20161119 WolfeAgency Accident Number
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Reportable Accident On Emergency Amended GZH0DMP
DOT Document Number Document Override Number
16111907
16
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1
9
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16111907
16
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9
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11/19/2016
4 - Accident Date
1750
5 - Time of Accident (Military Time)
01
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County SPIDER LAKE - 15, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
14 - On Hwy No.
PEDERSON RD
14 - On Street Name 14 - Bus/Frnt/Rmp
0.37 MI15 - Est. Distance NORTH15 - Hwy. Dir
07716 - Fr/At Hwy No.16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
46.078605
12 - Latitude -91.28848313 - Longitude
DITCH80 - First Harmful Event NO COLLISION WITH MOTOR VEHICLE IN TRANSPORT93 - Manner of Collision
NO CONTROL
112 - Access Control
CURVE
113 - Road Curvature
HILL
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 ICE116 - Road Surface Condition CLOUDY118 - 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
TREE
81 - Most Harmful Event: Collision With
NORTH
23 - Dir Of Travel
4524 - 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
WOLFE
25 - Operator/Pedestrian Last Name
ROBERT
25 - First Name
ANTHONY
25 - Middle Initial 25 - Suffix
07/13/1
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
NEGOTIATING-CURVE
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.
SPEED-TOO-FAST-FOR-CONDITIONS
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
01
Accident Report
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MV4000e 01/2005
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PK2012
Wisconsin Motor Vehicle GZH0DMP 1 4
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Vehicle
Vehicle Owner
Insurance
School Bus
IN
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91 - Drugs Reported
SNOW,-ICE,-OR-WET
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
54124E
56 - License Plate Number
END57 - Plate Type WI
58 - State
2017
59 - Exp Year
279
55 - Vehicle Identification Number
2003
50 - Year
VOLK
51 - Make
JETTA
52 - Model
4D - 4DR
53 - Body Style
BLK
54 - Color 100 - Skidmarks to Impact (Ft)
MIDDLE PASSENGER SIDE, FRONT PASSENGER SIDE, FRONT, FRONT DRIVER SIDE, MIDDLE DRIVER SIDE
94 - Vehicle Damage
VERY-SEVERE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
A1 TOWING
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
WOLFE
46 - Vehicle Owner Last Name
ROBERT
46 - First Name
ANTHONY
46 - Middle Initial 46 - Suffix
07/13/
Date Of Birth
46 - Company Name
47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code .49 - Telephone Number
LIBERTY-MUTUAL63 - Liability Insurance Company Policy Holder Same As Owner60
WOLFE
61 - Policy Holder Last Name
ROBERT
61 - Policy Holder First Name
61 - Policy Holder Company
01
01
01
01
BU
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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
Accident Report
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MV4000e 01/2005
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PK2012
Wisconsin Motor Vehicle
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZH0DMP 2 424
Fixed Objects Struck
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Property
UNKNOWN
Organization Type 84 - Property Owner Last Name 84 - First Name 84 - Middle Initial 84 - Suffix
01
84 - Company Name Government Property Type
85 - Address Street & Number 85 - PO Box
86 - City 86 - State 86 - Zip Code 87 - Telephone Number
83 - Government Damage Tag Number
01
82 - Striking Unit
DITCH
82 - Object Struck
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
105 - Photos By
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Diagram and Narrative
SGT. NICK ALMOGHRABI
I, SGT. NICK AL-MOGHRABI, WAS DISPATCHED TO THIS ONE VEHICLE PROPERTY DAMAGE CRASH ON 11/19/16. I WAS ADVISED THE
OPERATOR HAD GONE OFF THE ROADWAY, STRUCK A TREE, AND THEN LEFT THE SCENE AS HE HAD TO GET TO WORK IN THE
ASHLAND ER. THE OPERATOR'S WIFE CALLED IT IN ON HIS BEHALF. UPON MY ARRIVAL, I OBSERVED A VEHICLE THAT WAS OFF
THE RIGHT SHOULDER DOWN A SMALL EMBANKMENT AND UP AGAINST A TREE WITH THE FRONT END. THE ROAD WAS A
DOWNHILL CURVE THAT WAS COVERED IN ICE. I OBSERVED SEVERE DAMAGE TO THE VEHICLE IN MOST AREAS WITH NO AIR BAG
DEPLOYMENT. A1 TOWING WAS DISPATCHED TO REMOVE THE VEHICLE. UPON PHONE CONTACT WITH THE OPERATOR, DR. WOLFE, I ADVISED HIM THAT NO CITATIONS WOULD BE ISSUED. WOLFE STATED HEW AS WEARING A SEATBELT AT THE TIME OF
THE CRASH.
I, SGT. NICK AL-MOGHRABI, WAS DISPATCHED TO THIS ONE VEHICLE PROPERTY DAMAGE CRASH ON 11/19/16. I WAS ADVISED THE
OPERATOR HAD GONE OFF THE ROADWAY, STRUCK A TREE, AND THEN LEFT THE SCENE AS HE HAD TO GET TO WORK IN THE
ASHLAND ER. THE OPERATOR'S WIFE CALLED IT IN ON HIS BEHALF. UPON MY ARRIVAL, I OBSERVED A VEHICLE THAT WAS OFF
THE RIGHT SHOULDER DOWN A SMALL EMBANKMENT AND UP AGAINST A TREE WITH THE FRONT END. THE ROAD WAS A
DOWNHILL CURVE THAT WAS COVERED IN ICE. I OBSERVED SEVERE DAMAGE TO THE VEHICLE IN MOST AREAS WITH NO AIR BAG
DEPLOYMENT. A1 TOWING WAS DISPATCHED TO REMOVE THE VEHICLE. UPON PHONE CONTACT WITH THE OPERATOR, DR. WOLFE, I ADVISED HIM THAT NO CITATIONS WOULD BE ISSUED. WOLFE STATED HEW AS WEARING A SEATBELT AT THE TIME OF
THE CRASH.
Officer Information
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZH0DMP 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
11/19/2016
132 - Date Notified 1816133 - Time Notified (Military Time)1840134 - Time Arrived (Military Time)
11/19/2016
135 - Date Of Report
16111907 16111907 19 - Special Study
18 - Agency Space
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZH0DMP 4 4