20160910 GrammerAgency Accident Number
AC
C
I
D
E
N
T
#
PO
L
I
C
E
#
Police Number
GE
N
E
R
A
L
I
N
F
O
R
M
A
T
I
O
N
Reportable Accident On Emergency Amended GZDFCJ5
DOT Document Number Document Override Number
16091001
16
0
9
1
0
0
1
09/10/2016
4 - Accident Date
0900
5 - Time of Accident (Military Time)
01
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County SAND LAKE - 14, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
070
14 - On Hwy No.
EB
14 - On Street Name 14 - Bus/Frnt/Rmp
433 FT15 - Est. Distance SOUTH15 - Hwy. Dir
16 - Fr/At Hwy No.RONDEVOO RD16 - From/At Street Name 16 - Business/Frontage/Ramp
FIRE #
17 - Structure Type
6347
17 - Structure Number
45.861892
12 - Latitude -91.50476613 - 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
OUTSIDE-SHOULDER-RIGHT
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
E
R
A
T
O
R
/
P
E
D
E
S
T
R
I
A
N
Unit Status
OTHER POST
81 - Most Harmful Event: Collision With
EAST
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
GRAMMER
25 - Operator/Pedestrian Last Name
WILLIAM
25 - First Name
H
25 - Middle Initial 25 - Suffix
12/18/
32 - Date Of Birth
MALE
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
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
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.
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
01
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDFCJ5 1 4
VE
H
I
C
L
E
VE
H
O
W
N
E
R
Vehicle
Vehicle Owner
Insurance
School Bus
IN
S
91 - Drugs Reported
NOT-APPLICABLE
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
500077
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2016
59 - Exp Year
4426
55 - Vehicle Identification Number
2011
50 - Year
FORD
51 - Make
RANGER
52 - Model
PK - PICKUP
53 - Body Style
BLU
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT DRIVER SIDE, MIDDLE DRIVER SIDE, REAR DRIVER SIDE
94 - Vehicle Damage
SEVERE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
OPERATOR
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
GRAMMER
46 - Vehicle Owner Last Name
WILLIAM
46 - First Name
H
46 - Middle Initial 46 - Suffix
12/18 9
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
AMERICAN-FAMILY63 - Liability Insurance Company Policy Holder Same As Owner60
GRAMMER
61 - Policy Holder Last Name
WILLIAM
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
Trailer
01
TR
L
106 - Power Unit Number License Plate Number Plate Type State Expiration Year
Trailer Make Unit Type Vehicle Identification Number
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDFCJ5 2 424
Fixed Objects Struck
PR
O
P
E
R
T
Y
O
W
N
E
R
Property
GOVERNMENT
Organization Type 84 - Property Owner Last Name 84 - First Name 84 - Middle Initial 84 - Suffix
01
WISCONSIN DEPT OF TRANSPORTATION
84 - Company Name
FEDERAL/STATE
Government Property Type
718 W CLAIREMONT AV
85 - Address Street & Number 85 - PO Box
EAU CLAIRE
86 - City
WI
86 - State
54701
86 - Zip Code 87 - Telephone Number
83 - Government Damage Tag Number
01
82 - Striking Unit
DITCH
82 - Object Struck
01
82 - Striking Unit
EMBANKMENT
82 - Object Struck
01
82 - Striking Unit
OTHER-POST
82 - Object Struck 82 - Striking Unit 82 - Object Struck
82 - Striking Unit 82 - Object Struck 82 - Striking Unit 82 - Object Struck
105 - Photos By
DI
A
G
R
A
M
A
N
D
N
A
R
R
A
T
I
V
E
Diagram and Narrative
390
UNIT 1 TRAVELING EAST ON STH27-70 WHEN HE FELLS ASLEEP, LOSING CONTROL OF VEHICLE. VEHICLE LEFT ROADWAY ON
RIGHT SHOULDER, DRIVERS SIDE STRIKING GOVERNMENT SIGN POST. SIGN STILL STANDING POST MINOR DAMAGE. DRIVER
WOKE UP AND WAS ABLE TO REGAIN CONTROL, AND PULL OUT ONTO HIGHWAY. EXTENSIVE DAMAGE TO DRIVERS SIDE OF
VEHICLE INCLUDING MIRROR BUSTED OFF, DRIVERS SIDE AND PASSENGER DRIVERS SIDE WINDOWS BROKE OUT. DRIVER
STATES HE IS NOT INJURED. VEHICLE DRIVEABLE.
UNIT 1 TRAVELING EAST ON STH27-70 WHEN HE FELLS ASLEEP, LOSING CONTROL OF VEHICLE. VEHICLE LEFT ROADWAY ON
RIGHT SHOULDER, DRIVERS SIDE STRIKING GOVERNMENT SIGN POST. SIGN STILL STANDING POST MINOR DAMAGE. DRIVER
WOKE UP AND WAS ABLE TO REGAIN CONTROL, AND PULL OUT ONTO HIGHWAY. EXTENSIVE DAMAGE TO DRIVERS SIDE OF
VEHICLE INCLUDING MIRROR BUSTED OFF, DRIVERS SIDE AND PASSENGER DRIVERS SIDE WINDOWS BROKE OUT. DRIVER
STATES HE IS NOT INJURED. VEHICLE DRIVEABLE.
Officer Information
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDFCJ5 3 4
OF
F
I
C
E
R
I
N
F
O
R
M
A
T
I
O
N
125 - First Name 125 - Middle Initial
STANLEY
125 - Officer Last Name
SAVANNAH 390
131 - Officer ID
206
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
09/10/2016
132 - Date Notified 0913133 - Time Notified (Military Time)0917134 - Time Arrived (Military Time)
09/10/2016
135 - Date Of Report
16091001 19 - Special Study
18 - Agency Space
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDFCJ5 4 4