SHOULDER-BELT-AND-LAP-BELT-USED
72 - Safety Equipment
N - NO APPARENT INJURY
70 - Injury Severity
NON-DEPLOYED
73 - Airbag
NOT-EJECTED
75 - Ejected
Medical Transport
77
NOT-TRAPPED
76 - Trapped/Extricated 78 - Agency Space
Occupant
Address Same As Operator
OC
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01
65 - Unit No
REFUSED
66 - Occupant Last Name 66 - First Name 66 - Middle Initial 66 - Suffix
04
68 - Address Street & Number 68 - PO Box
68 - City 68 - State 68 - Zip Code
67 - Date of Birth 69 - Sex
THIRD-ROW-RIGHT-SIDE
71 - Seat Position
SHOULDER-BELT-AND-LAP-BELT-USED
72 - Safety Equipment
N - NO APPARENT INJURY
70 - Injury Severity
NON-DEPLOYED
73 - Airbag
NOT-EJECTED
75 - Ejected
Medical Transport
77
NOT-TRAPPED
76 - Trapped/Extricated 78 - Agency Space
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Wisconsin Motor Vehicle GZDVPJN 3 5
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
Fixed Objects Struck
PR
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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
CULVERT
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
POPLIN
UNIT 1 WAS NEGOTIATING A CORNER WHILE TRAVELING WEST ON COUNTY HWY B. THE ROAD CONDITIONS WERE SNOW COVERED AND SLIPPERY AND THERE WAS ACTIVE SNOW STILL COMING DOWN. UNIT 1 WENT INTO THE DEEPER SNOW ON THE
SIDE OF THE ROAD AND THE DRIVER OF UNIT 1 SAID THE DEEPER SNOW SUCKED HER INTO THE DITCH. UNIT 1 WENT INTO THE
DITCH AND STRUCK A CULVERT CAUSING MODERATE DAMAGE TO THE FRONT AND PASSENGER SIDE OF THE VEHICLE. UNIT 1
HAD TO BE TOWED OUT OF THE DITCH, BUT WAS THEN ABLE TO BE DRIVE AWAY FROM THE CRASH SCENE.
UNIT 1 WAS NEGOTIATING A CORNER WHILE TRAVELING WEST ON COUNTY HWY B. THE ROAD CONDITIONS WERE SNOW COVERED AND SLIPPERY AND THERE WAS ACTIVE SNOW STILL COMING DOWN. UNIT 1 WENT INTO THE DEEPER SNOW ON THE
SIDE OF THE ROAD AND THE DRIVER OF UNIT 1 SAID THE DEEPER SNOW SUCKED HER INTO THE DITCH. UNIT 1 WENT INTO THE
DITCH AND STRUCK A CULVERT CAUSING MODERATE DAMAGE TO THE FRONT AND PASSENGER SIDE OF THE VEHICLE. UNIT 1
HAD TO BE TOWED OUT OF THE DITCH, BUT WAS THEN ABLE TO BE DRIVE AWAY FROM THE CRASH SCENE.
Officer Information
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Wisconsin Motor Vehicle GZDVPJN 4 5
OF
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125 - First Name 125 - Middle Initial
POPLIN
125 - Officer Last Name
JAY 352
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
02/07/2016
132 - Date Notified 1927133 - Time Notified (Military Time)2001134 - Time Arrived (Military Time)
02/10/2016
135 - Date Of Report
16020701502 16020705 19 - Special Study
18 - Agency Space
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Wisconsin Motor Vehicle GZDVPJN 5 5