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20161123 SlaytonAgency 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 GZDNRR2 DOT Document Number Document Override Number 16112307 16 1 1 2 3 0 7 11/23/2016 4 - Accident Date 2152 5 - Time of Accident (Military Time) 01 6 - Total Units 00 7 - Total Injured 00 8 - Total Killed SAWYER - 572 - County RADISSON - 12, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location 040 14 - On Hwy No. SB 14 - On Street Name 14 - Bus/Frnt/Rmp 981 FT15 - Est. Distance SOUTH15 - Hwy. Dir 16 - Fr/At Hwy No.ELM CREEK RD16 - From/At Street Name 16 - Business/Frontage/Ramp 17 - Structure Type 17 - Structure Number 45.744772 12 - Latitude -91.22618613 - Longitude UNKNOWN80 - First Harmful Event NO COLLISION WITH MOTOR VEHICLE IN TRANSPORT93 - Manner of Collision NO CONTROL 112 - Access Control CURVE 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 DARK-NOT-LIGHTED114 - Light Condition WET116 - 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 OP E R A T O R / P E D E S T R I A N Unit Status CULVERT 81 - Most Harmful Event: Collision With SOUTH 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 2023 31 - Expiration Year 34 - On Duty Accident SLAYTON 25 - Operator/Pedestrian Last Name RUSSELL 25 - First Name G 25 - Middle Initial 25 - Suffix 10/11/1 32 - Date Of Birth MALE 33 - Sex 26 - Address Street & Number 26 - PO Box RADISSON 27 - City WI 27 - State 54867 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. NOT-APPLICABLE 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 of MV4000e 01/2005 Page PK2012 Wisconsin Motor Vehicle GZDNRR2 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 JP6932 56 - License Plate Number AUT57 - Plate Type WI 58 - State 2017 59 - Exp Year 663 55 - Vehicle Identification Number 2006 50 - Year DODG 51 - Make RAM 1500 52 - Model 2D - 2DR 53 - Body Style GRY 54 - Color 0100 - Skidmarks to Impact (Ft) NONE 94 - Vehicle Damage NONE 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 SLAYTON 46 - Vehicle Owner Last Name RUSSELL 46 - First Name G 46 - Middle Initial 46 - Suffix 10/11 Date Of Birth 46 - Company Name 47- Address Street & Number 47 - PO Box RADISSON48 - City WI48 - State 5486748 - Zip Code 49 - Telephone Number UNKNOWN63 - Liability Insurance Company Policy Holder Same As Owner60 SLAYTON 61 - Policy Holder Last Name RUSSELL 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 GZDNRR2 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 RADISSON TOWNSHIP 84 - Company Name COUNTY/MUNICIPAL Government Property Type RADISSON 85 - Address Street & Number 85 - PO Box RADISSON 86 - City WI 86 - State 54867 86 - Zip Code 87 - Telephone Number UNKNOWN 83 - Government Damage Tag Number 01 82 - Striking Unit CULVERT 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 DI A G R A M A N D N A R R A T I V E Diagram and Narrative DEPUTY RESPONDED TO A CALL OF A VEHICLE IN A DITCH NEAR A STREAM. DEPUTY ARRIVED TO THE SCENE AND FOUND A FULL SIZE TRUCK IN THE MUD NEXT TO THE STREAM. THE VEHICLE APPEARED UNDAMAGED. THE VEHICLE WAS ALSO UNOCCUPIED. DEPUTY OBSERVED SLIGHT DAMAGE TO THE CULVERT ON THE WEST SIDE OF THE ROADWAY. DEPUTY WAS UNABLE TO MAKE CONTACT WITH THE VEHICLE OWNER. THE VEHICLE WAS REMOVED WHILE THE DEPUTY WAS ON ANOTHER CALL. DEPUTY RESPONDED TO A CALL OF A VEHICLE IN A DITCH NEAR A STREAM. DEPUTY ARRIVED TO THE SCENE AND FOUND A FULL SIZE TRUCK IN THE MUD NEXT TO THE STREAM. THE VEHICLE APPEARED UNDAMAGED. THE VEHICLE WAS ALSO UNOCCUPIED. DEPUTY OBSERVED SLIGHT DAMAGE TO THE CULVERT ON THE WEST SIDE OF THE ROADWAY. DEPUTY WAS UNABLE TO MAKE CONTACT WITH THE VEHICLE OWNER. THE VEHICLE WAS REMOVED WHILE THE DEPUTY WAS ON ANOTHER CALL. Officer Information Accident Report of MV4000e 01/2005 Page PK2012 Wisconsin Motor Vehicle GZDNRR2 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 SIMPSON 125 - Officer Last Name MICHAEL 357 131 - 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 11/23/2016 132 - Date Notified 2152133 - Time Notified (Military Time)2212134 - Time Arrived (Military Time) 11/23/2016 135 - Date Of Report 16112307 19 - Special Study 18 - Agency Space Accident Report of MV4000e 01/2005 Page PK2012 Wisconsin Motor Vehicle GZDNRR2 4 4