20161206 YoungmanAgency Accident Number
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Reportable Accident On Emergency Amended GZHQM9G
DOT Document Number Document Override Number
16120602
16
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12/06/2016
4 - Accident Date
0433
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 INTERSECTION11 - Accident Location
14 - On Hwy No.
MCCLAINE RD
14 - On Street Name 14 - Bus/Frnt/Rmp
30 FT15 - Est. Distance WEST15 - Hwy. Dir
16 - Fr/At Hwy No.TIGER CAT RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number 12 - Latitude 13 - Longitude
TREE80 - First Harmful Event NO COLLISION WITH MOTOR VEHICLE IN TRANSPORT93 - Manner of Collision
FULL CONTROL
112 - Access Control
STRAIGHT
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
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
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Unit Status
TREE
81 - Most Harmful Event: Collision With
WEST
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
2023
31 - Expiration Year 34 - On Duty Accident
YOUNGMAN
25 - Operator/Pedestrian Last Name
KYLE
25 - First Name
JJ
25 - Middle Initial 25 - Suffix
01/19/
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
SLOWING-OR-STOPPING
119 - What Driver Was Doing
STOP-SIGN
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
SNOW,-ICE,-OR-WET
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
811YTB
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2017
59 - Exp Year
1739
55 - Vehicle Identification Number
2013
50 - Year
CHEV
51 - Make
EQUINOX
52 - Model
UT - SPORT UTILITY
53 - Body Style
BLU
54 - Color 100 - Skidmarks to Impact (Ft)
MIDDLE DRIVER SIDE, FRONT DRIVER SIDE, FRONT, FRONT PASSENGER SIDE, MIDDLE PASSENGER SIDE
94 - Vehicle Damage
MODERATE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
A1 TOWING
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
YOUNGMAN
46 - Vehicle Owner Last Name
KYLE
46 - First Name
JJ
46 - Middle Initial 46 - Suffix
01/19/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
USAA-GENERAL-INDEMNITY-CO63 - Liability Insurance Company Policy Holder Same As Owner60
YOUNGMAN
61 - Policy Holder Last Name
KYLE
61 - Policy Holder First Name
61 - Policy Holder Company
01
01
01
01
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
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Wisconsin Motor Vehicle GZHQM9G 2 424
Fixed Objects Struck
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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
TREE
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
DEPUTY MATTHEW JEFSON
I DEPUTY MATTHEW JEFSON RESPONDED TO A ONE VEHICLE ACCIDENT AT THE INTERSECTION OF MCCLAINE RD AND TIGER CAT
RD. DISPATCH ADVISED ON STAR CALLED AND REPORTED A ACCIDENT WITH NO INJURIES. I ARRIVED AND NOTICED A VEHICLE
HAD SLIDE THROUGH THE INTERSECTION AND STRUCK A TREE. I SPOKE TO THE OPERATOR AND HE STATED THAT HE WAS
TRAVELING AROUND 25 TO 30 MPH. HE STARTED TO SLOW EARLY BECAUSE OF THE FRESH SNOW ON THE GROUND. HE SAID
THAT HE APPLIED THE BRAKES BUT THE VEHICLE DID NOT SLOW AND HE SLIDE THROUGH THE INTERSECTION AND HIT A TREE.
HE STATED THAT HE WAS WEARING HIS SEATBELT. THE VEHICLE SUFFERED MODERATE DAMAGE. I WAITED ON SCENE UNTIL A1 TOWING ARRIVED.
I DEPUTY MATTHEW JEFSON RESPONDED TO A ONE VEHICLE ACCIDENT AT THE INTERSECTION OF MCCLAINE RD AND TIGER CAT
RD. DISPATCH ADVISED ON STAR CALLED AND REPORTED A ACCIDENT WITH NO INJURIES. I ARRIVED AND NOTICED A VEHICLE
HAD SLIDE THROUGH THE INTERSECTION AND STRUCK A TREE. I SPOKE TO THE OPERATOR AND HE STATED THAT HE WAS
TRAVELING AROUND 25 TO 30 MPH. HE STARTED TO SLOW EARLY BECAUSE OF THE FRESH SNOW ON THE GROUND. HE SAID
THAT HE APPLIED THE BRAKES BUT THE VEHICLE DID NOT SLOW AND HE SLIDE THROUGH THE INTERSECTION AND HIT A TREE.
HE STATED THAT HE WAS WEARING HIS SEATBELT. THE VEHICLE SUFFERED MODERATE DAMAGE. I WAITED ON SCENE UNTIL A1 TOWING ARRIVED.
Officer Information
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Wisconsin Motor Vehicle GZHQM9G 3 4
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125 - First Name 125 - Middle Initial
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
12/06/2016
132 - Date Notified 0433133 - Time Notified (Military Time)0445134 - Time Arrived (Military Time)
12/06/2016
135 - Date Of Report
16120602 19 - Special Study
18 - Agency Space
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