20160529 Heath HoffAgency Accident Number
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Reportable Accident On Emergency Amended GZGXX61
DOT Document Number Document Override Number
16052906563
16
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5
2
9
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16052902
16
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9
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05/29/2016
4 - Accident Date
1236
5 - Time of Accident (Military Time)
02
6 - Total Units
03
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County COUDERAY - 51, VILLAGE3 - Municipality INTERSECTION11 - Accident Location
027
14 - On Hwy No.14 - On Street Name 14 - Bus/Frnt/Rmp
0 FT15 - Est. Distance 15 - Hwy. Dir
16 - Fr/At Hwy No.MAPES RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number 12 - Latitude 13 - Longitude
MOTOR VEHICLE IN TRANSPORT80 - First Harmful Event SIDESWIPE. OPPOSITE DIRECTION93 - Manner of Collision
PARTIAL 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 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
1605290656379 - E M S Number
Operator/Pedestrian
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Unit Status
MOTOR VEHICLE IN TRANSPORT
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
WI
30 - State
2016
31 - Expiration Year 34 - On Duty Accident
HEATH
25 - Operator/Pedestrian Last Name
THERESE
25 - First Name
M
25 - Middle Initial 25 - Suffix
09/22/
32 - Date Of Birth
FEMALE
33 - Sex
26 - Address Street & Number 26 - PO Box
STONE LAKE
27 - City
WI
27 - State
54876
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
A - 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
MAKING-LEFT-TURN
119 - What Driver Was Doing
NO-CONTROL
120 - Traffic Control 162 - No. of Citations Issued
346.18(2)
64 - 1st Statute No.64 - 2nd Statute No.64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
FAIL-TO-YIELD-RIGHT-OF-WAY
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
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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
219YDP
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2016
59 - Exp Year
146
55 - Vehicle Identification Number
2008
50 - Year
STRN
51 - Make
VUE
52 - Model
UT - SPORT UTILITY
53 - Body Style
RED
54 - Color 100 - Skidmarks to Impact (Ft)
TOTAL (DAMAGE TO ALL AREAS)
94 - Vehicle Damage
VERY-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
HEATH
46 - Vehicle Owner Last Name
THERESE
46 - First Name
M
46 - Middle Initial 46 - Suffix
09/22/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
STONE LAKE48 - City WI48 - State 5487648 - Zip Code 49 - Telephone Number
PROGRESSIVE-CASUALTY-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60
HEATH
61 - Policy Holder Last Name
THERESE
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
EAST
23 - Dir Of Travel
4524 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
29 - Driver's License Number
SD
30 - State
2021
31 - Expiration Year 34 - On Duty Accident
HOFF
25 - Operator/Pedestrian Last Name
KENNETH
25 - First Name
ALAN
25 - Middle Initial 25 - Suffix
05/06/
32 - Date Of Birth
MALE
33 - Sex
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Wisconsin Motor Vehicle GZGXX61 2 525
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Vehicle
Vehicle Owner
Insurance
OP
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IN
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26 - Address Street & Number 26 - PO Box
MELLETTE
27 - City
SD
27 - State
57461
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
A - 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.
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
91 - Drugs Reported
NOT-APPLICABLE
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
2
22 - Total Occupants
3B3310
56 - License Plate Number
AUT57 - Plate Type SD
58 - State
2016
59 - Exp Year
5810
55 - Vehicle Identification Number
2014
50 - Year
NISS
51 - Make
ALTIMA
52 - Model
4D - 4DR
53 - Body Style
BLK
54 - Color 100 - Skidmarks to Impact (Ft)
TOTAL (DAMAGE TO ALL AREAS)
94 - Vehicle Damage
VERY-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
46 - Vehicle Owner Last Name 46 - First Name 46 - Middle Initial 46 - Suffix Date Of Birth
HARR MOTORS46 - Company Name
47- Address Street & Number
1885
47 - PO Box
ABERDEEN48 - City SD48 - State 5740248 - Zip Code 49 - Telephone Number
UNKNOWN63 - Liability Insurance Company Policy Holder Same As Owner60
61 - Policy Holder Last Name 61 - Policy Holder First Name
61 - Policy Holder Company
02
02
02
02
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Wisconsin Motor Vehicle GZGXX61 3 5
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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02
65 - Unit No
HOFF
66 - Occupant Last Name
KENDA
66 - First Name
ANN
66 - Middle Initial 66 - Suffix
01
68 - Address Street & Number 68 - PO Box
MELLETTE
68 - City
SD
68 - State
57461
68 - Zip Code
03/11/
67 - Date of Birth
F
69 - Sex
FRONT-SEAT-RIGHT-SIDE-(TRAIN ENGINEER)
71 - Seat Position
SHOULDER-BELT-AND-LAP-BELT-USED
72 - Safety Equipment
A - INCAPACITATING INJURY
70 - Injury Severity
DEPLOYED
73 - Airbag
NOT-APPLICABLE
75 - Ejected
Medical Transport
77
NOT-APPLICABLE
76 - Trapped/Extricated 78 - Agency Space
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
105 - Photos By
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Diagram and Narrative
DEPUTY POPLIN
ON MAY 29TH, 2016 I DEPUTY POPLIN WAS DISPATCHED TO A TWO VEHICLE CRASH WITH INJURIES AT STATE HWY 27/70 AT MAPES
RD. I ARRIVED AND SAW TWO VEHICLES WITH SEVERE DAMAGE AND 3 INJURED PERSONS. THE DRIVER OF UNIT 1 SAID SHE
DIDN'T REMEMBER WHAT HAPPENED AND WAS ALL OF A SUDDEN BEING TREATED BY EMS. THE
ON MAY 29TH, 2016 I DEPUTY POPLIN WAS DISPATCHED TO A TWO VEHICLE CRASH WITH INJURIES AT STATE HWY 27/70 AT MAPES
RD. I ARRIVED AND SAW TWO VEHICLES WITH SEVERE DAMAGE AND 3 INJURED PERSONS. THE DRIVER OF UNIT 1 SAID SHE
DIDN'T REMEMBER WHAT HAPPENED AND WAS ALL OF A SUDDEN BEING TREATED BY EMS. THE
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DRIVER OF UNIT 2 SAID HE FELT HE WAS CUT OFF AND TURNED IN FRONT OF. I SPOKE TO A WITNESS WHO WAS RIGHT BEHIND UNIT 1. THE WITNESS SAID HE SAW UNIT 1 TURN DIRECTLY IN FRONT OF UNIT 2 CAUSING THE CRASH.DRIVER OF UNIT 2 SAID HE FELT HE WAS CUT OFF AND TURNED IN FRONT OF. I SPOKE TO A WITNESS WHO WAS RIGHT BEHIND UNIT 1. THE WITNESS SAID HE SAW UNIT 1 TURN DIRECTLY IN FRONT OF UNIT 2 CAUSING THE CRASH.
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125 - First Name 125 - Middle Initial
Officer Information
POPLIN
125 - Officer Last Name
JAY 352
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
05/29/2016
132 - Date Notified 1236133 - Time Notified (Military Time)1247134 - Time Arrived (Military Time)
05/29/2016
135 - Date Of Report
16052906563 16052902 19 - Special Study
18 - Agency Space
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