20161204 Welsch LaierAgency Accident Number
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Reportable Accident On Emergency Amended GZJ2864
DOT Document Number Document Override Number
16120416142
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16120403
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12/04/2016
4 - Accident Date
1120
5 - Time of Accident (Military Time)
02
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County HAYWARD - 06, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
14 - On Hwy No.
NAMEKAGON TRL
14 - On Street Name 14 - Bus/Frnt/Rmp
0.26 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
46.015117
12 - Latitude -91.46087013 - Longitude
MOTOR VEHICLE IN TRANSPORT80 - First Harmful Event ANGLE93 - 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
DAYLIGHT114 - Light Condition ICE116 - 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
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Unit Status
MOTOR VEHICLE IN TRANSPORT
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
2017
31 - Expiration Year 34 - On Duty Accident
WELSCH
25 - Operator/Pedestrian Last Name
RICHARD
25 - First Name
C
25 - Middle Initial
JR
25 - Suffix
03/12/
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 62 - 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 GZJ2864 1 5
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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
286XVU
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2017
59 - Exp Year
1 194
55 - Vehicle Identification Number
2002
50 - Year
JEEP
51 - Make
WRANGLER
52 - Model
UT - SPORT UTILITY
53 - Body Style
BLK
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT
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
WELSCH
46 - Vehicle Owner Last Name
RICHARD
46 - First Name
C
46 - Middle Initial
JR
46 - Suffix
03/12/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code .49 - Telephone Number
ERIE-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60
WELSCH
61 - Policy Holder Last Name
RICHARD
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
Operator/Pedestrian
Unit Status
MOTOR VEHICLE IN TRANSPORT
81 - Most Harmful Event: Collision With
NORTH
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
2024
31 - Expiration Year 34 - On Duty Accident
LAIER
25 - Operator/Pedestrian Last Name
DOUGLAS
25 - First Name
W
25 - Middle Initial 25 - Suffix
07/20
32 - Date Of Birth
MALE
33 - Sex
Accident Report
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MV4000e 01/2005
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Wisconsin Motor Vehicle
Accident Report
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Wisconsin Motor Vehicle GZJ2864 2 525
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Vehicle
Vehicle Owner
Insurance
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IN
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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 62 - 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
91 - Drugs Reported
SNOW,-ICE,-OR-WET
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
364WHB
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2017
59 - Exp Year
37717
55 - Vehicle Identification Number
2012
50 - Year
CHRY
51 - Make
TOWN
52 - Model
VN - VAN
53 - Body Style
SIL
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT DRIVER SIDE, MIDDLE DRIVER SIDE, REAR DRIVER SIDE
94 - Vehicle Damage
SEVERE
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
LAIER
46 - Vehicle Owner Last Name
DOUGLAS
46 - First Name
W
46 - Middle Initial 46 - Suffix
07/20
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
ACUITY,-A-MUTUAL-INSURANCE-CO63 - Liability Insurance Company Policy Holder Same As Owner60
LAIER
61 - Policy Holder Last Name
DOUGLAS
61 - Policy Holder First Name
61 - Policy Holder Company
02
02
02
02
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Wisconsin Motor Vehicle GZJ2864 3 5
School Bus
02
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
105 - Photos By
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Diagram and Narrative
DEPUTY AMBER AL-MOGHRABI
ON DECEMBER 4, 2016 AT APPROXIMATELY 11:28, I WAS DISPATCHED TO 10660N NAMEKAGON TRAIL FOR A REPORT OF A TWO VEHICLE ACCIDENT. UPON ARRIVAL AT 11:49, I SPOKE WITH RICHARD WELSCH WHO STATED HE WAS TRAVELING SOUTH ON
NAMEKAGON TRAIL AND WHEN HE WAS GOING AROUND THE CURVE HE STARTED TO LOSE CONTROL OF HIS VEHICLE. RICHARD
STATED HE TRIED TO BRAKE AND JUST SLID INTO THE VEHICLE THAT WAS HEADED NORTHBOUND. RICHARD STATED HE DID NOT
HAVE MUCH DAMAGE TO HIS VEHICLE AND HE WAS TRAVELING APPROXIMATELY 10-15 MILES PER HOUR AT THE TIME OF THE
CRASH. I NOTICED THERE WAS MINOR DAMAGE TO THE DRIVER SIDE HEADLIGHT OF RICHARD'S VEHICLE WHICH I TOOK
PICTURES OF. I THEN SPOKE TO DOUGLAS. HE STATED THAT HE WAS TRAVELING NORTHBOUND ON NAMEKAGON TRAIL HEADED HOME. HE SAID WHEN HE WAS GOING AROUND THE CURVE HE SAW RICHARD'S VEHICLE SLIDING AND TRIED TO MANEUVER HIS
VEHICLE OUT OF THE WAY BUT THERE WAS A POLE IN THE WAY. DOUGLAS STATED THAT RICHARD'S VEHICLE HIT THE DRIVER
SIDE OF HIS VEHICLE. THERE WAS SEVERE DAMAGE TO DOUGLAS'S VEHICLE ON THE DRIVER SIDE. BOTH INDIVIDUALS STATED
THEY WERE WEARING THEIR SEATBELTS. I TOOK PICTURES OF THE DAMAGE TO DOUGLAS'S VEHICLE AND ENTERED ALL THE
PHOTOGRAPHS INTO EVIDENCE. I INFORMED BOTH PARTIES TO CONTACT THEIR INSURANCE COMPANIES. I CLEARED THE CALL
AT 12:02. THIS IS ALL THE INFORMATION I HAVE AT THIS TIME.
ON DECEMBER 4, 2016 AT APPROXIMATELY 11:28, I WAS DISPATCHED TO 10660N NAMEKAGON TRAIL FOR A REPORT OF A TWO VEHICLE ACCIDENT. UPON ARRIVAL AT 11:49, I SPOKE WITH RICHARD WELSCH WHO STATED HE WAS TRAVELING SOUTH ON
NAMEKAGON TRAIL AND WHEN HE WAS GOING AROUND THE CURVE HE STARTED TO LOSE CONTROL OF HIS VEHICLE. RICHARD
STATED HE TRIED TO BRAKE AND JUST SLID INTO THE VEHICLE THAT WAS HEADED NORTHBOUND. RICHARD STATED HE DID NOT
HAVE MUCH DAMAGE TO HIS VEHICLE AND HE WAS TRAVELING APPROXIMATELY 10-15 MILES PER HOUR AT THE TIME OF THE
CRASH. I NOTICED THERE WAS MINOR DAMAGE TO THE DRIVER SIDE HEADLIGHT OF RICHARD'S VEHICLE WHICH I TOOK
PICTURES OF. I THEN SPOKE TO DOUGLAS. HE STATED THAT HE WAS TRAVELING NORTHBOUND ON NAMEKAGON TRAIL HEADED HOME. HE SAID WHEN HE WAS GOING AROUND THE CURVE HE SAW RICHARD'S VEHICLE SLIDING AND TRIED TO MANEUVER HIS
VEHICLE OUT OF THE WAY BUT THERE WAS A POLE IN THE WAY. DOUGLAS STATED THAT RICHARD'S VEHICLE HIT THE DRIVER
SIDE OF HIS VEHICLE. THERE WAS SEVERE DAMAGE TO DOUGLAS'S VEHICLE ON THE DRIVER SIDE. BOTH INDIVIDUALS STATED
THEY WERE WEARING THEIR SEATBELTS. I TOOK PICTURES OF THE DAMAGE TO DOUGLAS'S VEHICLE AND ENTERED ALL THE
PHOTOGRAPHS INTO EVIDENCE. I INFORMED BOTH PARTIES TO CONTACT THEIR INSURANCE COMPANIES. I CLEARED THE CALL
AT 12:02. THIS IS ALL THE INFORMATION I HAVE AT THIS TIME.
Officer Information
Accident Report
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Wisconsin Motor Vehicle GZJ2864 4 5
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125 - First Name 125 - Middle Initial
ALMOGHRABI
125 - Officer Last Name
AMBER 340
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
12/04/2016
132 - Date Notified 1128133 - Time Notified (Military Time)1149134 - Time Arrived (Military Time)
12/04/2016
135 - Date Of Report
16120416142 16120403 19 - Special Study
18 - Agency Space
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZJ2864 5 5