20170630 SpragueSAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL133SSFC 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
01
Total Units
01
Time Notified
09:01 AM
Date Notified
06/30/2017
Time Arrived
09:14 AM
Date Arrived
06/30/2017
Crash Time
09:01 AM
Crash Date
06/30/2017
Investigating Officer/Deputy
DEPUTY ROB HOUSE
Agency Crash Number
17063003
Primary Crash Document #Document Number Override
6V
L
1
3
3
S
S
F
C
Additional InformationPhotos, Reconstruction
Photos ByHOUSE 317
Reconstruction BySAWYER COUNTY SHERIFFDiagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
UNIT 1 WAS TRAVELLING WESTBOUND ON HIGHWAY B. WHEN APPROACHING HILL NEAR HIGHWAY A, UNIT 1 WENT OFF INTO DITCHLINE ,TRAVELLED 160 FT. AND STRUCK A TREE STUMP.VEHICLE HAD SEVERE DAMAGE AND WAS TOWED BY ROADRUNNER. UNIT 1 DRIVER WAS
TRANSPORTED TO HAYWARD HOSPITAL AND AIRLIFTED TO DULUTH.UNKNOWN MEDICAL CONDITION REPORTED AT THIS TIME
Crash Time 09:01 AM
Crash Date 06/30/2017Wisconsin Motor Vehicle Crash
Form DT4000 1 of 5
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL133SSFC Wisconsin Motor Vehicle
Crash Report
Structure Type
No Structure
Y Coordinate
5100713
X Coordinate
174135.890625
Longitude
-91.207173513
Latitude
45.98248755
ON CTHA
113 FT N
OF CTHB
IN THE TOWN OF ROUND LAKE
IN SAWYER COUNTY
Location
Special StudyAccess Control
No 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)
Clear
Environment Factor(s)
None
Roadway Factor(s)
None
Road Surface Condition(s)
Dry
Light Condition
Daylight
Manner of Collision
No Collision W/Vehicle In Transport
First Harmful Event Location
Shoulder Left
First Harmful Event
Tree
Crash Scene
Intersection Type
Not an Intersection
Junction Location
Non-Junction
Within Interchange Area
NO
Time Roadway RepairedDate Roadway RepairedTime All Lanes Open
10:30 AM
Date All Lanes Open
06/30/2017
Time Initial Lane/Road Closed
09:43 AM
Date Initial Lane/Road Closed
06/30/2017
Reasons for Closure
Fire/EMS
Closure Type
Closure-one direction
Reporting Threshold
No
Truck Bus or HazMat
No
Road Grade
Uphill
Road Curvature
Straight
Surface Type
Blacktop (Bituminous)
Traffic Control Inoperative/Missing
NO
Traffic Control
No Control
Traffic Way
Two-Way, Not Divided
Emergency Motor Vehicle UseNot ApplicableSpecial FunctionNo Special FunctionMost Harmful Event: Collision With
Tree
Total Lanes
2
Speed Limit
55Pre CrashTire
Mark
Direction Of Travel
Westbound
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
C CLASS
Unit Status
In Transit
UN
I
T
01
Unit Summary
Model
NPR
Year
2005
Make
ISUZU
Vehicle Identification Number
547
Country of Issuance
UNITED STATES
St
WI
Plate Type
MFR - Dealer Manufactur
License Plate Number
EC3706001
Vehicle
Crash Time 09:01 AM
Crash Date 06/30/2017Wisconsin Motor Vehicle Crash
Form DT4000 2 of 5
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL133SSFC Wisconsin Motor Vehicle
Crash Report
Driver DistractionsUnknown If Distracted
Driver ActionsUnknown
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Going Straight
Vehicle Removed ByTowed Due To Damage
Towed Due To Disabling Damage
VE
H
I
C
L
E
UN
I
T
01
Extent Of Damage
Disabling Damage
Vehicle Damage
Undercarriage
Initial Contact Point
12--Front
Bus UseNot A BusBody Style
CB - CAB CHASSIS
Color
WHI - White
VE
H
I
C
L
E
UN
I
T
Address1
HAYWARD, WI 54843 , US
Organization/CompanyNELSON LUMBER COMPANY01
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventMotor Veh In Transport01
EventTree02
Event
03
Event
04
Organization/Company
NELSON LUMBER COMPANY
Insurance Company
UNIVERSAL-CASUALTY-CO
Policy Holder
UN
I
T
Crash Time 09:01 AM
Crash Date 06/30/2017Wisconsin Motor Vehicle Crash
Form DT4000 3 of 5
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL133SSFC Wisconsin Motor Vehicle
Crash Report
Individual Condition
Confused or Disoriented (Non Lucid)
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
HAYWARD AREA MEMORIAL HOSPITAL
EMS Run #EMS Agency Identifier
6000954
Medical Transport
EMS Air
Trapped/Extricated
Not Trapped
Ejection Path
Not Ejected/Not Applicable
Ejected
Not Ejected
Airbag
Unknown
Injury Severity
Possible 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
03/02/
Sex
Male
Citations Issued
0
DriverCLARK JOHN SPRAGUE
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Address
, ,
Unknown
PR
O
P
OW
N
E
R
01
Property Owner
Fixed Objects Struck
Crash Time 09:01 AM
Crash Date 06/30/2017Wisconsin Motor Vehicle Crash
Form DT4000 4 of 5
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL133SSFC Wisconsin Motor Vehicle
Crash Report
Damage Tag NumberStruck Object
Tree
Striking Unit
0101
Crash Time 09:01 AM
Crash Date 06/30/2017Wisconsin Motor Vehicle Crash
Form DT4000 5 of 5
This report does not include any CJIS data.