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.