20160808 WollwertAgency Accident Number
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Reportable Accident On Emergency Amended GZDHL6K
DOT Document Number Document Override Number
16080809
16
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8
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08/08/2016
4 - Accident Date
2014
5 - Time of Accident (Military Time)
01
6 - Total Units
01
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County ROUND LAKE - 13, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
14 - On Hwy No.
TWIN LAKE RD 6
14 - On Street Name 14 - Bus/Frnt/Rmp
0.25 MI15 - Est. Distance WEST15 - Hwy. Dir
16 - Fr/At Hwy No.MC CLAIN RD 416 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
46.041645
12 - Latitude -91.29523613 - 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
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 79 - E M S Number
Operator/Pedestrian
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TREE
81 - Most Harmful Event: Collision With
SOUTH
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
2021
31 - Expiration Year 34 - On Duty Accident
WOLLWERT
25 - Operator/Pedestrian Last Name
MIRALEINE
25 - First Name
F
25 - Middle Initial 25 - Suffix
10/11/
32 - Date Of Birth
FEMALE
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
A - INCAPACITATING INJURY
38 - Injury Severity
DEPLOYED
41 - Airbag
NOT-EJECTED
42 - Ejected 44
Medical Transport
TRAPPED/EXTRICATED
43 - Trapped/Extricated 92 - Pedestrian Location 92 - Pedestrian Action
GOING-STRAIGHT
119 - What Driver Was Doing
NO-CONTROL
120 - Traffic Control 62 - No. of Citations Issued
64 - 1st Statute No.64 - 2nd Statute No.64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
DRIVER-CONDITION
122 - Driver Factors
REDUCED ALERTNESS88 - 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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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
325LND
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2016
59 - Exp Year
5GTDN13646821
55 - Vehicle Identification Number
2006
50 - Year
HUMM
51 - Make
H3 SUV
52 - Model
TK - TRUCK
53 - Body Style
GRY
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
WOLLWERT
46 - Vehicle Owner Last Name
MIRALEINE
46 - First Name
F
46 - Middle Initial 46 - Suffix
10/11/
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
61 - Policy Holder Last Name 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
INDIVIDUAL
Organization Type
WATERSTON
84 - Property Owner Last Name
BARBARA
84 - First Name
W
84 - Middle Initial 84 - Suffix
01
84 - Company Name Government Property Type
85 - Address Street & Number 85 - PO Box
HAYWARD
86 - City
WI
86 - State
54843
86 - Zip Code 87 - Telephone Number
83 - Government Damage Tag Number
01
82 - Striking Unit
TREE
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
N. RASCHKA
ON AUGUST 8, 2016 AT APPROXIMATELY 8:14 PM I, DEPUTY RASCHKA RESPONDED TO A ONE VEHICLE ACCIDENT ON TWIN LAKE
RD JUST NORTH OF MCCLAINE RD. I ARRIVED ON-SCENE AND OBSERVED A GREY HUMMER TYPE VEHICLE IN THE DITCH ON THE
EAST SHOULDER OF THE ROADWAY WITH THE FRONT END UP AGAINST A LARGE TREE. A MALE SUBJECT ADVISED THAT HE
FOUND THE VEHICLE AND HIS WIFE WAS ON THE DRIVERS SIDE TENDING TO THE OPERATOR OF THE VEHICLE. I OPENED THE
PASSENGER DOOR AND OBSERVED A FEMALE WHO WAS CONSCIOUS AND BREATHING, IDENTIFIED HERSELF AS MIRALEINE
WOLLWERT 10/11/1973. SHE STATED THAT SHE HER LEGS WERE TRAPPED UNDER THE STEERING WHEEL. THE FEMALE PASSERBY WHO WAS TENDING TO MS. WOLLWERT STATED SHE BELIEVED HER LEFT ARM WAS BROKEN AND I NOTED A LARGE LACERATION
TO HER RIGHT EYE LID. MS. WOLLWERT ADVISED THAT SHE HAD JUST GOTTEN HOME FROM THE PHILIPPINES ON AUGUST 4, WAS
JETLAGGED AND HAD JUST WORKED ALL DAY AT THE HOSPITAL AS A PHYSICAL THERAPIST SHE ADVISED THAT SHE BELIEVED
SHE FELL ASLEEP. SHE STATED SHE DID NOT HAVE ANY OTHER MEDICAL ISSUES AND HAD BEEN EATING THROUGHOUT THE DAY.
I ADVISED HER THE HELP WAS COMING. TOWN OF HAYWARD FIRE DEPARTMENT EXTRICATED MS. WOLLWERT AND I CALLED FOR
A CHOPPER. MS. WOLLWERT WAS EXTRICATED AND TRANSPORTED TO ST. MARY'S HOSPITAL IN DULUTH. PHOTOS WERE TAKEN OF THE VEHICLE, THE STEERING WHEEL AIRBAG WAS DEPLOYED AND MS. WOLLWERT WAS WEARING HER SHOULDER AND LAP
BELT. ROADRUNNER TOWING REMOVED THE VEHICLE. THERE WERE NO SKID MARKS TO IMPACT, IT APPEARED THE VEHICLE
VEERED OFF THE ROADWAY APPROXIMATELY 150 FEET PRIOR TO IMPACT, RIDING THE SHOULDER UNTIL THE VEHICLE COLLIDED
WITH A TREE. MEASUREMENTS WERE NOT TAKEN. END
ON AUGUST 8, 2016 AT APPROXIMATELY 8:14 PM I, DEPUTY RASCHKA RESPONDED TO A ONE VEHICLE ACCIDENT ON TWIN LAKE
RD JUST NORTH OF MCCLAINE RD. I ARRIVED ON-SCENE AND OBSERVED A GREY HUMMER TYPE VEHICLE IN THE DITCH ON THE
EAST SHOULDER OF THE ROADWAY WITH THE FRONT END UP AGAINST A LARGE TREE. A MALE SUBJECT ADVISED THAT HE
FOUND THE VEHICLE AND HIS WIFE WAS ON THE DRIVERS SIDE TENDING TO THE OPERATOR OF THE VEHICLE. I OPENED THE
PASSENGER DOOR AND OBSERVED A FEMALE WHO WAS CONSCIOUS AND BREATHING, IDENTIFIED HERSELF AS MIRALEINE
WOLLWERT 10/11/1973. SHE STATED THAT SHE HER LEGS WERE TRAPPED UNDER THE STEERING WHEEL. THE FEMALE PASSERBY WHO WAS TENDING TO MS. WOLLWERT STATED SHE BELIEVED HER LEFT ARM WAS BROKEN AND I NOTED A LARGE LACERATION
TO HER RIGHT EYE LID. MS. WOLLWERT ADVISED THAT SHE HAD JUST GOTTEN HOME FROM THE PHILIPPINES ON AUGUST 4, WAS
JETLAGGED AND HAD JUST WORKED ALL DAY AT THE HOSPITAL AS A PHYSICAL THERAPIST SHE ADVISED THAT SHE BELIEVED
SHE FELL ASLEEP. SHE STATED SHE DID NOT HAVE ANY OTHER MEDICAL ISSUES AND HAD BEEN EATING THROUGHOUT THE DAY.
I ADVISED HER THE HELP WAS COMING. TOWN OF HAYWARD FIRE DEPARTMENT EXTRICATED MS. WOLLWERT AND I CALLED FOR
A CHOPPER. MS. WOLLWERT WAS EXTRICATED AND TRANSPORTED TO ST. MARY'S HOSPITAL IN DULUTH. PHOTOS WERE TAKEN OF THE VEHICLE, THE STEERING WHEEL AIRBAG WAS DEPLOYED AND MS. WOLLWERT WAS WEARING HER SHOULDER AND LAP
BELT. ROADRUNNER TOWING REMOVED THE VEHICLE. THERE WERE NO SKID MARKS TO IMPACT, IT APPEARED THE VEHICLE
VEERED OFF THE ROADWAY APPROXIMATELY 150 FEET PRIOR TO IMPACT, RIDING THE SHOULDER UNTIL THE VEHICLE COLLIDED
WITH A TREE. MEASUREMENTS WERE NOT TAKEN. END
Accident Report
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Wisconsin Motor Vehicle GZDHL6K 3 4
OF REPORT. OF REPORT.
OF
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125 - First Name 125 - Middle Initial
Officer Information
RASCHKA
125 - Officer Last Name
NICOLE 388
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
08/08/2016
132 - Date Notified 2014133 - Time Notified (Military Time)2019134 - Time Arrived (Military Time)
08/08/2016
135 - Date Of Report
16080809 19 - Special Study
18 - Agency Space
Accident Report
of
MV4000e 01/2005
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Wisconsin Motor Vehicle GZDHL6K 4 4