20160318 TartAgency Accident Number
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Reportable Accident On Emergency Amended GZDZNDX
DOT Document Number Document Override Number
16031801
16
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3
1
8
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1
03/18/2016
4 - Accident Date
0300
5 - Time of Accident (Military Time)
01
6 - Total Units
01
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County LENROOT - 08, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
063
14 - On Hwy No.
NB
14 - On Street Name 14 - Bus/Frnt/Rmp
994 FT15 - Est. Distance SOUTH15 - Hwy. Dir
16 - Fr/At Hwy No.NELSON LAKE RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
46.067124
12 - Latitude -91.43495513 - Longitude
DITCH80 - 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-LEFT
117 - Relation To Roadway
DARK-NOT-LIGHTED114 - Light Condition DRY116 - 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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DITCH
81 - Most Harmful Event: Collision With
NORTH
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
2020
31 - Expiration Year 34 - On Duty Accident
TART
25 - Operator/Pedestrian Last Name
JUSTIN
25 - First Name
J
25 - Middle Initial 25 - Suffix
07/17
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
B - NON-INCAPACITATING 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 162 - No. of Citations Issued
346.63(1)(A)
64 - 1st Statute No.64 - 2nd Statute No.64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
OTHER
122 - Driver Factors
ABILITY IMPAIRED88 - Driver or Pedestrian Cond ALCOHOL-PRESENT
89 - Substance Presence
TEST GIVEN90 - Alcohol Test 1490 - Alcohol Content TEST NOT GIVEN91 - Drug Test
01
Accident Report
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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
1
22 - Total Occupants
401UMR
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2016
59 - Exp Year
015
55 - Vehicle Identification Number
2013
50 - Year
FORD
51 - Make
FOCUS
52 - Model
4H - HATCHBACK 4
53 - Body Style
BLK
54 - Color
0100 - Skidmarks to Impact (Ft)
REAR DRIVER SIDE, MIDDLE DRIVER SIDE, FRONT DRIVER SIDE, TOP OF VEHICLE, REAR PASSENGER SIDE,
MIDDLE PASSENGER SIDE, FRONT PASSENGER SIDE
94 - Vehicle Damage
MODERATE
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
TART
46 - Vehicle Owner Last Name
KEVIN
46 - First Name
J
46 - Middle Initial 46 - Suffix
07/31/
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
TART
61 - Policy Holder Last Name
KEVIN
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
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
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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
DITCH
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 GILLIS
DRIVER SAID THAT HE HAD NO IDEA WHY HE WENT OFF OF THE ROADWAY, ENTERED THE DITCH ON THE WEST SIDE OF THE
HIGHWAY, OVER CORRECTED AND ROLLED THE VEHICLE APPROXIMATELY TWO TIMES. THIS DEPUTY BELIEVES THAT THE CRASH
WAS A RESULT OF IMPAIRED DRIVING DUE TO ALCOHOL CONSUMPTION.
DRIVER SAID THAT HE HAD NO IDEA WHY HE WENT OFF OF THE ROADWAY, ENTERED THE DITCH ON THE WEST SIDE OF THE
HIGHWAY, OVER CORRECTED AND ROLLED THE VEHICLE APPROXIMATELY TWO TIMES. THIS DEPUTY BELIEVES THAT THE CRASH
WAS A RESULT OF IMPAIRED DRIVING DUE TO ALCOHOL CONSUMPTION.
Officer Information
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Wisconsin Motor Vehicle GZDZNDX 3 4
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125 - First Name 125 - Middle Initial
SIMPSON
125 - Officer Last Name
MICHAEL 357
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
03/18/2016
132 - Date Notified 0300133 - Time Notified (Military Time)0305134 - Time Arrived (Military Time)
03/18/2016
135 - Date Of Report
16031801 19 - Special Study
18 - Agency Space
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