20170705 Richards Headley17070502
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VT 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
12:05 PM
Date Notified
07/05/2017
Time Arrived
12:06 PM
Date Arrived
07/05/2017
Crash Time
12:05 PM
Crash Date
07/05/2017
Investigating Officer/Deputy
DEPUTY JEFF CAIN
Agency Crash NumberPrimary Crash Document #Document Number Override
6V
L
1
3
M
V
8
V
T
Additional InformationPhotos, Other Documents
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 1 WAS STOPPED IN TRAFFIC IN THE NORTHBOUND LANE OF HWY 27 DUE TO ROAD CONSTRUCTION BACKUP WHEN UNIT 2, ALSO NORTHBOUND DROVE INTO THE BACK OF UNIT 1
Structure Type
Y Coordinate
5101712.5
X Coordinate
151552.140625
Longitude
-91.498595754
Latitude
45.980361817
ON STH27 NB
753 FT N
OF FUN VALLEY RD
IN THE TOWN OF BASS LAKE
IN SAWYER COUNTY
Location
Crash Time 12:05 PM
Crash Date 07/05/2017Wisconsin Motor Vehicle Crash
Form DT4000 1 of 12
This report does not include any CJIS data.
17070502
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VT Wisconsin Motor Vehicle
Crash Report
Special StudyAccess Control
No 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)
Work Zone (Construction/Maintenance/Utility)
Road Surface Condition(s)
Dry
Light Condition
Daylight
Manner of Collision
02--Front To Rear
First Harmful Event Location
On Roadway
First Harmful Event
Motor Veh In Transport
Crash Scene
Intersection Type
Not an Intersection
Junction Location
Non-Junction
Within Interchange Area
NO
Normal Posted Speed Limit
45
Advisory/Regulatory Speed Limit
Regulatory
Work Zone Speed Limit
45
Law Enforcement Present
No
Workers Present
YES
Work Zone Crash Type
Intermittent or Moving Work
Work Zone Crash Location
Advance Warning Area
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
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
45Pre CrashTire
Mark
Direction Of Travel
Northbound
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
3
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
Vehicle Removed ByTowed Due To Damage
Extent Of Damage
Minor Damage
Vehicle Damage
6--Rear
Initial Contact Point
6--Rear
Bus UseNot A BusBody Style
PK - PICKUP
Color
GRY - Gray
Model
F150
Year
2014
Make
FORD
Vehicle Identification Number
00516
Country of Issuance
UNITED STATES
St
WI
Plate Type
LTK - Light Truck
License Plate Number
KK9326
VE
H
I
C
L
E
UN
I
T
01
Vehicle
Crash Time 12:05 PM
Crash Date 07/05/2017Wisconsin Motor Vehicle Crash
Form DT4000 2 of 12
This report does not include any CJIS data.
17070502
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VT Wisconsin Motor Vehicle
Crash Report
Driver DistractionsNot Distracted
Driver Actions
No Contributing Action
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Stop In Traffic
OWNERNot Towed
VE
H
I
C
L
E
UN
I
T
01
Address
ROBERTS, WI 54023 , US
IndividualPAUL DOUGLAS RICHARDS01
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventMotor Veh In Transport01
Event
02
Event
03
Event
04
Individual
PAUL RICHARDS
Insurance Company
STATE-FARM-GENERAL-INS-CO
Policy Holder
UN
I
T
Crash Time 12:05 PM
Crash Date 07/05/2017Wisconsin Motor Vehicle Crash
Form DT4000 3 of 12
This report does not include any CJIS data.
17070502
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VT 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
ROBERTS, WI 54023 , US
RaceWHITEDate of Birth
01/19
Sex
Male
Citations Issued
0
DriverPAUL DOUGLAS RICHARDS
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 12:05 PM
Crash Date 07/05/2017Wisconsin Motor Vehicle Crash
Form DT4000 4 of 12
This report does not include any CJIS data.
17070502
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VT 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
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
3--Front Seat-Right Side (Train Engineers/Right
00
2
Safety Equipment
Shoulder & Lap Belt
On Duty Crash
01
Driver License NumberAddress
ROBERTS, WI 54023 , US
RaceWHITEDate of Birth
10/04/
Sex
Female
Citations Issued
0
PassengerMICHELLE N RICHARDS
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 12:05 PM
Crash Date 07/05/2017Wisconsin Motor Vehicle Crash
Form DT4000 5 of 12
This report does not include any CJIS data.
17070502
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VT 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
3
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
6--Second Seat-Right Side
00
3
Safety Equipment
Shoulder & Lap Belt
On Duty Crash
01
Driver License NumberAddress
ROBERTS, WI 54023 , US
RaceWHITEDate of Birth
08/16
Sex
Male
Citations Issued
0
PassengerCOOPER D RICHARDS
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 12:05 PM
Crash Date 07/05/2017Wisconsin Motor Vehicle Crash
Form DT4000 6 of 12
This report does not include any CJIS data.
17070502
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VT 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
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
45Pre CrashTire
Mark
Direction Of Travel
Northbound
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
1
Train/Bus # InjuredTotal Occs
4
Operating As EndorsementsVehicle Type
Utility Truck/Pickup Truck
Unit Type
Truck
Vehicle Operating As Classification
D CLASS
Unit Status
In Transit
UN
I
T
02
Unit Summary
Driver DistractionsPassenger
Driver ActionsOperated Motor Vehicle In Inattentive, Careless or Erratic Manner
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Going Straight
Vehicle Removed By
OWNER
Towed Due To Damage
Not Towed
VE
H
I
C
L
E
UN
I
T
02
Extent Of Damage
Functional Damage
Vehicle Damage
12--Front
Initial Contact Point
12--Front
Bus UseNot A BusBody Style
PK - PICKUP
Color
GRN - Green
Model
NO DATA FO
Year
2014
Make
DODGE
Vehicle Identification Number
0549
Country of Issuance
UNITED STATES
St
WI
Plate Type
LTK - Light Truck
License Plate Number
LX5259
VE
H
I
C
L
E
UN
I
T
02
Vehicle
Address
STONE LAKE, WI 54876 , US
IndividualCHAD CHRISTOPHER HEADLEY02
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventMotor Veh In Transport01
Crash Time 12:05 PM
Crash Date 07/05/2017Wisconsin Motor Vehicle Crash
Form DT4000 7 of 12
This report does not include any CJIS data.
17070502
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VT Wisconsin Motor Vehicle
Crash Report
Event
02
Event
03
Event
04
Individual
CHAD HEADLEY
Insurance Company
STATE-FARM-GENERAL-INS-CO
Policy Holder
UN
I
T
Crash Time 12:05 PM
Crash Date 07/05/2017Wisconsin Motor Vehicle Crash
Form DT4000 8 of 12
This report does not include any CJIS data.
17070502
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VT 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
4
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
4
Safety Equipment
Shoulder & Lap Belt
On Duty Crash
02
ber
State: Wisconsin Country: UNITED STATES
Address
STONE LAKE, WI 54876 , US
RaceWHITEDate of Birth
12/30/
Sex
Male
Citations Issued
1
DriverCHAD CHRISTOPHER HEADLEY
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 12:05 PM
Crash Date 07/05/2017Wisconsin Motor Vehicle Crash
Form DT4000 9 of 12
This report does not include any CJIS data.
17070502
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VT 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
5
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
3--Front Seat-Right Side (Train Engineers/Right
00
5
Safety Equipment
Shoulder & Lap Belt
On Duty Crash
02
Driver License NumberAddress
STONE LAKE, WI 54876 , US
RaceWHITEDate of Birth
04/29/
Sex
Male
Citations Issued
0
PassengerCHASE D EWERT
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 12:05 PM
Crash Date 07/05/2017Wisconsin Motor Vehicle Crash
Form DT4000 10 of 12
This report does not include any CJIS data.
17070502
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VT 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
6
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
4--Second Seat-Left Side(Motorcycle/Bicycle Pa
00
6
Safety Equipment
Shoulder & Lap Belt
On Duty Crash
02
Driver License NumberAddress
STONE LAKE, WI 54876 , US
RaceWHITEDate of Birth
08/19/
Sex
Female
Citations Issued
0
PassengerCAMRYN L EWERT
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 12:05 PM
Crash Date 07/05/2017Wisconsin Motor Vehicle Crash
Form DT4000 11 of 12
This report does not include any CJIS data.
17070502
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VT 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
7
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
6--Second Seat-Right Side
00
7
Safety Equipment
Shoulder & Lap Belt
On Duty Crash
02
Driver License NumberAddress
STONE LAKE, WI 54876 , US
RaceWHITEDate of Birth
04/27/
Sex
Female
Citations Issued
0
PassengerKENDRA L HART
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Violations
DescriptionINATTENTIVE DRIVINGSeq Num001Statute Number346.89(1)Issue To?
004
UTC Number
E01461301
Crash Time 12:05 PM
Crash Date 07/05/2017Wisconsin Motor Vehicle Crash
Form DT4000 12 of 12
This report does not include any CJIS data.