20161123 WalterAgency Accident Number
AC
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PO
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Police Number
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Reportable Accident On Emergency Amended GZDFCJC
DOT Document Number Document Override Number
16112305
16
1
1
2
3
0
5
11/23/2016
4 - Accident Date
1630
5 - Time of Accident (Military Time)
01
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County ROUND LAKE - 13, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
14 - On Hwy No.
PINE POINT RD
14 - On Street Name 14 - Bus/Frnt/Rmp
448 FT15 - Est. Distance WEST15 - Hwy. Dir
16 - Fr/At Hwy No.LOUIES LANDING RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
46.036000
12 - Latitude -91.07664313 - Longitude
DITCH80 - 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
OUTSIDE-SHOULDER-LEFT
117 - Relation To Roadway
DARK-NOT-LIGHTED114 - Light Condition SNOW/SLUSH116 - Road Surface Condition SNOW118 - 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
DITCH
81 - Most Harmful Event: Collision With
EAST
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
2024
31 - Expiration Year 34 - On Duty Accident
WALTER
25 - Operator/Pedestrian Last Name
KEITH
25 - First Name
A
25 - Middle Initial
SR
25 - Suffix
11/12/
32 - Date Of Birth
MALE
33 - Sex
26 - Address Street & Number 26 - PO Box
SOUTH MILWAUKEE
27 - City
WI
27 - State
53172
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
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.
NOT-APPLICABLE
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 GZDFCJC 1 4
VE
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Vehicle
Vehicle Owner
Insurance
School Bus
IN
S
91 - Drugs Reported
SNOW,-ICE,-OR-WET
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
2
22 - Total Occupants
TK957MZG
56 - License Plate Number
AUT57 - Plate Type IN
58 - State
2017
59 - Exp Year
139
55 - Vehicle Identification Number
2015
50 - Year
CHEV
51 - Make
SILVERADO
52 - Model
PK - PICKUP
53 - Body Style
WHI
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT DRIVER SIDE, MIDDLE DRIVER SIDE, FRONT, REAR PASSENGER SIDE
94 - Vehicle Damage
MODERATE
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
WALTER
46 - Vehicle Owner Last Name
KEITH
46 - First Name
A
46 - Middle Initial
SR
46 - Suffix
11/12
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
SOUTH MILWAUKEE48 - City WI48 - State 5317248 - Zip Code 49 - Telephone Number
LIBERTY-MUTUAL-FIRE-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60
WALTER
61 - Policy Holder Last Name
KEITH
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
Occupant
Address Same As Operator
OC
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N
T
01
65 - Unit No
WALTER
66 - Occupant Last Name
KEITH
66 - First Name
A
66 - Middle Initial
JR
66 - Suffix
01
68 - Address Street & Number 68 - PO Box
68 - City 68 - State 68 - Zip Code
05/10/67 - Date of Birth M69 - Sex
FRONT-SEAT-RIGHT-SIDE-(TRAIN ENGINEER)
71 - Seat Position
SHOULDER-BELT-AND-LAP-BELT-USED
72 - Safety Equipment
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Wisconsin Motor Vehicle
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N - NO APPARENT INJURY
70 - Injury Severity
DEPLOYED
73 - Airbag
NOT-EJECTED
75 - Ejected
Medical Transport
77
NOT-TRAPPED
76 - Trapped/Extricated 78 - Agency Space
Trailer
01
TR
L
1106 - Power Unit Number License Plate Number Plate Type WIState Expiration Year
Trailer Make Unit Type Vehicle Identification Number
Fixed Objects Struck
PR
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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 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
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Diagram and Narrative
I WAS DISPATCHED TO A ONE VEHICLE PROPERTY DAMAGE CRASH ON PINE POINT RD. DISPATCH ADVISED THAT THERE WERE NO
INJURIES. I ARRIVED AND NOTICED A VEHICLE IN THE DITCH PULLING A TRAILER. THE VEHICLE HAD LOST CONTROL DUE TO THE
SNOW ON THE ROAD. THE VEHICLE THEN WENT INTO THE DITCH AND STRUCK A LARGE BOULDER. THE VEHICLE THEN CAME TO A REST SHORTLY THERE AFTER. ROAD RUNNER ARRIVED ON SCENE AND
I WAS DISPATCHED TO A ONE VEHICLE PROPERTY DAMAGE CRASH ON PINE POINT RD. DISPATCH ADVISED THAT THERE WERE NO
INJURIES. I ARRIVED AND NOTICED A VEHICLE IN THE DITCH PULLING A TRAILER. THE VEHICLE HAD LOST CONTROL DUE TO THE
SNOW ON THE ROAD. THE VEHICLE THEN WENT INTO THE DITCH AND STRUCK A LARGE BOULDER. THE VEHICLE THEN CAME TO A REST SHORTLY THERE AFTER. ROAD RUNNER ARRIVED ON SCENE AND
Accident Report
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Wisconsin Motor Vehicle GZDFCJC 3 4
REMOVED BOTH THE TRAILER AND VEHICLE. REMOVED BOTH THE TRAILER AND VEHICLE.
OF
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125 - First Name 125 - Middle Initial
Officer Information
JEFSON
125 - Officer Last Name
MATTHEW 324
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 1641133 - Time Notified (Military Time)1712134 - Time Arrived (Military Time)
11/23/2016
135 - Date Of Report
16112305 19 - Special Study
18 - Agency Space
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Page
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Wisconsin Motor Vehicle GZDFCJC 4 4