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20170912 ImmSAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13MV8W0 Wisconsin Motor Vehicle Crash Report Secondary CrashAmendedCrash Type Private Property/Parking LotReportable TagsSchool Bus Related NoActive School ZoneGovernment Property Trailer or TowedWork ZoneLane ClosureHit and RunOn Emergency Total Killed 00 Total Injured 01 Total Units 02 Time Notified 01:42 PM Date Notified 09/18/2017 Time Arrived 01:42 PM Date Arrived 09/18/2017 Crash Time 05:50 AM Crash Date 09/12/2017 Investigating Officer/Deputy DEPUTY JEFF CAIN Agency Crash Number 17091803 Primary Crash Document #Document Number Override 6V L 1 3 M V 8 W 0 Additional InformationOther Documents Photos By Reconstruction ByDiagram Description Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report. TIMOTHY LOUCKS REPORTED THAT WHILE HE WAS WALKING ACROSS THE PARKING LOT OF HIS WORKPLACE AT 9745N BOYS CAMP ROAD, A CO-WORKER, JED IMM RAN OVER HIS FOOT WITH THE LEFT FRONT WHEEL OF THE VEHICLE HE WAS DRIVING. LOUCKS AND IMM REPORTED THE INCIDENT TO THEIR SUPERVISOR, THEN IMM TRANSPORTED LOUCKS TO THE HAYWARD AREA MEMORIAL HOSPITAL FOR TREATMENT. Crash Time 05:50 AM Crash Date 09/12/2017Wisconsin Motor Vehicle Crash Form DT4000 1 of 6 This report does not include any CJIS data. SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13MV8W0 Wisconsin Motor Vehicle Crash Report Structure Type Fire Y Coordinate 5102201 X Coordinate 149034.171875 Longitude -91.531359547 Latitude 45.983463301 PARKING LOT BOYS CAMP RD LOT 9745N (FIRE 9745N) IN THE TOWN OF HAYWARDIN SAWYER COUNTY Location Special StudyAccess Control No Control Tribal Land Crash Classification - Jurisdiction No Special Jurisdiction Crash Classification - Location Public Property Relation To Trafficway Non Trafficway - Parking Lot Animal Type Weather Condition(s) Unknown Environment Factor(s) None Roadway Factor(s) None Road Surface Condition(s) Dry Light Condition Dark/Lighted Manner of Collision First Harmful Event Location In Parking Lane or Zone First Harmful Event Pedestrian Crash Scene Intersection Type Not an Intersection Junction Location Non-Junction Within Interchange Area NO Reporting Threshold No Truck Bus or HazMat No Road Grade Level Road Curvature Straight Surface Type Blacktop (Bituminous) Traffic Control Inoperative/Missing NO Traffic Control No Control Traffic Way Parking Lot or Private Property Emergency Motor Vehicle UseNot ApplicableSpecial FunctionMost Harmful Event: Collision With Pedestrian Total LanesSpeed Limit N/APre CrashTire Mark Direction Of Travel Not On Roadway Insurance? YES Total HazMat Types 0 Total Trailers 0 Total # Citations Issued 0 Train/Bus # InjuredTotal Occs 1 Operating As EndorsementsVehicle Type (Sport) Utility Vehicle Unit Type Automobile Vehicle Operating As Classification D CLASS Unit Status In Transit UN I T 01 Unit Summary Extent Of Damage No Damage Vehicle Damage No Damage Initial Contact Point 11--Left Front Corner Bus UseNot A BusBody Style UT - SPORT UTILITY VEHICLE Color GRN - Green Model ASCENDER Year 2006 Make ISUZU Vehicle Identification Number 4NUDT135362701693 Country of Issuance UNITED STATES St WI Plate Type AUT - Automobile License Plate Number 822LMW VE H I C L E UN I T 01 Vehicle Crash Time 05:50 AM Crash Date 09/12/2017Wisconsin Motor Vehicle Crash Form DT4000 2 of 6 This report does not include any CJIS data. SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13MV8W0 Wisconsin Motor Vehicle Crash Report Driver DistractionsDistraction Details Unknown Driver Actions Failed To Yield Right-Of-Way Driver Prior Action Other Vehicle Factors Not Applicable What Driver Was Doing Legally Parked Vehicle Removed By OPERATOR Towed Due To Damage Not Towed VE H I C L E UN I T 01 Address WINTER, WI 54896 , US IndividualJEAN A IMM01 VE H I C L E OW N E R Vehicle Owner Sequence Of Events EventMotor Veh In Transport01 EventPedestrian02 Event 03 Event 04 Individual JED IMM Insurance Company USAA-CASUALTY-INS-CO Policy Holder UN I T Crash Time 05:50 AM Crash Date 09/12/2017Wisconsin Motor Vehicle Crash Form DT4000 3 of 6 This report does not include any CJIS data. SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13MV8W0 Wisconsin Motor Vehicle Crash Report Individual Condition Appeared Normal Drug Type Drug Test ResultsDrug Test TypeDrug Test GivenTest Not Given Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given Test Not Given Suspected Drug UseSuspected Alcohol Use Action Other IN D I V I D U A L UN I T Action To/From SchoolLocationPrior ActionStriking Unit # 00 1 01 Time of DeathDate of DeathHospital EMS Run #EMS Agency IdentifierMedical Transport Not Transported Trapped/Extricated Unknown Ejection Path Unknown Ejected Unknown Airbag Unknown Injury Severity No Apparent Injury IN D I V I D U A L UN I T Tint ComplianceEye Protection Helmet ComplianceHelmet Use Seat Position 1--Front Seat-Left Side (Driver/Motorcycle/Bicycl 00 1 Safety Equipment None Used - Vehicle Occupant On Duty Crash 01 D mberI State: Wisconsin Country: UNITED STATES Address WINTER, WI 54896 , US RaceWHITEDate of Birth 12/02/1 Sex Male Citations Issued 0 DriverJED R IMM IN D I V I D U A L UN I T Injury Drug & Alcohol Individual Non Motorist Equipment Crash Time 05:50 AM Crash Date 09/12/2017Wisconsin Motor Vehicle Crash Form DT4000 4 of 6 This report does not include any CJIS data. SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13MV8W0 Wisconsin Motor Vehicle Crash Report Reporting Threshold No Truck Bus or HazMat No Road Grade Level Road Curvature Straight Surface Type Blacktop (Bituminous) Traffic Control Inoperative/Missing NO Traffic Control No Control Traffic Way Parking Lot or Private Property Emergency Motor Vehicle UseNot ApplicableSpecial FunctionNo Special FunctionMost Harmful Event: Collision With Motor Veh In Transport Total LanesSpeed Limit N/APre CrashTire Mark Direction Of Travel Not On Roadway Insurance? NO Total HazMat Types 0 Total Trailers 0 Total # Citations Issued 0 Train/Bus # InjuredTotal Occs 1 Operating As EndorsementsVehicle Type Pedestrian Unit Type Pedestrian Vehicle Operating As Classification O CLASS Unit Status In Transit UN I T 02 Unit Summary Sequence Of Events EventMotor Veh In Transport01 Event 02 Event 03 Event 04 Crash Time 05:50 AM Crash Date 09/12/2017Wisconsin Motor Vehicle Crash Form DT4000 5 of 6 This report does not include any CJIS data. SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13MV8W0 Wisconsin Motor Vehicle Crash Report Individual Condition Not Observed Drug Type Drug Test ResultsDrug Test TypeDrug Test GivenTest Not Given Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given Test Not Given Suspected Drug UseSuspected Alcohol Use Action Other IN D I V I D U A L UN I T Action No Improper Action To/From School NO Location Parking Lane/Zone Prior Action Unknown Striking Unit # 01 00 2 02 Time of DeathDate of DeathHospital HAYWARD AREA MEMORIAL HOSPITAL EMS Run #EMS Agency IdentifierMedical Transport Other Trapped/Extricated Not Applicable Ejection Path Not Ejected/Not Applicable Ejected Not Applicable Airbag Not Applicable Injury Severity Suspected Minor Injury IN D I V I D U A L UN I T Tint ComplianceEye Protection Helmet ComplianceHelmet Use Seat Position Pedestrian (Non-Occupant) 00 2 Safety Equipment None On Duty Crash 02 Driver License NumberL2008166729009 State: Wisconsin Country: UNITED STATES AddressW8420 COUNTY HIGHWAY A SPOONER, WI 54801 , US RaceWHITEDate of Birth 08/10/1967 Sex Male Citations Issued 0 PedestrianTIMOTHY ROGERS LOUCKS IN D I V I D U A L UN I T Injury Drug & Alcohol Individual Non Motorist Equipment Crash Time 05:50 AM Crash Date 09/12/2017Wisconsin Motor Vehicle Crash Form DT4000 6 of 6 This report does not include any CJIS data.