20161105 BeaudinAgency Accident Number
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Reportable Accident On Emergency Amended GZDFCJ9
DOT Document Number Document Override Number
16110503
16
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5
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11/05/2016
4 - Accident Date
1804
5 - Time of Accident (Military Time)
01
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County HUNTER - 07, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
CC
14 - On Hwy No.14 - On Street Name 14 - Bus/Frnt/Rmp
379 FT15 - Est. Distance NORTH15 - Hwy. Dir
16 - Fr/At Hwy No.LAMPE RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.909579
12 - Latitude -91.18683813 - 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
BLACKTOP, BITUMINOUS, OR ASPHALT - 2
Surface Type
NOT-PHYSICALLY-DIVIDED-(2-WAY TRAFFIC)115 - Traffic Way
OUTSIDE-SHOULDER-RIGHT
117 - Relation To Roadway
DARK-NOT-LIGHTED114 - 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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Unit Status
OVERTURN
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
2016
31 - Expiration Year 34 - On Duty Accident
BEAUDIN
25 - Operator/Pedestrian Last Name
BRENDA
25 - First Name
J
25 - Middle Initial 25 - Suffix
11/21
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
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 262 - No. of Citations Issued
344.62(1)
64 - 1st Statute No.
346.70(1)
64 - 2nd Statute No.64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
FAILURE-TO-HAVE-CONTROL
122 - Driver Factors
NOT OBSERVED88 - 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
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
LE4245
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2017
59 - Exp Year
8339
55 - Vehicle Identification Number
1996
50 - Year
CHEV
51 - Make
K1500
52 - Model
PK - PICKUP
53 - Body Style
BLK
54 - Color 100 - Skidmarks to Impact (Ft)
TOTAL (DAMAGE TO ALL AREAS)
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
BEAUDIN
46 - Vehicle Owner Last Name
BRENDA
46 - First Name
J
46 - Middle Initial 46 - Suffix
11/21/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
NONE63 - 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
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
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105 - Photos By
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Diagram and Narrative
DEPUTY MATTHEW JEFSON
I WAS DISPATCHED TO A 1 VEHICLE ROLL OVER ON CTH CC NEAR LAMPE RD. WHILE EN ROUTE DISPATCH ADVISED THAT PASSING
VEHICLE HAD CALLED IT IN. THEY STATED THAT NO ONE WAS AROUND. I ARRIVED ON SCENE AND NOTICED THAT THE VEHICLE
WAS LAYING ON ITS ROOF. I HAD DISPATCH SEND NEXT AVAILABLE TOW. I THEN TOOK PHOTOS OF THE CRASH. DEPUTY CASEY
CULHANE WENT TO THE REGISTERED OWNER'S HOUSE. DEPUTY CULHANE ADVISED THAT THE RO HAD STATED THAT IT WAS HER THAT DROVE AND CRASHED BUT COULDNT GIVE ANY DETAILS ABOUT IT. ROADRUNNER ARRIVED AND REMOVED THE VEHICLE.
I WAS DISPATCHED TO A 1 VEHICLE ROLL OVER ON CTH CC NEAR LAMPE RD. WHILE EN ROUTE DISPATCH ADVISED THAT PASSING
VEHICLE HAD CALLED IT IN. THEY STATED THAT NO ONE WAS AROUND. I ARRIVED ON SCENE AND NOTICED THAT THE VEHICLE
WAS LAYING ON ITS ROOF. I HAD DISPATCH SEND NEXT AVAILABLE TOW. I THEN TOOK PHOTOS OF THE CRASH. DEPUTY CASEY
CULHANE WENT TO THE REGISTERED OWNER'S HOUSE. DEPUTY CULHANE ADVISED THAT THE RO HAD STATED THAT IT WAS HER THAT DROVE AND CRASHED BUT COULDNT GIVE ANY DETAILS ABOUT IT. ROADRUNNER ARRIVED AND REMOVED THE VEHICLE.
OF
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125 - First Name 125 - Middle Initial
Officer Information
JEFSON125 - Officer Last Name MATTHEW 324131 - 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
11/05/2016132 - Date Notified 1805133 - Time Notified (Military Time)1826134 - Time Arrived (Military Time)11/19/2016135 - Date Of Report
16110503 19 - Special Study
18 - Agency Space
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