20160226 Hall HenkAgency Accident Number
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Reportable Accident On Emergency Amended GZDGTZD
DOT Document Number Document Override Number
16022605
16
0
2
2
6
0
5
02/26/2016
4 - Accident Date
1522
5 - Time of Accident (Military Time)
02
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County BASS LAKE - 01, TOWN3 - Municipality INTERSECTION11 - Accident Location
027
14 - On Hwy No.
SB
14 - On Street Name 14 - Bus/Frnt/Rmp 15 - Est. Distance 15 - Hwy. Dir
16 - Fr/At Hwy No.HENKS RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.926853
12 - Latitude -91.49419513 - Longitude
MOTOR VEHICLE IN TRANSPORT80 - First Harmful Event REAR-END93 - 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 DRY116 - 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
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Unit Status
MOTOR VEHICLE IN TRANSPORT
81 - Most Harmful Event: Collision With
SOUTH
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
2022
31 - Expiration Year 34 - On Duty Accident
HALL
25 - Operator/Pedestrian Last Name
KRISTINA
25 - First Name
I
25 - Middle Initial 25 - Suffix
10/30
32 - Date Of Birth
FEMALE
33 - Sex
26 - Address Street & Number 26 - PO Box
MINONG
27 - City
WI
27 - State
54859
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
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 162 - No. of Citations Issued
344.62(1)
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
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Vehicle
Vehicle Owner
Insurance
School Bus
IN
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91 - Drugs Reported
NOT-APPLICABLE
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
5
22 - Total Occupants
661YGL
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2017
59 - Exp Year
768
55 - Vehicle Identification Number
1999
50 - Year
DODG
51 - Make
DURANGO
52 - Model
UT - SPORT UTILITY
53 - Body Style
GRN
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT, FRONT DRIVER SIDE, FRONT PASSENGER SIDE
94 - Vehicle Damage
MODERATE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
A-1 TOWING
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
HALL
46 - Vehicle Owner Last Name
KRISTINA
46 - First Name
I
46 - Middle Initial 46 - Suffix
10/30/1
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
MINONG48 - City WI48 - State 5485948 - Zip Code 49 - Telephone Number
NONE63 - 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
SOUTH
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
2016
31 - Expiration Year 34 - On Duty Accident
HENK
25 - Operator/Pedestrian Last Name
STEPHEN
25 - First Name
A
25 - Middle Initial 25 - Suffix
07/06/1
32 - Date Of Birth
MALE
33 - Sex
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Wisconsin Motor Vehicle GZDGTZD 2 626
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Vehicle
Vehicle Owner
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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
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-RIGHT-TURN
119 - What Driver Was Doing
NO-CONTROL
120 - Traffic Control 0062 - 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
273442F
56 - License Plate Number
FRM57 - Plate Type WI
58 - State
2016
59 - Exp Year
096
55 - Vehicle Identification Number
2002
50 - Year
CHEV
51 - Make
SILVERADO
52 - Model
PK - PICKUP
53 - Body Style
BLK
54 - Color 100 - Skidmarks to Impact (Ft)
REAR
94 - Vehicle Damage
MINOR
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
HENK
46 - Vehicle Owner Last Name
STEPHEN
46 - First Name
A
46 - Middle Initial 46 - Suffix
07/06/1
Date Of Birth
46 - Company Name
D
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
AMERICAN-FAMILY-MUTUAL-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60
HENK
61 - Policy Holder Last Name
STEPHEN
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
Occupant
Address Same As Operator
OC
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01
65 - Unit No
UNKNOWN
66 - Occupant Last Name 66 - First Name 66 - Middle Initial 66 - Suffix
01
68 - Address Street & Number 68 - PO Box
MINONG
68 - City
WI
68 - State
54859
68 - Zip Code
67 - Date of Birth 69 - Sex
UNKNOWN
71 - Seat Position
CHILD-SAFETY-SEAT-USED
72 - Safety Equipment
N - NO APPARENT INJURY
70 - Injury Severity
NOT APPLICABLE
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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P
A
N
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01
65 - Unit No
JOHNSON
66 - Occupant Last Name
CHRISTOPHER
66 - First Name
J
66 - Middle Initial 66 - Suffix
02
68 - Address Street & Number 68 - PO Box
HAYWARD
68 - City
WI
68 - State
54843
68 - Zip Code
09/16/
67 - Date of Birth
M
69 - Sex
FRONT-SEAT-RIGHT-SIDE-(TRAIN ENGINEER)
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
C
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P
A
N
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01
65 - Unit No
DENHARTOG
66 - Occupant Last Name
MARK
66 - First Name
A
66 - Middle Initial
JR
66 - Suffix
03
68 - Address Street & Number 68 - PO Box
MINONG
68 - City
WI
68 - State
54859
68 - Zip Code
02/16/
67 - Date of Birth
M
69 - Sex
SECOND-SEAT-MIDDLE
71 - Seat Position
LAP-BELT-ONLY-USED
72 - Safety Equipment
N - NO APPARENT INJURY
70 - Injury Severity
NOT APPLICABLE
73 - Airbag
NOT-EJECTED
75 - Ejected
Medical Transport
77
NOT-TRAPPED
76 - Trapped/Extricated 78 - Agency Space
Occupant
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Address Same As Operator
OC
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65 - Unit No
UNKNOWN
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
UNKNOWN
71 - Seat Position
SHOULDER-BELT-AND-LAP-BELT-USED
72 - Safety Equipment
N - NO APPARENT INJURY
70 - Injury Severity
NOT APPLICABLE
73 - Airbag
NOT-EJECTED
75 - Ejected
Medical Transport
77
NOT-TRAPPED
76 - Trapped/Extricated 78 - Agency Space
Trailer
01
TR
L
106 - Power Unit Number License Plate Number Plate Type State Expiration Year
Trailer Make Unit Type Vehicle Identification Number
105 - Photos By
DI
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Diagram and Narrative
DEPUTY GILLIS
THE TWO VEHICLES WERE TRAVELING SOUTH ON HWY 27. THE TRUCK WAS TURNING RIGHT ONTO HENKS RD AND THE VEHICLE
BEHIND THE TRUCK REAR ENDED THE TRUCK WHILE IT WAS TURNING. THE TRUCK HAD IT'S TURN SIGNAL ON TO TURN, BUT THE
OTHER VEHICLE DIDN'T SEE THAT THE TRUCK WAS TURNING.
THE TWO VEHICLES WERE TRAVELING SOUTH ON HWY 27. THE TRUCK WAS TURNING RIGHT ONTO HENKS RD AND THE VEHICLE
BEHIND THE TRUCK REAR ENDED THE TRUCK WHILE IT WAS TURNING. THE TRUCK HAD IT'S TURN SIGNAL ON TO TURN, BUT THE
OTHER VEHICLE DIDN'T SEE THAT THE TRUCK WAS TURNING.
Officer Information
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125 - First Name 125 - Middle Initial
GILLIS125 - Officer Last Name KEVIN 345131 - Officer ID
129 - Law Enforcement Agency No.
SAWYER COUNTY SHERIFFS DEPT
130 - Law Enforcement Agency Name
15880 EAST FIFTH STREET126 - Law Enforcement Agency Address Street & Number
HAYWARD
127 - City
WI
127 - State
54843
127 - Zip Code
(715) 634-4858 EXT.
128 - Telephone Number
02/26/2016132 - Date Notified 1524133 - Time Notified (Military Time)1524134 - Time Arrived (Military Time)03/01/2016135 - Date Of Report
16022605 19 - Special Study
18 - Agency Space
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