20161107 MasterAgency Accident Number
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Reportable Accident On Emergency Amended GZH0DMK
DOT Document Number Document Override Number
16110103
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16110103
16
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11/01/2016
4 - Accident Date
1628
5 - Time of Accident (Military Time)
01
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County BASS LAKE - 01, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
14 - On Hwy No.
WONDER AVE
14 - On Street Name 14 - Bus/Frnt/Rmp
323 FT15 - Est. Distance SOUTH15 - Hwy. Dir
16 - Fr/At Hwy No.BIRCH ST16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.916476
12 - Latitude -91.40706913 - Longitude
TREE80 - 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
NOT-PHYSICALLY-DIVIDED-(2-WAY TRAFFIC)115 - Traffic Way
OUTSIDE-SHOULDER-LEFT
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
TREE
81 - Most Harmful Event: Collision With
NORTH
23 - Dir Of Travel
3524 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
29 - Driver's License Number
WI
30 - State
2018
31 - Expiration Year 34 - On Duty Accident
MASTER
25 - Operator/Pedestrian Last Name
AUSTIN
25 - First Name
MICHAEL
25 - Middle Initial 25 - Suffix
11/27/
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 162 - No. of Citations Issued
346.62(2)
64 - 1st Statute No.64 - 2nd Statute No.64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
LEFT-OF-CENTER, FAILURE-TO-HAVE-CONTROL
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
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Wisconsin Motor Vehicle GZH0DMK 1 4
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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
LV1129
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2016
59 - Exp Year
3733
55 - Vehicle Identification Number
1997
50 - Year
FORD
51 - Make
EXPLORER
52 - Model
UT - SPORT UTILITY
53 - Body Style
BLU
54 - Color 100 - Skidmarks to Impact (Ft)
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
MASTER
46 - Vehicle Owner Last Name
AUSTIN
46 - First Name
MICHAEL
46 - Middle Initial 46 - Suffix
11/27
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
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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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MV4000e 01/2005
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Wisconsin Motor Vehicle
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Wisconsin Motor Vehicle GZH0DMK 2 424
Fixed Objects Struck
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Property
GOVERNMENT
Organization Type 84 - Property Owner Last Name 84 - First Name 84 - Middle Initial 84 - Suffix
01
BASS LAKE TOWNSHIP
84 - Company Name
COUNTY/MUNICIPAL
Government Property Type
14412W CTH K
85 - Address Street & Number 85 - PO Box
HAYWARD
86 - City
WI
86 - State
54843
86 - Zip Code
(715) 634-8469 EXT.
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
SGT ALMOGHRABI
I, SGT. NICK AL-MOGHRABI, WAS DISPATCHED TO WONDER AVE IN BASS LAKE TOWNSHIP REFERENCE A VEHICLE CHASING
ANOTHER NORTHBOUND ON WONDER AVE. I WAS ADVISED THAT ONE VEHICLE HAD ENTERED THE WOODS AND CAME BACK
ONTO WONDER AVE. UPON MY ARRIVAL IN THE AREA, I OBSERVED A BLUE FORD EXPLORER ON WONDER AVE NEAR BIRCH WITH
A FLAT REAR DRIVER'S SIDE TIRE. UPON CONTACT WITH THE SUBJECT, HE TOLD ME HE KNEW WHAT I WAS GOING TO ASK AND
STATED HE WAS MESSING AROUND FOLLOWING HIS FRIEND ON WONDER AVE ZIG ZAGGING. THE OPERATOR ADMITTED TO
STRIKING A TREE WHICH CAUSED HIS FLAT TIRE. I OBSERVED A LARGE DENT AND DAMAGE TO THE REAR DRIVER'S SIDE CORNER. I PHOTOGRAPHED THE VEHICLE AND THE TREE IN WHICH HE STRUCK. I SPOKE TO A RESIDENT ACROSS FROM WHERE THE TREE
WAS STRUCK AS I OBSERVED SEVERAL SMALL CHILDREN PLAYING IN THE DRIVEWAY. I WAS ADVISED THEY WERE PLAYING
DURING THE TIME THE DRIVER STRUCK THE TREE. I FURTHER OBSERVED TRACKS FROM ONE SIDE OF WONDER AVE (DIRT ROAD)
TO THE OTHER BACK AND FORTH. I ASKED THE OPERATOR IF HE HAD SEEN THE CHILDREN PLAYING AND HE ADMITTED HE
HADN'T. R/O ISSUED A CITATION FOR RECKLESS DRIVING ENDANGERING SAFETY. THE OPERATOR WAS PUTTING HIS SPARE TIRE
ON AS I CLEARED THE SCENE.
I, SGT. NICK AL-MOGHRABI, WAS DISPATCHED TO WONDER AVE IN BASS LAKE TOWNSHIP REFERENCE A VEHICLE CHASING
ANOTHER NORTHBOUND ON WONDER AVE. I WAS ADVISED THAT ONE VEHICLE HAD ENTERED THE WOODS AND CAME BACK
ONTO WONDER AVE. UPON MY ARRIVAL IN THE AREA, I OBSERVED A BLUE FORD EXPLORER ON WONDER AVE NEAR BIRCH WITH
A FLAT REAR DRIVER'S SIDE TIRE. UPON CONTACT WITH THE SUBJECT, HE TOLD ME HE KNEW WHAT I WAS GOING TO ASK AND
STATED HE WAS MESSING AROUND FOLLOWING HIS FRIEND ON WONDER AVE ZIG ZAGGING. THE OPERATOR ADMITTED TO
STRIKING A TREE WHICH CAUSED HIS FLAT TIRE. I OBSERVED A LARGE DENT AND DAMAGE TO THE REAR DRIVER'S SIDE CORNER. I PHOTOGRAPHED THE VEHICLE AND THE TREE IN WHICH HE STRUCK. I SPOKE TO A RESIDENT ACROSS FROM WHERE THE TREE
WAS STRUCK AS I OBSERVED SEVERAL SMALL CHILDREN PLAYING IN THE DRIVEWAY. I WAS ADVISED THEY WERE PLAYING
DURING THE TIME THE DRIVER STRUCK THE TREE. I FURTHER OBSERVED TRACKS FROM ONE SIDE OF WONDER AVE (DIRT ROAD)
TO THE OTHER BACK AND FORTH. I ASKED THE OPERATOR IF HE HAD SEEN THE CHILDREN PLAYING AND HE ADMITTED HE
HADN'T. R/O ISSUED A CITATION FOR RECKLESS DRIVING ENDANGERING SAFETY. THE OPERATOR WAS PUTTING HIS SPARE TIRE
ON AS I CLEARED THE SCENE.
Officer Information
Accident Report
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Wisconsin Motor Vehicle GZH0DMK 3 4
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125 - First Name 125 - Middle Initial
ALMOGHRABI
125 - Officer Last Name
NICK 392
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
11/01/2016
132 - Date Notified 1628133 - Time Notified (Military Time)1637134 - Time Arrived (Military Time)
11/01/2016
135 - Date Of Report
16110103 16110103 19 - Special Study
18 - Agency Space
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZH0DMK 4 4