20160902 TorgersonAgency Accident Number
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Reportable Accident On Emergency Amended GZDGTZG
DOT Document Number Document Override Number
16090303
16
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9
0
3
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3
09/02/2016
4 - Accident Date
2100
5 - Time of Accident (Military Time)
02
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County LENROOT - 08, 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
06316 - Fr/At Hwy No.16 - From/At Street Name 16 - Business/Frontage/Ramp
FIRE #
17 - Structure Type
11544 N
17 - Structure Number
46.050671
12 - Latitude -91.44007013 - Longitude
PARKED MOTOR VEHICLE80 - First Harmful Event SIDESWIPE. SAME DIRECTION93 - Manner of Collision
NO CONTROL
112 - Access Control
STRAIGHT
113 - Road Curvature
LEVEL/FLAT
113 - Road Terrain
DIRT -5
Surface Type
PARKING-LOT-OR-PRIVATE-PROPERTY115 - Traffic Way
PARKING-LOT-OR-PRIVATE-PROPERTY
117 - Relation To Roadway
DARK-NOT-LIGHTED114 - Light Condition SAND-MUD-DIRT-OR-OIL116 - 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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Unit Status
PARKED MOTOR VEHICLE
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
WI
30 - State
2024
31 - Expiration Year 34 - On Duty Accident
TORGERSON
25 - Operator/Pedestrian Last Name
MATTHEW
25 - First Name
S
25 - Middle Initial 25 - Suffix
11/15/
32 - Date Of Birth
MALE
33 - Sex
26 - Address Street & Number 26 - PO Box
TURTLE LAKE
27 - City
WI
27 - State
54889
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.
INATTENTIVE-DRIVING
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
TRUCK
21 - Unit Type
PICKUP/UTILITY-TRUCK
Vehicle Type
1
22 - Total Occupants
MWFRAC
56 - License Plate Number
LTK57 - Plate Type WI
58 - State
2017
59 - Exp Year
49475
55 - Vehicle Identification Number
2015
50 - Year
CHEV
51 - Make
SIL K2500
52 - Model
PK - PICKUP
53 - Body Style 54 - Color 100 - Skidmarks to Impact (Ft)
NONE
94 - Vehicle Damage
NONE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
OWNER
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
TORGERSON
46 - Vehicle Owner Last Name
MATTHEW
46 - First Name
S
46 - Middle Initial 46 - Suffix
11/15
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
TURTLE LAKE48 - City WI48 - State 5488948 - Zip Code .49 - Telephone Number
ACUITY,-A-MUTUAL-INSURANCE-CO63 - Liability Insurance Company Policy Holder Same As Owner60
TORGERSON
61 - Policy Holder Last Name
MATTHEW
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
L - LEGALLY PARKED
Unit Status
MOTOR VEHICLE IN TRANSPORT
81 - Most Harmful Event: Collision With 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 30 - State 31 - Expiration Year 34 - On Duty Accident
25 - Operator/Pedestrian Last Name 25 - First Name 25 - Middle Initial 25 - Suffix
32 - Date Of Birth 33 - Sex
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Wisconsin Motor Vehicle GZDGTZG 2 424
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Insurance
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IN
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26 - Address Street & Number 26 - PO Box
27 - City 27 - State 27 - Zip Code 28 - Telephone Number
39 - Seat Position
NOT-APPLICABLE-NONMOTORIST
40 - Safety Equipment
38 - Injury Severity
NOT APPLICABLE
41 - Airbag
NOT-APPLICABLE
42 - Ejected 44
Medical Transport
NOT-APPLICABLE
43 - Trapped/Extricated 92 - Pedestrian Location 92 - Pedestrian Action
LEGALLY-PARKED
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.
NOT-APPLICABLE
122 - Driver Factors
88 - Driver or Pedestrian Cond 89 - Substance Presence
90 - Alcohol Test 90 - Alcohol Content 91 - Drug Test
91 - Drugs Reported
NOT-APPLICABLE
124 - Highway Factors
TRUCK
21 - Unit Type
PICKUP/UTILITY-TRUCK
Vehicle Type
00
22 - Total Occupants
555PCK
56 - License Plate Number
LTK57 - Plate Type MN
58 - State
2017
59 - Exp Year
1C6RR7MT7ES147915
55 - Vehicle Identification Number
2014
50 - Year
DODG
51 - Make
RAM
52 - Model
PK - PICKUP
53 - Body Style
BLU
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT PASSENGER SIDE, FRONT
94 - Vehicle Damage
MODERATE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
OWNER
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
46 - Company Name
47- Address Street & Number 47 - PO Box
48 - City 48 - State 48 - Zip Code 49 - Telephone Number
NOT-REQUIRED63 - Liability Insurance Company Policy Holder Same As Owner60
61 - Policy Holder Last Name 61 - Policy Holder First Name
61 - Policy Holder Company
02
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School Bus
02
BU
S
FromTo
Bus Travelling to/from School Name Body Make Seating Capacity
School District Contracted With
Trailer
01
TR
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1106 - Power Unit Number RU57718License Plate Number RVTPlate Type MNState 2015Expiration Year
XLR
Trailer Make
RECR
Unit Type
4X4FXLR38D5156617
Vehicle Identification Number
105 - Photos By
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Diagram and Narrative
J. WOHLING
ON SEPTEMBER 3, 2015 I, DEPUTY WOHLING, WAS FLAGGED DOWN BY THE OWNER OF UNIT 2. HE STATED THAT HIS TRUCK HAD BEEN HIT THE NIGHT PRIOR AND WANTED TO REPORT IT. I MET WITH HIM AT HIS CAMPSITE AND TOOK PHOTOS OF THE DAMAGE. I
THEM MET WITH THE OWNER/DRIVER OF UNIT WHO STATED THAT IT WAS HIS FAULT AND THAT HE SHOULD HAVE ASKED THE
OWNER OF UNIT 2 MOVE HIS VEHICLE
ON SEPTEMBER 3, 2015 I, DEPUTY WOHLING, WAS FLAGGED DOWN BY THE OWNER OF UNIT 2. HE STATED THAT HIS TRUCK HAD BEEN HIT THE NIGHT PRIOR AND WANTED TO REPORT IT. I MET WITH HIM AT HIS CAMPSITE AND TOOK PHOTOS OF THE DAMAGE. I
THEM MET WITH THE OWNER/DRIVER OF UNIT WHO STATED THAT IT WAS HIS FAULT AND THAT HE SHOULD HAVE ASKED THE
OWNER OF UNIT 2 MOVE HIS VEHICLE
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125 - First Name 125 - Middle Initial
Officer Information
WOHLING125 - Officer Last Name JT 349131 - Officer ID
129 - Law Enforcement Agency No.
SAWYER COUNTY SHERIFFS DEPT
130 - Law Enforcement Agency Name
15880 EAST FIFTH STREET126 - Law Enforcement Agency Address Street & Number
HAYWARD
127 - City
WI
127 - State
54843
127 - Zip Code
(715) 634-4858 EXT.
128 - Telephone Number
09/03/2016132 - Date Notified 0917133 - Time Notified (Military Time)0918134 - Time Arrived (Military Time)09/03/2016135 - Date Of Report
16090303 19 - Special Study
18 - Agency Space
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