20160402 FisherAgency Accident Number
AC
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#
PO
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Police Number
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Reportable Accident On Emergency Amended GZD7FQT
DOT Document Number Document Override Number
04/02/2016
4 - Accident Date
1100
5 - Time of Accident (Military Time)
01
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County BASS LAKE - 01, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
027
14 - On Hwy No.
NB
14 - On Street Name 14 - Bus/Frnt/Rmp
699 FT15 - Est. Distance NORTH15 - Hwy. Dir
16 - Fr/At Hwy No.METCALF RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.886411
12 - Latitude -91.50138713 - Longitude
OVERTURN80 - First Harmful Event NO COLLISION WITH MOTOR VEHICLE IN TRANSPORT93 - Manner of Collision
FULL CONTROL
112 - Access Control
STRAIGHT
113 - Road Curvature
LEVEL/FLAT
113 - Road Terrain
BLACKTOP, BITUMINOUS, OR ASPHALT - 2
Surface Type
NOT-PHYSICALLY-DIVIDED-(2-WAY TRAFFIC)115 - Traffic Way
ON-ROADWAY
117 - Relation To Roadway
DAYLIGHT114 - Light Condition SNOW/SLUSH116 - Road Surface Condition SEVERE-CROSSWINDS118 - 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
E
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A
T
O
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/
P
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Unit Status
OVERTURN
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
IL
30 - State 31 - Expiration Year 34 - On Duty Accident
FISHER
25 - Operator/Pedestrian Last Name
LAWRENCE
25 - First Name
F
25 - Middle Initial 25 - Suffix
05/24/1
32 - Date Of Birth
MALE
33 - Sex
26 - Address Street & Number 26 - PO Box
CHICAGO
27 - City
IL
27 - State
60655
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
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 UNKNOWN
89 - Substance Presence
TEST NOT GIVEN90 - Alcohol Test 90 - Alcohol Content TEST NOT GIVEN91 - Drug Test
01
Accident Report
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VE
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VE
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N
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Vehicle
Vehicle Owner
Insurance
School Bus
IN
S
91 - Drugs Reported
SNOW,-ICE,-OR-WET
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
G378970
56 - License Plate Number
AUT57 - Plate Type IL
58 - State
2017
59 - Exp Year
762
55 - Vehicle Identification Number
2006
50 - Year
DODG
51 - Make
CARRYALL
52 - Model
4D - 4DR
53 - Body Style
SIL
54 - Color 100 - Skidmarks to Impact (Ft)
TOP OF VEHICLE, FRONT, FRONT DRIVER SIDE, REAR DRIVER SIDE, REAR, MIDDLE DRIVER SIDE, FRONT
PASSENGER SIDE, MIDDLE PASSENGER SIDE, REAR 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
FISHER
46 - Vehicle Owner Last Name
LAWRENCE
46 - First Name
F
46 - Middle Initial 46 - Suffix
05/24
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
CHICAGO48 - City IL48 - State 6065548 - Zip Code 49 - Telephone Number
STATE-FARM63 - Liability Insurance Company Policy Holder Same As Owner60
FISHER
61 - Policy Holder Last Name
LAWRENCE
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
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Wisconsin Motor Vehicle GZD7FQT 2 323
105 - Photos By
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Diagram and Narrative
DEPUTY C DEPEW
VEHICLE WAS TRAVELING NORTH ON STH 27 NORTH OF METCALF RD . DRIVER STATED THAT HE STARTED TO SLIDE IN THE SLUSH
AND ICE AND BEGAN TO LOOSE CONTROL OF THE VEHICLE AND IT OVERTURNED WHEN IT HIT THE SHOULDER TURNING ONE FULL
TIME COMING TO REST ON ITS TIRES. ROAD CONDITIONS WERE ICE COVERED AND VERY SLIPPERY WITH HIGH WINDS
VEHICLE WAS TRAVELING NORTH ON STH 27 NORTH OF METCALF RD . DRIVER STATED THAT HE STARTED TO SLIDE IN THE SLUSH
AND ICE AND BEGAN TO LOOSE CONTROL OF THE VEHICLE AND IT OVERTURNED WHEN IT HIT THE SHOULDER TURNING ONE FULL
TIME COMING TO REST ON ITS TIRES. ROAD CONDITIONS WERE ICE COVERED AND VERY SLIPPERY WITH HIGH WINDS
OF
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125 - First Name 125 - Middle Initial
Officer Information
DEPEW
125 - Officer Last Name
CRAIG 344
131 - Officer ID
129 - Law Enforcement Agency No.SAWYER COUNTY SHERIFFS DEPT130 - Law Enforcement Agency Name
15880 EAST FIFTH STREET
126 - Law Enforcement Agency Address Street & Number
HAYWARD127 - City WI127 - State 54843127 - Zip Code (715) 634-4858 EXT.128 - Telephone Number
04/02/2016
132 - Date Notified 1112133 - Time Notified (Military Time)1127134 - Time Arrived (Military Time)
04/02/2016
135 - Date Of Report
19 - Special Study
18 - Agency Space
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZD7FQT 3 3