20161216 Burton MilesGZHTL64 51Wisconsin Motor Vehicle
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79 - E M S Number103
Measurements Taken
102
Witness Statements
101
Supplemental Reports
9
Names Exchanged
9
Construction Zone
9
Load Spillage
9
Truck, Bus, or Hazardous Materials
9
Trailer or Towed
9
Photos Taken
9
Fire
9
Government Property
9
Hit and Run
118 - Weather
Snow
116 - Road Surface Condition
Snow/Slush
114 - Light Condition
Daylight
117 - Relation To Roadway
On-Roadway
115 - Traffic Way
Not-Physically-Divided-(2-Way Traffic)
Surface Type
Blacktop, Bituminous, or Asphalt - 2
113 - Road Terrain
Level/Flat
113 - Road Curvature
Straight
112 - Access Control
Partial Control
93 - Manner of Collision
Angle
80 - First Harmful Event
Motor Vehicle In Transport
13 - Longitude-91.46773512 - Latitude
46.026660
17 - Structure Number17 - Structure Type
16 - Business/Frontage/Ramp16 - From/At Street Name
OLSON RD
16 - Fr/At Hwy No.
15 - Hwy. Dir15 - Est. Distance14 - Bus/Frnt/Rmp14 - On Street Name
HOSPITAL RD
14 - On Hwy No.
11 - Accident LocationIntersection3 - Municipality
HAYWARD - 06, Town
2 - County
SAWYER - 57
8 - Total Killed
00
7 - Total Injured
00
6 - Total Units
02
5 - Time of Accident (Military Time)
1150
4 - Accident Date
12/16/2016
16
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6
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4
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16121616635
Document Override NumberDOT Document Number
GZHTL64AmendedOn EmergencyReportable Accident
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Police Number
PO
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AC
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Agency Accident Number
01
91 - Drugs Reported
91 - Drug Test
Test Not Given
90 - Alcohol Content90 - Alcohol TestTest Not Given
89 - Substance Presence
Unknown88 - Driver or Pedestrian CondAppeared Normal
122 - Driver Factors
Failure-to-Have-Control
64 - 5th Statute No.64 - 4th Statute No.64 - 3rd Statute No.64 - 2nd Statute No.64 - 1st Statute No.
62 - No. of Citations Issued0120 - Traffic Control
No-Control
119 - What Driver Was Doing
GOING STRAIGHT
92 - Pedestrian Action92 - Pedestrian Location43 - Trapped/ExtricatedNot-Trapped
Medical Transport
4442 - Ejected
Not-Ejected
41 - Airbag
Non-Deployed
38 - Injury Severity
N - No Apparent Injury
40 - Safety EquipmentShoulder-Belt-And-Lap-Belt-Used39 - Seat PositionFront-Seat-Left-Side-(MC/Bike Driver, Train Conductor)
28 - Telephone Number
.
27 - Zip Code
54843
27 - State
WI
27 - City
HAYWARD
26 - PO Box26 - Address Street & Number
33 - Sex
Male
32 - Date Of Birth
08/16/
25 - Suffix25 - Middle InitialM25 - First NameHAROLD25 - Operator/Pedestrian Last NameBURTON
34 - On Duty Accident31 - Expiration Year
2024
30 - State
WI
29 - Driver's License Number
Operating Commercial Motor Vehicle3537 - Endorsements36 - Operating as ClassifiedD CLASS
24 - Speed Limit35
23 - Dir Of Travel
WEST
81 - Most Harmful Event: Collision With
Motor Vehicle In Transport
Unit Status
OP
E
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P
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Operator/Pedestrian
GZHTL64 52Wisconsin Motor Vehicle
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School District Contracted With
Seating CapacityBody MakeSchool NameBus Travelling to/from
To From
BU
S
01
01
01
01
61 - Policy Holder Company
61 - Policy Holder First Name
HAROLD
61 - Policy Holder Last Name
BURTON
60
Policy Holder Same As Owner
63 - Liability Insurance Company
PROPERTY-OWNERS-INSURANCE-CO
49 - Telephone Number48 - Zip Code
5484348 - StateWI
48 - City
HAYWARD
47 - PO Box47- Address Street & Number
46 - Company Name
Date Of Birth
08/16/1
46 - Suffix46 - Middle Initial
M
46 - First Name
HAROLD
46 - Vehicle Owner Last Name
BURTON
Vehicle Owner Same As Operator
45
123 - Vehicle Factors
Not-Applicable
97 - Vehicle Removed By96
Vehicle Towed Due To Damage
95 - Extent Of Damage
Severe
94 - Vehicle Damage
Front, Front Driver Side
100 - Skidmarks to Impact (Ft)35
54 - Color
RED
53 - Body Style
TK - TRUCK
52 - Model
RAM
51 - Make
DODG
50 - Year
2014
55 - Vehicle Identification Number6231959 - Exp Year201858 - StateWI57 - Plate TypeLTK56 - License Plate NumberBURT0N
22 - Total Occupants
1
Vehicle Type
Pickup/Utility-Truck
21 - Unit Type
Truck
124 - Highway Factors
Snow,-Ice,-or-Wet
IN
S
School Bus
Insurance
Vehicle Owner
Vehicle
VE
H
O
W
N
E
R
VE
H
I
C
L
E
02
28 - Telephone Number27 - Zip Code
54843
27 - State
WI
27 - City
HAYWARD
26 - PO Box26 - Address Street & Number
33 - Sex
Male
32 - Date Of Birth
03/07/
25 - Suffix25 - Middle InitialL25 - First NameJEFFREY25 - Operator/Pedestrian Last NameMILES
34 - On Duty Accident31 - Expiration Year
2020
30 - State
WI
29 - Driver's License Number
Operating Commercial Motor Vehicle3537 - Endorsements36 - Operating as ClassifiedD CLASS
24 - Speed Limit25
23 - Dir Of Travel
SOUTH
81 - Most Harmful Event: Collision With
Motor Vehicle In Transport
Unit Status
Operator/Pedestrian
GZHTL64 53Wisconsin Motor Vehicle
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02
02
61 - Policy Holder Company
61 - Policy Holder First Name
JEFFREY
61 - Policy Holder Last Name
MILES
60 Policy Holder Same As Owner63 - Liability Insurance CompanyACUITY,-A-MUTUAL-INSURANCE-CO
49 - Telephone Number48 - Zip Code5484348 - StateWI48 - CityHAYWARD
47 - PO Box47- Address Street & Number
46 - Company Name
Date Of Birth
03/07
46 - Suffix46 - Middle Initial
L
46 - First Name
JEFFREY
46 - Vehicle Owner Last Name
MILES
Vehicle Owner Same As Operator
45
123 - Vehicle Factors
Not-Applicable
97 - Vehicle Removed By96
Vehicle Towed Due To Damage
95 - Extent Of Damage
Severe
94 - Vehicle Damage
Front, Front Driver Side
100 - Skidmarks to Impact (Ft)9
54 - Color
BRO
53 - Body Style
UT - SPORT UTILITY
52 - Model
TAHOE
51 - Make
CHEV
50 - Year
2013
55 - Vehicle Identification Number
5857
59 - Exp Year
2017
58 - State
WI57 - Plate TypeAUT
56 - License Plate Number
738JSB
22 - Total Occupants
1
Vehicle Type
Passenger-Car
21 - Unit Type
Automobile
124 - Highway Factors
Snow,-Ice,-or-Wet
91 - Drugs Reported
91 - Drug TestTest Not Given90 - Alcohol Content90 - Alcohol TestTest Not Given
89 - Substance Presence
Unknown88 - Driver or Pedestrian CondAppeared Normal
122 - Driver Factors
Speed-Too-Fast-for-Conditions, Failure-to-Have-Control
64 - 5th Statute No.64 - 4th Statute No.64 - 3rd Statute No.64 - 2nd Statute No.64 - 1st Statute No.
62 - No. of Citations Issued0120 - Traffic Control
Stop-Sign
119 - What Driver Was Doing
SLOW/STOPPING
92 - Pedestrian Action92 - Pedestrian Location43 - Trapped/Extricated
Not-Trapped
Medical Transport
4442 - Ejected
Not-Ejected
41 - Airbag
Non-Deployed
38 - Injury Severity
N - No Apparent Injury
40 - Safety Equipment
Shoulder-Belt-And-Lap-Belt-Used
39 - Seat Position
Front-Seat-Left-Side-(MC/Bike Driver, Train Conductor)
OP
E
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A
T
O
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P
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D
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S
T
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N
Insurance
Vehicle Owner
Vehicle
VE
H
O
W
N
E
R
VE
H
I
C
L
E
GZHTL64 54Wisconsin Motor Vehicle
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Accident Report
School District Contracted With
Seating CapacityBody MakeSchool NameBus Travelling to/from
To From
BU
S
02
IN
S
School Bus
Vehicle Identification NumberUnit TypeTrailer Make
Expiration YearStatePlate TypeLicense Plate Number106 - Power Unit Number
TR
L
01
Trailer
DEPUTY POPLIN
Diagram and Narrative
DI
A
G
R
A
M
A
N
D
N
A
R
R
A
T
I
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105 - Photos By
UNIT 1 WAS GOING WEST ON HOSPITAL ROAD AND SAW UNIT 2 COMING TO THE STOP SIGN. UNIT 2 SLID PAST THE STOP SIGN DUE TO THE SNOWY ICY CONDITIONS. UNIT 1 THEN APPLIED THE BREAKS AND SLID ON THE SNOWY ROAD AS WELL CAUSING
THE UNITS TO STRIKE. BOTH UNITS SUSTAINED SEVERE DAMAGE AND WERE TOWED DUE TO THE INCIDENT.
126 - Law Enforcement Agency Address Street & Number
15880 EAST FIFTH STREET
130 - Law Enforcement Agency Name
SAWYER COUNTY SHERIFFS DEPT
129 - Law Enforcement Agency No.
131 - Officer ID
352JAY
125 - Officer Last Name
POPLIN
Officer Information
125 - Middle Initial125 - First Name
GZHTL64 55Wisconsin Motor Vehicle
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18 - Agency Space
19 - Special Study1612160416121616635
135 - Date Of Report
12/16/2016
134 - Time Arrived (Military Time)1159133 - Time Notified (Military Time)1150132 - Date Notified
12/16/2016
128 - Telephone Number
(715) 634-4858 Ext.
127 - Zip Code
54843
127 - State
WI
127 - City
HAYWARD
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