20160629 EttenhoferAgency Accident Number
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Reportable Accident On Emergency Amended GZDTZ9N
DOT Document Number Document Override Number
16062903
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16062908402
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06/29/2016
4 - Accident Date
1453
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 INTERSECTION11 - Accident Location
14 - On Hwy No.
FEDERAL FOREST RD 203
14 - On Street Name 14 - Bus/Frnt/Rmp 15 - Est. Distance 15 - Hwy. Dir
07716 - Fr/At Hwy No.16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
46.073292
12 - Latitude -91.07864513 - Longitude
OTHER NON-COLLISION80 - 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
DIRT -5
Surface Type
NOT-PHYSICALLY-DIVIDED-(2-WAY TRAFFIC)115 - Traffic Way
OUTSIDE-SHOULDER-LEFT
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
1606290840279 - E M S Number
Operator/Pedestrian
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Unit Status
TREE
81 - Most Harmful Event: Collision With
NORTH
23 - Dir Of Travel
2524 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
29 - Driver's License Number
WI
30 - State
2017
31 - Expiration Year 34 - On Duty Accident
ETTENHOFER
25 - Operator/Pedestrian Last Name
JUDITH
25 - First Name
A
25 - Middle Initial 25 - Suffix
09/10
32 - Date Of Birth
FEMALE
33 - Sex
26 - Address Street & Number 26 - PO Box
SPRING GREEN
27 - City
WI
27 - State
53588
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
TRAPPED/NOT-EXTRICATED
43 - Trapped/Extricated 92 - Pedestrian Location 92 - Pedestrian Action
NEGOTIATING-CURVE
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
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Accident Report
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZDTZ9N 1 4
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Vehicle
Vehicle Owner
Insurance
School Bus
IN
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91 - Drugs Reported
LOOSE-GRAVEL
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
697UDU
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2017
59 - Exp Year
055
55 - Vehicle Identification Number
2006
50 - Year
HOND
51 - Make
ELEMENT
52 - Model
UT - SPORT UTILITY
53 - Body Style
BLK
54 - Color
0100 - Skidmarks to Impact (Ft)
FRONT DRIVER SIDE, FRONT, FRONT 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
ETTENHOFER
46 - Vehicle Owner Last Name
JUDITH
46 - First Name
A
46 - Middle Initial 46 - Suffix
09/10
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
SPRING GREEN48 - City WI48 - State 5358848 - Zip Code 49 - Telephone Number
STATE-FARM63 - Liability Insurance Company Policy Holder Same As Owner60
ETTENHOFER
61 - Policy Holder Last Name
JUDITH
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
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
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 82 - Striking Unit 82 - Object Struck
105 - Photos By
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Diagram and Narrative
DEPUTY HOUSE
UNIT 1 WAS TRAVELLING NORTH ON FOREST ROAD 203..APPROXIMATELY 5 MILES NORTH OF HIGHWAY 77 UNIT 1 WAS
NEGOTIATING A CURVE WHEN IT LEFT THE ROADWAY AND STRUCK A TREE... DRIVER ADMITTED THAT SHE WAS NOT PAYING
ATTENTION TO THE ROADWAY AT THE TIME.. UNIT 1 SUSTAINED SEVERE DAMAGE TO FRONT END OF VEHICLE..UNIT 1 DRIVER
WAS TRANSPORTED TO HOSPITAL FOR INJURIES..ROADRUNNER TOWING REMOVED VEHICLE
UNIT 1 WAS TRAVELLING NORTH ON FOREST ROAD 203..APPROXIMATELY 5 MILES NORTH OF HIGHWAY 77 UNIT 1 WAS
NEGOTIATING A CURVE WHEN IT LEFT THE ROADWAY AND STRUCK A TREE... DRIVER ADMITTED THAT SHE WAS NOT PAYING
ATTENTION TO THE ROADWAY AT THE TIME.. UNIT 1 SUSTAINED SEVERE DAMAGE TO FRONT END OF VEHICLE..UNIT 1 DRIVER
WAS TRANSPORTED TO HOSPITAL FOR INJURIES..ROADRUNNER TOWING REMOVED VEHICLE
Officer Information
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Wisconsin Motor Vehicle GZDTZ9N 3 4
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125 - First Name 125 - Middle Initial
HOUSE
125 - Officer Last Name
ROB 317
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
06/29/2016
132 - Date Notified 1456133 - Time Notified (Military Time)1508134 - Time Arrived (Military Time)
07/13/2016
135 - Date Of Report
16062903 16062908402 19 - Special Study
18 - Agency Space
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