20170412 Erickson Waterman17041204
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VR 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
02
Time Notified
12:49 PM
Date Notified
04/12/2017
Time Arrived
12:54 PM
Date Arrived
04/12/2017
Crash Time
12:49 PM
Crash Date
04/12/2017
Investigating Officer/Deputy
DEP/DEPU JEFF CAIN
Agency Crash Number
17041204
Primary Crash Document #Document Number Override
6V
L
1
3
M
V
8
V
R
Additional InformationNone, Photos
Photos ByDEPUTY JEFF CAIN
Reconstruction ByDiagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
UNIT 2 WAS EASTBOUND ON MICHIGAN STREET AND CROSSING US HWY 63 WHEN UNIT 1 OPERATING WESTBOUND ON MICHIGAN STREET WAS ATTEMPTING TO TURN LEFT ONTO US 63 SOUTHBOUND COLLIDED WITH THE LEFT SIDE OF UNIT 1
Structure Type
No Structure
Y Coordinate
5105136
X Coordinate
152662.21875
Longitude
-91.486795767
Latitude
46.011642736
INTERSECTION
ON USH63 SB
AT MINNESOTA AVE
IN THE CITY OF HAYWARD
IN SAWYER COUNTY
Location
Crash Time 12:49 PM
Crash Date 04/12/2017This report does not include any CJIS data.
7of1
Wisconsin Motor Vehicle Crash
Form DT4000
17041204
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VR Wisconsin Motor Vehicle
Crash Report
Special StudyAccess Control
Full Control
Tribal Land
Crash Classification - Jurisdiction
No Special Jurisdiction
Crash Classification - Location
Public Property
Relation To Trafficway
Trafficway - On Road
Animal Type
Weather Condition(s)
Clear
Environment Factor(s)
None
Roadway Factor(s)
None
Road Surface Condition(s)
Dry
Light Condition
Daylight
Manner of Collision
08--Front To Side
First Harmful Event Location
On Roadway
First Harmful Event
Motor Veh In Transport
Crash Scene
Intersection Type
Four-Way Intersection
Junction Location
Intersection
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
Stop Sign
Traffic Way
Two-Way, Not Divided
Emergency Motor Vehicle UseNot ApplicableSpecial FunctionNo Special FunctionMost Harmful Event: Collision With
Motor Veh In Transport
Total Lanes
2
Speed Limit
N/APre CrashTire
Mark
Direction Of Travel
Westbound
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
1
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
Driver Actions
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Left Turn
Vehicle Removed By
OPERATOR
Towed Due To Damage
Not Towed01
Extent Of Damage
Minor Damage
Vehicle Damage
12--Front
Initial Contact Point
12--Front
Bus UseNot A BusBody Style
PK - PICKUP
Color
WHI - White
Model
K2500
Year
1995
Make
CHEVROLET
Vehicle Identification Number
2515
Country of Issuance
UNITED STATES
St
WI
Plate Type
LTK - Light Truck
License Plate Number
ME1426
VE
H
I
C
L
E
UN
I
T
01
Vehicle
Crash Time 12:49 PM
Crash Date 04/12/2017This report does not include any CJIS data.
7of2
Wisconsin Motor Vehicle Crash
Form DT4000
17041204
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VR Wisconsin Motor Vehicle
Crash Report
Driver DistractionsLooked But Did Not See
Failed To Yield Right-Of-Way
VE
H
I
C
L
E
UN
I
T
Address
HAYWARD, WI 54843 , US
IndividualDARIN J ERICKSON01
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventMotor Veh In Transport01
EventLeft Turn02
Event
03
Event
04
Individual
DARIN ERICKSON
Insurance Company
SOCIETY-INS-A-MUTUAL-CO
Policy Holder
UN
I
T
Crash Time 12:49 PM
Crash Date 04/12/2017This report does not include any CJIS data.
7of3
Wisconsin Motor Vehicle Crash
Form DT4000
17041204
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VR 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
Non Deployed
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
HAYWARD, WI 54843 , US
RaceWHITEDate of Birth
02/20/
Sex
Male
Citations Issued
1
DriverETHAN DAVID ERICKSON
IN
D
I
V
I
D
U
A
L
UN
I
T
Drug &
Alcohol
Injury
Equipment
Non Motorist
Individual
Violations
DescriptionFAIL/YIELD WHILE MAKING LEFT TURNSeq Num001Statute Number346.18(2)Issue To?
001
UTC Number
E10460901
Crash Time 12:49 PM
Crash Date 04/12/2017This report does not include any CJIS data.
7of4
Wisconsin Motor Vehicle Crash
Form DT4000
17041204
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VR 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
Stop Sign
Traffic Way
Two-Way, Not Divided
Emergency Motor Vehicle UseNot ApplicableSpecial FunctionNo Special FunctionMost Harmful Event: Collision With
Motor Veh In Transport
Total Lanes
2
Speed Limit
N/APre 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
Passenger Car
Unit Type
Automobile
Vehicle Operating As Classification
D CLASS
Unit Status
In Transit
UN
I
T
02
Unit Summary
Driver DistractionsNot Distracted
Driver ActionsNo Contributing Action
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Going Straight
Vehicle Removed By
ROADRUNNER TOWING
Towed Due To Damage
Towed Due To Disabling Damage
VE
H
I
C
L
E
UN
I
T
02
Extent Of Damage
Functional Damage
Vehicle Damage
9--Left Side Middle
Initial Contact Point
9--Left Side Middle
Bus UseNot A BusBody Style
SW - STATIONWAGON
Color
RED - Red
Model
PRIUS V
Year
2014
Make
TOYOTA
Vehicle Identification Number
6985
Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - Automobile
License Plate Number
75647D
VE
H
I
C
L
E
UN
I
T
02
Vehicle
Address
HAYWARD, WI 54843 , US
IndividualALAN JAMES WATERMAN02
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventMotor Veh In Transport01
Crash Time 12:49 PM
Crash Date 04/12/2017This report does not include any CJIS data.
7of5
Wisconsin Motor Vehicle Crash
Form DT4000
17041204
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VR Wisconsin Motor Vehicle
Crash Report
EventMotor Veh Tran Other Rdwy02
Event
03
Event
04
Individual
ALAN WATERMAN
Insurance Company
AMERICAN-FAMILY-INS-CO
Policy Holder
UN
I
T
Crash Time 12:49 PM
Crash Date 04/12/2017This report does not include any CJIS data.
7of6
Wisconsin Motor Vehicle Crash
Form DT4000
17041204
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VR 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
2
02
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
Non Deployed
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
2
Safety Equipment
Shoulder & Lap Belt
On Duty Crash
02
er
State: Wisconsin Country: UNITED STATES
Address
HAYWARD, WI 54843 , US
RaceWHITEDate of Birth
06/05/
Sex
Male
Citations Issued
0
DriverALAN JAMES WATERMAN
IN
D
I
V
I
D
U
A
L
UN
I
T
Drug &
Alcohol
Injury
Equipment
Non Motorist
Individual
Crash Time 12:49 PM
Crash Date 04/12/2017This report does not include any CJIS data.
7of7
Wisconsin Motor Vehicle Crash
Form DT4000