20161110 SpacekAgency Accident Number
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Police Number
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Reportable Accident On Emergency Amended GZHTL62
DOT Document Number Document Override Number
16111015048
16
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1
1
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1
5
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16111001
16
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1
11/10/2016
4 - Accident Date
0813
5 - Time of Accident (Military Time)
01
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County WINTER - 17, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
W
14 - On Hwy No.14 - On Street Name 14 - Bus/Frnt/Rmp
1311 FT15 - Est. Distance NORTH15 - Hwy. Dir
16 - Fr/At Hwy No.PRICE DAM RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.793543
12 - Latitude -90.99025913 - Longitude
JACKKNIFE80 - 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
ON-ROADWAY
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
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Unit Status
JACKKNIFE
81 - Most Harmful Event: Collision With
WEST
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
2019
31 - Expiration Year 34 - On Duty Accident
SPACEK
25 - Operator/Pedestrian Last Name
COLE
25 - First Name
S
25 - Middle Initial 25 - Suffix
12/15/
32 - Date Of Birth
MALE
33 - Sex
26 - Address Street & Number 26 - PO Box
PHILLIPS
27 - City
WI
27 - State
54555
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 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
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
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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
XD54251
56 - License Plate Number
HTK57 - Plate Type WI
58 - State
2016
59 - Exp Year
55675
55 - Vehicle Identification Number
2008
50 - Year
FORD
51 - Make
SUPERDUTY
52 - Model
TK - TRUCK
53 - Body Style
RED
54 - Color 100 - Skidmarks to Impact (Ft)
REAR DRIVER SIDE, REAR, FRONT 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
SPACEK
46 - Vehicle Owner Last Name
COLE
46 - First Name
S
46 - Middle Initial 46 - Suffix
12/15/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
PHILLIPS48 - City WI48 - State 5455548 - Zip Code 49 - Telephone Number
WILSON-MUTUAL-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60
SPACEK
61 - Policy Holder Last Name
COLE
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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1
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
POPLIN
UNIT 1 IS A HEAVY TRUCK PICK UP AND WAS GOING WEST ON COUNTY HWY W OVER A BRIDGE ON 11/10/2016. UNIT 1 WAS
PULLING A COMPRESSOR TRAILER AND WHEN UNIT 1 HIT THE BUMP ENTERING THE BRIDGE IT CAUSED THE COMPRESSOR
TRAILER TO JUMP OFF OF THE TRAILER HITCH CAUSING A JACKKNIFE. THIS JACKKNIFE CAUSED SEVERE DAMAGE TO UNIT 1'S
REAR DRIVER'S SIDE AND THE DRIVER'S DOOR. THE COMPRESSOR TRAILER ALSO SUSTAINED DAMAGE AS WELL. THE TRAILER WAS PROPERLY CHAINED AND HOOKED TO THE TRUCK THE KEEP THE TRAILER SECURED.
UNIT 1 IS A HEAVY TRUCK PICK UP AND WAS GOING WEST ON COUNTY HWY W OVER A BRIDGE ON 11/10/2016. UNIT 1 WAS
PULLING A COMPRESSOR TRAILER AND WHEN UNIT 1 HIT THE BUMP ENTERING THE BRIDGE IT CAUSED THE COMPRESSOR
TRAILER TO JUMP OFF OF THE TRAILER HITCH CAUSING A JACKKNIFE. THIS JACKKNIFE CAUSED SEVERE DAMAGE TO UNIT 1'S
REAR DRIVER'S SIDE AND THE DRIVER'S DOOR. THE COMPRESSOR TRAILER ALSO SUSTAINED DAMAGE AS WELL. THE TRAILER WAS PROPERLY CHAINED AND HOOKED TO THE TRUCK THE KEEP THE TRAILER SECURED.
OF
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125 - First Name 125 - Middle Initial
Officer Information
POPLIN125 - Officer Last Name JAY 352131 - 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
11/10/2016132 - Date Notified 0813133 - Time Notified (Military Time)0828134 - Time Arrived (Military Time)11/10/2016135 - Date Of Report
16111015048 16111001 19 - Special Study
18 - Agency Space
Accident Report
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MV4000e 01/2005
Page
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Wisconsin Motor Vehicle GZHTL62 3 3