20161205 WidzinsAgency Accident Number
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Reportable Accident On Emergency Amended GZJ2867
DOT Document Number Document Override Number
16120516174
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16120504
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12/05/2016
4 - Accident Date
1330
5 - Time of Accident (Military Time)
01
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County SPIDER LAKE - 15, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
077
14 - On Hwy No.
WB
14 - On Street Name 14 - Bus/Frnt/Rmp
457 FT15 - Est. Distance NORTH15 - Hwy. Dir
16 - Fr/At Hwy No.FEDERAL FOREST RD 20416 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
46.096503
12 - Latitude -91.00443813 - 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-RIGHT
117 - Relation To Roadway
DAYLIGHT114 - Light Condition SNOW/SLUSH116 - 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
OTHER NON-COLLISION
81 - Most Harmful Event: Collision With
WEST
23 - Dir Of Travel
5524 - Speed Limit
A CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
29 - Driver's License Number
FL
30 - State
2022
31 - Expiration Year 34 - On Duty Accident
WIDZINS
25 - Operator/Pedestrian Last Name
STANLEY
25 - First Name
M
25 - Middle Initial
JR
25 - Suffix
08/16
32 - Date Of Birth
MALE
33 - Sex
26 - Address Street & Number 26 - PO Box
DELRAY BEACH
27 - City
FL
27 - State
33445
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.
SPEED-TOO-FAST-FOR-CONDITIONS, FAILURE-TO-HAVE-CONTROL
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
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Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZJ2867 1 3
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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
TRUCK
21 - Unit Type
TRUCK-TRACTOR- (SEMI-ATTACHED)
Vehicle Type
1
22 - Total Occupants
2483676
56 - License Plate Number
APO57 - Plate Type IN
58 - State
2031
59 - Exp Year
09154
55 - Vehicle Identification Number
2016
50 - Year
KW
51 - Make
UNKNOWN
52 - Model
SE - SEMI-TRAILER
53 - Body Style
BLU
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT PASSENGER SIDE, MIDDLE PASSENGER SIDE, REAR PASSENGER SIDE, REAR
94 - Vehicle Damage
SEVERE
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
46 - Vehicle Owner Last Name 46 - First Name 46 - Middle Initial 46 - Suffix Date Of Birth
MARTEN TRANSPORT LTD46 - Company Name
129 MARTEN STREET
47- Address Street & Number 47 - PO Box
MONDOVI48 - City WI48 - State 5475548 - Zip Code .49 - Telephone Number
UNKNOWN63 - Liability Insurance Company Policy Holder Same As Owner60
61 - Policy Holder Last Name 61 - Policy Holder First Name
MARTEN TRANSPORT LTD61 - 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
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106 - Power Unit Number
3453FP
License Plate Number
APO
Plate Type
OK
State Expiration Year
HYND
Trailer Make
SEMI
Unit Type
441
Vehicle Identification Number
Accident Report
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MV4000e 01/2005
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Wisconsin Motor Vehicle
Accident Report
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZJ2867 2 323
105 - Photos By
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Diagram and Narrative
DEPUTY AMBER AL-MOGHRABI
ON DECEMBER 5, 2016, I, DEPUTY AMBER AL-MOGHRABI WAS WORKING PATROL FOR THE SAWYER COUNTY SHERIFF'S
DEPARTMENT. AT APPROXIMATELY 13:51 I WAS DISPATCHED TO STATE HIGHWAY 77 JUST EAST OF FOREST ROAD 204 FOR A
SEMI TRAILER THAT WAS ON ITS SIDE. DISPATCH INFORMED ME THERE WERE NO INJURIES AND THE SEMI WAS OFF THE
ROADWAY. UPON ARRIVAL AT 14:22, I NOTICED A THE SEMI LAYING ON THE PASSENGER SIDE, BUT WAS UNABLE TO SEE ALL THE DAMAGE. THERE WAS A GENTLEMAN THAT WAS STANDING ON TOP OF THE TRUCK WHO STATED THE DRIVER OF THE VEHICLE
WAS INSIDE THE CAB ON THE PHONE WITH HIS BOSS. I ASKED IF HE WAS TRAPPED IN THE VEHICLE AND HE STATED HE WAS
NOT. THE DRIVER THEN GOT OUT OF THE VEHICLE AND TOLD ME HIS NAME WAS STANLEY WIDZINS. HE STATED HE WAS
TRAVELING WESTBOUND ON STATE HIGHWAY 77 AT APPROXIMATELY 60 MILES PER HOUR, AND WHILE NEGOTIATING THE CURVE
JUST EAST OF FOREST ROAD 204 AN ELK WAS STANDING IN THE MIDDLE OF THE ROAD. STANLEY STATED HE SLAMMED ON HIS
BRAKES AND WHEN HE DID THE FRONT RIGHT TIRE CAUGHT THE GRAVEL AND PULLED HIM OFF THE ROAD. HE SAID THE TRUCK
FELL TO THE PASSENGER SIDE AND SLID THE REST OF THE WAY. HE STATED HE WAS WEARING HIS SEAT BELT WHICH IS THE
ONLY THING THAT KEPT HIM FROM FALLING INTO THE PASSENGER SIDE. STANLEY INFORMED ME THAT HE WAS NOT INJURED
AND THAT HE HAD NOT BEEN DRINKING OR ON DRUGS. I INFORMED STANLEY THE TOW TRUCKS WERE ON THEIR WAY AND
POSSIBLY A TROOPER FROM STATE PATROL TO INSPECT THE SEMI-TRAILER. I TOOK PICTURES OF THE VEHICLE WHILE WE
WAITED FOR THE TOW TRUCK TO ARRIVE. ONE OF THE TOW TRUCKS ARRIVED ON SCENE AT APPROXIMATELY 15:24 AND
SHORTLY AFTER A TROOPER FROM STATE PATROL ARRIVED. TROOPER KOSKI AND I EXCHANGED INFORMATION AND HE
INSPECTED THE SEMI WHILE THE TOW COMPANY WAS HOOKING UP THE VEHICLE. AT 17:00 I INFORMED STANLEY I WAS CLEARING FROM THE SCENE AND WOULD BE DOING A CRASH REPORT THAT HIS COMPANY COULD GET FROM THE SHERIFF'S
DEPARTMENT. SEE FULL NARRATIVE IN CASE REPORT.
ON DECEMBER 5, 2016, I, DEPUTY AMBER AL-MOGHRABI WAS WORKING PATROL FOR THE SAWYER COUNTY SHERIFF'S
DEPARTMENT. AT APPROXIMATELY 13:51 I WAS DISPATCHED TO STATE HIGHWAY 77 JUST EAST OF FOREST ROAD 204 FOR A
SEMI TRAILER THAT WAS ON ITS SIDE. DISPATCH INFORMED ME THERE WERE NO INJURIES AND THE SEMI WAS OFF THE
ROADWAY. UPON ARRIVAL AT 14:22, I NOTICED A THE SEMI LAYING ON THE PASSENGER SIDE, BUT WAS UNABLE TO SEE ALL THE DAMAGE. THERE WAS A GENTLEMAN THAT WAS STANDING ON TOP OF THE TRUCK WHO STATED THE DRIVER OF THE VEHICLE
WAS INSIDE THE CAB ON THE PHONE WITH HIS BOSS. I ASKED IF HE WAS TRAPPED IN THE VEHICLE AND HE STATED HE WAS
NOT. THE DRIVER THEN GOT OUT OF THE VEHICLE AND TOLD ME HIS NAME WAS STANLEY WIDZINS. HE STATED HE WAS
TRAVELING WESTBOUND ON STATE HIGHWAY 77 AT APPROXIMATELY 60 MILES PER HOUR, AND WHILE NEGOTIATING THE CURVE
JUST EAST OF FOREST ROAD 204 AN ELK WAS STANDING IN THE MIDDLE OF THE ROAD. STANLEY STATED HE SLAMMED ON HIS
BRAKES AND WHEN HE DID THE FRONT RIGHT TIRE CAUGHT THE GRAVEL AND PULLED HIM OFF THE ROAD. HE SAID THE TRUCK
FELL TO THE PASSENGER SIDE AND SLID THE REST OF THE WAY. HE STATED HE WAS WEARING HIS SEAT BELT WHICH IS THE
ONLY THING THAT KEPT HIM FROM FALLING INTO THE PASSENGER SIDE. STANLEY INFORMED ME THAT HE WAS NOT INJURED
AND THAT HE HAD NOT BEEN DRINKING OR ON DRUGS. I INFORMED STANLEY THE TOW TRUCKS WERE ON THEIR WAY AND
POSSIBLY A TROOPER FROM STATE PATROL TO INSPECT THE SEMI-TRAILER. I TOOK PICTURES OF THE VEHICLE WHILE WE
WAITED FOR THE TOW TRUCK TO ARRIVE. ONE OF THE TOW TRUCKS ARRIVED ON SCENE AT APPROXIMATELY 15:24 AND
SHORTLY AFTER A TROOPER FROM STATE PATROL ARRIVED. TROOPER KOSKI AND I EXCHANGED INFORMATION AND HE
INSPECTED THE SEMI WHILE THE TOW COMPANY WAS HOOKING UP THE VEHICLE. AT 17:00 I INFORMED STANLEY I WAS CLEARING FROM THE SCENE AND WOULD BE DOING A CRASH REPORT THAT HIS COMPANY COULD GET FROM THE SHERIFF'S
DEPARTMENT. SEE FULL NARRATIVE IN CASE REPORT.
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125 - First Name 125 - Middle Initial
Officer Information
ALMOGHRABI125 - Officer Last Name AMBER 340131 - Officer ID
129 - Law Enforcement Agency No.
SAWYER COUNTY SHERIFFS DEPT
130 - Law Enforcement Agency Name
15880 EAST FIFTH STREET126 - Law Enforcement Agency Address Street & Number
HAYWARD
127 - City
WI
127 - State
54843
127 - Zip Code
(715) 634-4858 EXT.
128 - Telephone Number
12/05/2016132 - Date Notified 1351133 - Time Notified (Military Time)1422134 - Time Arrived (Military Time)12/05/2016135 - Date Of Report
16120516174 16120504 19 - Special Study
18 - Agency Space
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZJ2867 3 3