20170326 ChaferSAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKRJ Wisconsin Motor Vehicle
Crash Report
Secondary
CrashAmendedCrash Type
DT4000 (Standard Crash)Reportable
TagsSchool Bus Related
NoActive School ZoneGovernment
Property
Trailer or TowedWork ZoneLane ClosureHit and RunOn Emergency
Total Killed
00
Total Injured
00
Total Units
01
Time Notified
08:09 PM
Date Notified
03/26/2017
Time Arrived
08:49 PM
Date Arrived
03/26/2017
Crash Time
07:50 PM
Crash Date
03/26/2017
Investigating Officer/Deputy
DEPUTY NATHAN FREY
Agency Crash Number
17032612
Primary Crash Document #Document Number Override
6V
L
1
3
Z
Q
K
R
J
Additional InformationPhotos
Photos ByJT WOHLING #349
Reconstruction ByDiagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
UNIT WAS TRAVELING WEST ON WOODALE. OPERATOR STATED HIS BOOT LACES WERE TANGLED IN ACCELERATOR WHEN HE APPROACHED THE INTERSECTION OF Y ROAD. OPERATOR STATES HE COULD NOT BRAKE AND PROCEEDED THROUGH INTERSECTION STRIKING AN EMBANKMENT.
OPERATOR WAS UNABLE TO REVERSE OUT OF DITCH, SO DROVE THROUGH THE WOODED AREA IN FRONT OF THE UNIT. UNIT RECEIVED
ADDITIONAL DAMAGE FROM THIS.
Crash Time 07:50 PM
Crash Date 03/26/2017This report does not include any CJIS data.
4of1
Wisconsin Motor Vehicle Crash
Form DT4000
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKRJ Wisconsin Motor Vehicle
Crash Report
Structure Type
No Structure
Y Coordinate
5072076.5
X Coordinate
156046.53125
Longitude
-91.419593614
Latitude
45.716687299
INTERSECTION
ON Y RD
AT WOODALE RD 6
IN THE TOWN OF METEOR
IN SAWYER COUNTY
Location
Special StudyAccess Control
Full Control
Tribal Land
Crash Classification - Jurisdiction
No Special Jurisdiction
Crash Classification - Location
Public Property
Relation To Trafficway
Trafficway - Not On Road
Animal Type
Weather Condition(s)
Cloudy
Environment Factor(s)
None
Roadway Factor(s)
Worn, Travel-Polished Surface
Road Surface Condition(s)
Sand
Light Condition
Dark/Unlit
Manner of Collision
No Collision W/Vehicle In Transport
First Harmful Event Location
Roadside
First Harmful Event
Ditch
Crash Scene
Intersection Type
T-Intersection
Junction Location
Intersection
Within Interchange Area
NO
Reporting Threshold
No
Truck Bus or HazMat
No
Road Grade
Sag(Bottom)
Road Curvature
Straight
Surface Type
Blacktop (Bituminous)
Traffic Control Inoperative/Missing
NO
Traffic Control
Stop Sign
Traffic Way
Two-Way, Not Divided
Emergency Motor Vehicle UseNot ApplicableSpecial FunctionUnknownMost Harmful Event: Collision With
Ditch
Total Lanes
2
Speed Limit
35Pre CrashTire
Mark
Direction Of Travel
Eastbound
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
1
Operating As EndorsementsVehicle Type
Utility Truck/Pickup Truck
Unit Type
Truck
Vehicle Operating As Classification
D CLASS
Unit Status
In Transit
UN
I
T
01
Unit Summary
Extent Of Damage
Disabling Damage
Vehicle Damage
1--Right Front Corner, 2--Right Side Front, 3--Right Side Middle, 10--Left Side
Front, 11--Left Front Corner, 12--Front, Undercarriage
Initial Contact Point
12--Front
Bus UseNot A BusBody Style
PK - PICKUP
Color
MAR - Maroon (Burgundy)
Model
SILVERADO
Year
2005
Make
CHEVROLET
Vehicle Identification Number
9603
Country of Issuance
UNITED STATES
St
WI
Plate Type
LTK - Light Truck
License Plate Number
KW6527
VE
H
I
C
L
E
UN
I
T
01
Vehicle
Crash Time 07:50 PM
Crash Date 03/26/2017This report does not include any CJIS data.
4of2
Wisconsin Motor Vehicle Crash
Form DT4000
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKRJ Wisconsin Motor Vehicle
Crash Report
Driver DistractionsOther Distraction
Driver Actions
Other Contributing Action
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Slow/Stopping
Vehicle Removed By
OWNER
Towed Due To Damage
Not Towed
VE
H
I
C
L
E
UN
I
T
01
Address
EXELAND, WI 54835 , US
IndividualMICHAEL JOSEPH CHAFER01
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventMotor Veh In Transport01
EventDitch02
Event
03
Event
04
Individual
MICHAEL CHAFER
Insurance Company
STATE-FARM-GENERAL-INS-CO
Policy Holder
UN
I
T
Crash Time 07:50 PM
Crash Date 03/26/2017This report does not include any CJIS data.
4of3
Wisconsin Motor Vehicle Crash
Form DT4000
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKRJ 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
Not Trapped
Ejection Path
Not Ejected/Not Applicable
Ejected
Not Ejected
Airbag
Deployed-Front
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
Shoulder & Lap Belt
On Duty Crash
01
ber
State: Wisconsin Country: UNITED STATES
Address
EXELAND, WI 54835 , US
RaceWHITEDate of Birth
12/07/
Sex
Male
Citations Issued
0
DriverMICHAEL JOSEPH CHAFER
IN
D
I
V
I
D
U
A
L
UN
I
T
Drug &
Alcohol
Injury
Equipment
Non Motorist
Individual
Crash Time 07:50 PM
Crash Date 03/26/2017This report does not include any CJIS data.
4of4
Wisconsin Motor Vehicle Crash
Form DT4000