20160412 KeatingAgency Accident Number
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Police Number
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Reportable Accident On Emergency Amended GZDNRQV
DOT Document Number Document Override Number
04/12/2016
4 - Accident Date
1535
5 - Time of Accident (Military Time)
01
6 - Total Units
01
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County SPIDER LAKE - 15, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
077
14 - On Hwy No.
EB
14 - On Street Name 14 - Bus/Frnt/Rmp
0.35 MI15 - Est. Distance NORTH15 - Hwy. Dir
16 - Fr/At Hwy No.FEDERAL FOREST RD 20816 - From/At Street Name 16 - Business/Frontage/Ramp
FIRE #
17 - Structure Type
5310
17 - Structure Number
46.130163
12 - Latitude -90.94612313 - Longitude
DITCH80 - First Harmful Event NO COLLISION WITH MOTOR VEHICLE IN TRANSPORT93 - Manner of Collision
NO 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
OUTSIDE-SHOULDER-LEFT
117 - Relation To Roadway
DUSK114 - 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
OP
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Unit Status
TREE
81 - Most Harmful Event: Collision With
EAST
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
MI
30 - State
2019
31 - Expiration Year 34 - On Duty Accident
KEATING
25 - Operator/Pedestrian Last Name
MICHAEL
25 - First Name
J
25 - Middle Initial 25 - Suffix
12/10/
32 - Date Of Birth
MALE
33 - Sex
26 - Address Street & Number 26 - PO Box
WAKEFIELD
27 - City
MI
27 - State
49968
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
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.
INATTENTIVE-DRIVING
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
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZDNRQV 1 4
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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
1
22 - Total Occupants
CJB1661
56 - License Plate Number
AUT57 - Plate Type MI
58 - State
2016
59 - Exp Year
1563
55 - Vehicle Identification Number
2011
50 - Year
TOYT
51 - Make
AVALON
52 - Model
4D - 4DR
53 - Body Style
BLK
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT, FRONT DRIVER SIDE, MIDDLE DRIVER SIDE, REAR DRIVER SIDE, REAR, REAR PASSENGER SIDE, MIDDLE
PASSENGER SIDE, FRONT PASSENGER SIDE, UNDERCARRIAGE
94 - Vehicle Damage
VERY-SEVERE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
TOW
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
CALLOVI
46 - Vehicle Owner Last Name
FRANCES
46 - First Name
A
46 - Middle Initial 46 - Suffix
10/16
Date Of Birth
46 - Company Name
47- Address Street & Number
255
47 - PO Box
RAMSAY48 - City MI48 - State 4995948 - Zip Code 49 - Telephone Number
AUTO-OWNERS-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60
CALLOVI
61 - Policy Holder Last Name
FRANCES
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 GZDNRQV 2 424
Fixed Objects Struck
PR
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Property
GOVERNMENT
Organization Type 84 - Property Owner Last Name 84 - First Name 84 - Middle Initial 84 - Suffix
01
WISCONSIN DEPT OF TRANSPORTATION
84 - Company Name
FEDERAL/STATE
Government Property Type
85 - Address Street & Number 85 - PO Box
SUPERIOR
86 - City
WI
86 - State
54880
86 - Zip Code 87 - Telephone Number
314565
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
STANLEY 390
2016041206 DRIVER OF UNIT 1 FELL ASLEEP, LEFT THE ROADWAY HITTING DITCH, DAMAGING CULVERT INLET AT 5310W STH 77.
UNIT 1 LAUNCHED OVER DRIVEWAY LANDED AND STRUCK A TREE. CAR TOTALED DRIVER TRANSPORTED BY EMS TO HAYWARD
ER.
2016041206 DRIVER OF UNIT 1 FELL ASLEEP, LEFT THE ROADWAY HITTING DITCH, DAMAGING CULVERT INLET AT 5310W STH 77.
UNIT 1 LAUNCHED OVER DRIVEWAY LANDED AND STRUCK A TREE. CAR TOTALED DRIVER TRANSPORTED BY EMS TO HAYWARD
ER.
Officer Information
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZDNRQV 3 4
OF
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125 - First Name 125 - Middle Initial
STANLEY
125 - Officer Last Name
SAVANNAH 390
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
04/12/2016
132 - Date Notified 1538133 - Time Notified (Military Time)1718134 - Time Arrived (Military Time)
04/12/2016
135 - Date Of Report
19 - Special Study
2016041206
18 - Agency Space
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZDNRQV 4 4