20161124 BillenAgency Accident Number
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Police Number
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Reportable Accident On Emergency Amended GZJ3QMG
DOT Document Number Document Override Number
16112407
16
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4
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7
11/24/2016
4 - Accident Date
1951
5 - Time of Accident (Military Time)
01
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County HAYWARD - 53, CITY3 - Municipality PRIVATE PROPERTY11 - Accident Location
14 - On Hwy No.
PRIVATE PROPERTY
14 - On Street Name 14 - Bus/Frnt/Rmp 15 - Est. Distance 15 - Hwy. Dir
5016 - Fr/At Hwy No.16 - From/At Street Name BUSINESS16 - Business/Frontage/Ramp
FIRE #
17 - Structure Type
10489
17 - Structure Number 12 - Latitude 13 - Longitude
UTILITY POLE80 - First Harmful Event NO COLLISION WITH MOTOR VEHICLE IN TRANSPORT93 - Manner of Collision
NO CONTROL
112 - Access Control 113 - Road Curvature
LEVEL/FLAT
113 - Road Terrain
BLACKTOP, BITUMINOUS, OR ASPHALT - 2
Surface Type
PARKING-LOT-OR-PRIVATE-PROPERTY115 - Traffic Way
PARKING-LOT-OR-PRIVATE-PROPERTY
117 - Relation To Roadway
DARK-LIGHTED114 - Light Condition DRY116 - 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
UTILITY POLE
81 - Most Harmful Event: Collision With
SOUTH
23 - Dir Of Travel
2524 - 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
POLICE
34 - On Duty Accident
BILLEN
25 - Operator/Pedestrian Last Name
ROBERT
25 - First Name
C
25 - Middle Initial 25 - Suffix
05/14/
32 - Date Of Birth
MALE
33 - Sex
26 - Address Street & Number 26 - PO Box
EAU CLAIRE
27 - City
WI
27 - State
54701
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
BACKING-MANEUVER
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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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
93283
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2099
59 - Exp Year
398
55 - Vehicle Identification Number
2016
50 - Year
FORD
51 - Make
POLICE INT
52 - Model
4D - 4DR
53 - Body Style
WHI
54 - Color 100 - Skidmarks to Impact (Ft)
MIDDLE PASSENGER SIDE
94 - Vehicle Damage
VERY-MINOR
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
46 - Vehicle Owner Last Name 46 - First Name 46 - Middle Initial 46 - Suffix Date Of Birth
CITY OF HAYWARD46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code (715) 634-8961 EXT.49 - Telephone Number
GOVERNMENT63 - 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
L
106 - Power Unit Number License Plate Number Plate Type State Expiration Year
Trailer Make Unit Type Vehicle Identification Number
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Fixed Objects Struck
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ORGANIZATION
Organization Type 84 - Property Owner Last Name 84 - First Name 84 - Middle Initial 84 - Suffix
01
WALGREENS
84 - Company Name Government Property Type
10489 STATE RD 27
85 - Address Street & Number 85 - PO Box
HAYWARD
86 - City
WI
86 - State
54843
86 - Zip Code
(715) 634-1919 EXT.
87 - Telephone Number
83 - Government Damage Tag Number
01
82 - Striking Unit
UTILITY-POLE
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
WHILE ON ROUTINE PATROL, COMPLETING A TRAFFIC CONTACT AT THE HAYWARD WALGREENS, I OBSERVED OFFICER ROBERT
BILLEN BACK UP FROM HIS PARKED POSITION AND STRIKE A LIGHT POLE AT A VERY SLOW SPEED. I FINISHED MY CONTACT AND
WENT TO INVESTIGATE. OFFICER BILLEN STATED HE DID NOT SEE THE LIGHT POLE IN HIS SIDE VIEW MIRROR. THERE WAS NO
DAMAGE TO THE CONCRETE BASE OF THE LIGHT POLE, AND VERY MINOR DAMAGE TO THE FRONT PASSENGER DOOR SKIN.
WHILE ON ROUTINE PATROL, COMPLETING A TRAFFIC CONTACT AT THE HAYWARD WALGREENS, I OBSERVED OFFICER ROBERT
BILLEN BACK UP FROM HIS PARKED POSITION AND STRIKE A LIGHT POLE AT A VERY SLOW SPEED. I FINISHED MY CONTACT AND
WENT TO INVESTIGATE. OFFICER BILLEN STATED HE DID NOT SEE THE LIGHT POLE IN HIS SIDE VIEW MIRROR. THERE WAS NO
DAMAGE TO THE CONCRETE BASE OF THE LIGHT POLE, AND VERY MINOR DAMAGE TO THE FRONT PASSENGER DOOR SKIN.
Officer Information
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125 - First Name 125 - Middle Initial
FREY
125 - Officer Last Name
NATHAN 397
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
11/24/2016
132 - Date Notified 1951133 - Time Notified (Military Time)1951134 - Time Arrived (Military Time)
11/27/2016
135 - Date Of Report
16112407 19 - Special Study
18 - Agency Space
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