20160816 CrawfordAgency Accident Number
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Police Number
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Reportable Accident On Emergency Amended GZDWFRC
DOT Document Number Document Override Number
16081602
16
0
8
1
6
0
2
08/16/2016
4 - Accident Date
1204
5 - Time of Accident (Military Time)
01
6 - Total Units
01
7 - Total Injured 8 - Total Killed
SAWYER - 572 - County EDGEWATER - 04, TOWN3 - Municipality PRIVATE PROPERTY11 - Accident Location
14 - On Hwy No.
PRIVATE PROPERTY
14 - On Street Name 14 - Bus/Frnt/Rmp 15 - Est. Distance 15 - Hwy. Dir
16 - Fr/At Hwy No.MAPLE TERRACE DR 1316 - From/At Street Name 16 - Business/Frontage/Ramp
OTHER #
17 - Structure Type
16878W
17 - Structure Number
45.661993
12 - Latitude -91.54035013 - Longitude
OVERTURN80 - 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
SLAG, GRAVEL, OR STONE - 4
Surface Type
PARKING-LOT-OR-PRIVATE-PROPERTY115 - Traffic Way
PARKING-LOT-OR-PRIVATE-PROPERTY
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
OP
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Unit Status
OVERTURN
81 - Most Harmful Event: Collision With
EAST
23 - Dir Of Travel
N/A24 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
29 - Driver's License Number
IL
30 - State
2019
31 - Expiration Year 34 - On Duty Accident
CRAWFORD
25 - Operator/Pedestrian Last Name
ROBERT
25 - First Name
DALE
25 - Middle Initial 25 - Suffix
03/18/
32 - Date Of Birth
MALE
33 - Sex
26 - Address Street & Number 26 - PO Box
PEORIA
27 - City
IL
27 - State
61603
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
MAKING-RIGHT-TURN
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.
SPEED-TOO-FAST-FOR-CONDITIONS
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
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDWFRC 1 3
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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
2
22 - Total Occupants
Q300439
56 - License Plate Number
AUT57 - Plate Type IL
58 - State
2017
59 - Exp Year
JN8DR09X02W6
55 - Vehicle Identification Number
2002
50 - Year
NISS
51 - Make
PATHFINDER
52 - Model
UT - SPORT UTILITY
53 - Body Style
BLU
54 - Color 100 - Skidmarks to Impact (Ft)
TOP OF VEHICLE, FRONT DRIVER SIDE, MIDDLE DRIVER SIDE, REAR DRIVER SIDE, FRONT
94 - Vehicle Damage
SEVERE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
A-1 TOWING
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
CRAWFORD
46 - Vehicle Owner Last Name
ROBERT
46 - First Name
DALE
46 - Middle Initial 46 - Suffix
03/18
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
PEORIA48 - City IL48 - State 6160348 - Zip Code .49 - Telephone Number
FARMERS-CASUALTY-CO-(MUTUAL)63 - Liability Insurance Company Policy Holder Same As Owner60
CRAWFORD
61 - Policy Holder Last Name
ROBERT
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
Occupant
Address Same As Operator
OC
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01
65 - Unit No
GRAVITT
66 - Occupant Last Name
TAMMY
66 - First Name
LYNN
66 - Middle Initial 66 - Suffix
01
68 - Address Street & Number 68 - PO Box
PEORIA
68 - City
IL
68 - State
61603
68 - Zip Code
01/29/67 - Date of Birth F69 - Sex
FRONT-SEAT-RIGHT-SIDE-(TRAIN ENGINEER)
71 - Seat Position
SHOULDER-BELT-AND-LAP-BELT-USED
72 - Safety Equipment
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDWFRC 2 323
C - POSSIBLE INJURY
70 - Injury Severity
NON-DEPLOYED
73 - Airbag
NOT-EJECTED
75 - Ejected
Medical Transport
77
NOT-TRAPPED
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 JEFF CAIN
UNIT ONE WAS WESTBOUND ON HWY 48 AND ATTEMPTING TO TURN INTO A PRIVATE DRIVEWAY WHEN IT LOST CONTROL ON THE GRAVEL AND OVERTURNED.UNIT ONE WAS WESTBOUND ON HWY 48 AND ATTEMPTING TO TURN INTO A PRIVATE DRIVEWAY WHEN IT LOST CONTROL ON THE GRAVEL AND OVERTURNED.
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125 - First Name 125 - Middle Initial
Officer Information
CAIN
125 - Officer Last Name
JEFF 314
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
08/16/2016
132 - Date Notified 1204133 - Time Notified (Military Time)1235134 - Time Arrived (Military Time)
08/17/2016
135 - Date Of Report
16081602 19 - Special Study
18 - Agency Space
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDWFRC 3 3