20161203 TrepaniaAgency Accident Number
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Police Number
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Reportable Accident On Emergency Amended GZGZNDR
DOT Document Number Document Override Number
16120302
16
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16120302
16
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12/03/2016
4 - Accident Date
0630
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
H
14 - On Hwy No.14 - On Street Name 14 - Bus/Frnt/Rmp
734 FT15 - Est. Distance SOUTH15 - Hwy. Dir
16 - Fr/At Hwy No.ASHEGON FIRE LN16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.847068
12 - Latitude -91.23092913 - Longitude
OTHER NON-COLLISION80 - 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 SLEET-HAIL-(FREEZING RAIN OR DRIZZLE)118 - 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
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
TREPANIA
25 - Operator/Pedestrian Last Name
PAIGE
25 - First Name
M
25 - Middle Initial 25 - Suffix
02/22
32 - Date Of Birth
FEMALE
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
TRAPPED/EXTRICATED
43 - Trapped/Extricated 92 - Pedestrian Location 92 - Pedestrian Action
NEGOTIATING-CURVE
119 - What Driver Was Doing
NO-CONTROL
120 - Traffic Control 262 - No. of Citations Issued
344.62(1)
64 - 1st Statute No.
343.44(1)(A)
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
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZGZNDR 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
A930
56 - License Plate Number
LCO57 - Plate Type WI
58 - State
2017
59 - Exp Year
3633
55 - Vehicle Identification Number
2000
50 - Year
BUIC
51 - Make
REGAL
52 - Model
4D - 4DR
53 - Body Style
BLU
54 - Color
0100 - Skidmarks to Impact (Ft)
FRONT, FRONT DRIVER SIDE, FRONT PASSENGER SIDE, REAR
94 - Vehicle Damage
MODERATE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96 97 - Vehicle Removed By
TIRES
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
TREPANIA
46 - Vehicle Owner Last Name
PAIGE
46 - First Name
M
46 - Middle Initial 46 - Suffix
02/22/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
RADISSON48 - City WI48 - State 5486748 - Zip Code .49 - Telephone Number
NONE63 - Liability Insurance Company Policy Holder Same As Owner60
TREPANIA
61 - Policy Holder Last Name
PAIGE
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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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
Page
PK2012
Wisconsin Motor Vehicle
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZGZNDR 2 424
Fixed Objects Struck
PR
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Property
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
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 82 - Striking Unit 82 - Object Struck
105 - Photos By
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Diagram and Narrative
SGT RIPCZINSKI
UNIT #1 WAS NORTHBOUND ON CTH H, OPERATOR LOST CONTROL OF THE VEHICLE AS IT TURNED A CORNER IN THE ROADWAY.
ROADWAY WAS GLAZED OVER IN ICE, MIXED WITH RAIN AND SLIPPERY. UNIT # 1 CROSSED THE OPPOSING LANE AND SLID INTO
THE DITCH LINE AREA OF THE SOUTHBOUND LANE, COLLIDING WITH SEVERAL SMALL TREES AND COMING TO REST.
UNIT #1 WAS NORTHBOUND ON CTH H, OPERATOR LOST CONTROL OF THE VEHICLE AS IT TURNED A CORNER IN THE ROADWAY.
ROADWAY WAS GLAZED OVER IN ICE, MIXED WITH RAIN AND SLIPPERY. UNIT # 1 CROSSED THE OPPOSING LANE AND SLID INTO
THE DITCH LINE AREA OF THE SOUTHBOUND LANE, COLLIDING WITH SEVERAL SMALL TREES AND COMING TO REST.
Officer Information
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZGZNDR 3 4
OF
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125 - First Name 125 - Middle Initial
RIPCZINSKI
125 - Officer Last Name
GREG 326
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
12/03/2016
132 - Date Notified 0637133 - Time Notified (Military Time)0652134 - Time Arrived (Military Time)
12/03/2016
135 - Date Of Report
16120302 16120302 19 - Special Study
18 - Agency Space
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZGZNDR 4 4