20161207 ParentAgency Accident Number
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Reportable Accident On Emergency Amended GZJ2868
DOT Document Number Document Override Number
16120716245
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7
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16120702
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12/07/2016
4 - Accident Date
1115
5 - Time of Accident (Military Time)
01
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County BASS LAKE - 01, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
E
14 - On Hwy No.14 - On Street Name 14 - Bus/Frnt/Rmp
0.47 MI15 - Est. Distance NORTH15 - Hwy. Dir
16 - Fr/At Hwy No.WILLIAMS RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.972488
12 - Latitude -91.42945613 - 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
ON-ROADWAY
117 - Relation To Roadway
DAYLIGHT114 - Light Condition ICE116 - 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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OTHER NON-COLLISION
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
2022
31 - Expiration Year 34 - On Duty Accident
PARENT
25 - Operator/Pedestrian Last Name
LAWRENCE
25 - First Name
M
25 - Middle Initial 25 - Suffix
05/15/
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.
SPEED-TOO-FAST-FOR-CONDITIONS
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
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Wisconsin Motor Vehicle GZJ2868 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
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
A994
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2017
59 - Exp Year 55 - Vehicle Identification Number
2002
50 - Year
NISS
51 - Make
ALTIMA
52 - Model
SD - SEDAN
53 - Body Style
SIL
54 - Color 100 - Skidmarks to Impact (Ft)
REAR DRIVER SIDE, MIDDLE DRIVER SIDE, FRONT DRIVER SIDE
94 - Vehicle Damage
MODERATE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
OWNER
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
PARENT
46 - Vehicle Owner Last Name
LAWRENCE
46 - First Name
M
46 - Middle Initial 46 - Suffix
05/15
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
NONE63 - 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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MV4000e 01/2005
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Wisconsin Motor Vehicle
Accident Report
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Wisconsin Motor Vehicle GZJ2868 2 323
105 - Photos By
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Diagram and Narrative
DEPUTY AMBER AL-MOGHRABI
ON DECEMBER 7, 2016, I, DEPUTY AMBER AL-MOGHRABI WAS DISPATCHED TO COUNTY HIGHWAY E JUST NORTH OF WILLIAMS
ROAD FOR A VEHICLE THAT WAS IN THE DITCH BLOCKING TRAFFIC. DISPATCHED ADVISED THERE WERE NO INJURIES. WHILE
ENROUTE, DISPATCHED ADVISED THEY RECEIVED A SECOND CALL STATING THAT THE VEHICLE HAD ROLLED BUT LANDED ON ITS
TIRES. UPON ARRIVAL AT 11:39, I WAS UNABLE TO FIND A VEHICLE IN THE DITCH. DISPATCH STATED THAT THEY RECEIVED ANOTHER CALL THAT THE VEHICLE WAS PULLED OUT OF THE DITCH AND WAS IN THE DRIVEWAY OF 9339 COUNTY ROAD E. I
ARRIVED AT THAT ADDRESS AND RAN THE PLATE THROUGH DISPATCH OF THE DAMAGED VEHICLE IN THE DRIVEWAY. I ADVISED
DISPATCH THAT NO ONE WAS AROUND THE VEHICLE. THEY INFORMED ME THE VEHICLE CAME BACK TO LAWRENCE PARENT WHO
LIVES AT AN ADDRESS ON COUNTY ROAD E. I CLEARED FROM THE VEHICLE AND PROCEEDED TO THAT ADDRESS. AT
APPROXIMATELY 11:52 I ARRIVED AT 14432 W COUNTY ROAD E TO SPEAK WITH LAWRENCE. HE STATED HE WAS THE DRIVER AND
WAS JUST LEAVING TO GO BACK TO THE VEHICLE. HE STATED HE NEEDED TO COME HOME TO GET SOME TOOLS AND DRESS
WARMER. LAWRENCE SAID HE WAS TRAVELING NORTHBOUND ON COUNTY ROAD E AND WHILE NEGOTIATING A CURVE HE SLID
AND LOST CONTROL OF THE VEHICLE. LAWRENCE SAID HE ROLLED ONCE AND LANDED UPRIGHT ON HIS TIRES. HE STATED HE
WAS TRAVELING ABOUT 30 MILES PER HOUR AND WAS WEARING HIS SEATBELT. I INFORMED LAWRENCE THE VEHICLE NEEDED
TO BE REMOVED FROM THE OTHER PROPERTY, BUT THAT I WAS GOING TO GO BACK AND TAKE PHOTOGRAPHS. I CLEARED
FROM THE HOUSE AND WENT BACK TO THE VEHICLE. I NOTICED THE DRIVER SIDE MIRROR WAS BROKEN OFF, THERE WAS A
DENT TO THE REAR DRIVER DOOR, AND THE DRIVER SIDE TAILLIGHT WAS BROKEN. I TOOK PHOTOGRAPHS OF THE VEHICLE AND
CLEARED AT 12:09.
ON DECEMBER 7, 2016, I, DEPUTY AMBER AL-MOGHRABI WAS DISPATCHED TO COUNTY HIGHWAY E JUST NORTH OF WILLIAMS
ROAD FOR A VEHICLE THAT WAS IN THE DITCH BLOCKING TRAFFIC. DISPATCHED ADVISED THERE WERE NO INJURIES. WHILE
ENROUTE, DISPATCHED ADVISED THEY RECEIVED A SECOND CALL STATING THAT THE VEHICLE HAD ROLLED BUT LANDED ON ITS
TIRES. UPON ARRIVAL AT 11:39, I WAS UNABLE TO FIND A VEHICLE IN THE DITCH. DISPATCH STATED THAT THEY RECEIVED ANOTHER CALL THAT THE VEHICLE WAS PULLED OUT OF THE DITCH AND WAS IN THE DRIVEWAY OF 9339 COUNTY ROAD E. I
ARRIVED AT THAT ADDRESS AND RAN THE PLATE THROUGH DISPATCH OF THE DAMAGED VEHICLE IN THE DRIVEWAY. I ADVISED
DISPATCH THAT NO ONE WAS AROUND THE VEHICLE. THEY INFORMED ME THE VEHICLE CAME BACK TO LAWRENCE PARENT WHO
LIVES AT AN ADDRESS ON COUNTY ROAD E. I CLEARED FROM THE VEHICLE AND PROCEEDED TO THAT ADDRESS. AT
APPROXIMATELY 11:52 I ARRIVED AT 14432 W COUNTY ROAD E TO SPEAK WITH LAWRENCE. HE STATED HE WAS THE DRIVER AND
WAS JUST LEAVING TO GO BACK TO THE VEHICLE. HE STATED HE NEEDED TO COME HOME TO GET SOME TOOLS AND DRESS
WARMER. LAWRENCE SAID HE WAS TRAVELING NORTHBOUND ON COUNTY ROAD E AND WHILE NEGOTIATING A CURVE HE SLID
AND LOST CONTROL OF THE VEHICLE. LAWRENCE SAID HE ROLLED ONCE AND LANDED UPRIGHT ON HIS TIRES. HE STATED HE
WAS TRAVELING ABOUT 30 MILES PER HOUR AND WAS WEARING HIS SEATBELT. I INFORMED LAWRENCE THE VEHICLE NEEDED
TO BE REMOVED FROM THE OTHER PROPERTY, BUT THAT I WAS GOING TO GO BACK AND TAKE PHOTOGRAPHS. I CLEARED
FROM THE HOUSE AND WENT BACK TO THE VEHICLE. I NOTICED THE DRIVER SIDE MIRROR WAS BROKEN OFF, THERE WAS A
DENT TO THE REAR DRIVER DOOR, AND THE DRIVER SIDE TAILLIGHT WAS BROKEN. I TOOK PHOTOGRAPHS OF THE VEHICLE AND
CLEARED AT 12:09.
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125 - First Name 125 - Middle Initial
Officer Information
ALMOGHRABI
125 - Officer Last Name
AMBER 340
131 - Officer ID
129 - Law Enforcement Agency No.SAWYER COUNTY SHERIFFS DEPT130 - Law Enforcement Agency Name
15880 EAST FIFTH STREET
126 - Law Enforcement Agency Address Street & Number
HAYWARD127 - City WI127 - State 54843127 - Zip Code (715) 634-4858 EXT.128 - Telephone Number
12/07/2016
132 - Date Notified 1124133 - Time Notified (Military Time)1139134 - Time Arrived (Military Time)
12/07/2016
135 - Date Of Report
16120716245 16120702 19 - Special Study
18 - Agency Space
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZJ2868 3 3