20170713 Forrest17071302
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13QBC3J 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
01:33 AM
Date Notified
07/13/2017
Time Arrived
01:40 AM
Date Arrived
07/13/2017
Crash Time
01:30 AM
Crash Date
07/13/2017
Investigating Officer/Deputy
SERGEANT JEFF JOHNSON
Agency Crash Number
17071302
Primary Crash Document #Document Number Override
6V
L
1
3
Q
B
C
3
J
Additional InformationPhotos, Reconstruction
Photos BySGT. J. JOHNSON
Reconstruction BySAWYER COUNTY SHERIFFDiagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
ON 7/13/17 AT APPX 0130 HRS, VEH 1 WAS TAKEN W/OUT PERMISSION BY THE NEPHEW OF THE R/O. HE ATTEMPTED TO BACK OUT OF THE DRIVEWAY AT 4162 N CTH F; HOWEVER BEING AN INEXPERIENCED DRIVER, HE BACKED STRAIGHT ACROSS CTH F AND GOT STUCK IN THE WEST
DITCH OF CTH F. HE ATTEMPTED TO BACK OUT OF THE DITCH, WHICH CAUSED REPORTABLE DAMAGE TO THE FRONT END OF THE VEH. HE WAS
SUBSEQUENTLY ARRESTED FOR OPERATING WITHOUT OWNER'S CONCENT AND OBSTRUCTING LAW ENFORCEMENT.
Crash Time 01:30 AM
Crash Date 07/13/2017Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
17071302
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13QBC3J Wisconsin Motor Vehicle
Crash Report
Structure Type
No Structure
Y Coordinate
5080673
X Coordinate
153331.3125
Longitude
-91.460530173
Latitude
45.792473694
ON CTHF
1175 FT S
OF HAUER RD
IN THE TOWN OF SAND 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
Dark/Unlit
Manner of Collision
No Collision W/Vehicle In Transport
First Harmful Event Location
Roadside
First Harmful Event
Ditch
Crash Scene
Intersection Type
Not an Intersection
Junction Location
Non-Junction
Within Interchange Area
NO
Time Roadway RepairedDate Roadway RepairedTime All Lanes Open
02:10 AM
Date All Lanes Open
07/13/2017
Time Initial Lane/Road Closed
02:00 AM
Date Initial Lane/Road Closed
07/13/2017
Reasons for Closure
Tow truck
Closure Type
Full closure
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
Ditch
Total Lanes
2
Speed Limit
45Pre CrashTire
Mark
Direction Of Travel
Westbound
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
01
Operating As EndorsementsVehicle Type
Passenger Car
Unit Type
Automobile
Vehicle Operating As Classification
D CLASS
Unit Status
Stolen
UN
I
T
01
Unit Summary
Model
VERANO
Year
2016
Make
BUICK
Vehicle Identification Number
3848
Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - Automobile
License Plate Number
251YUE01
Vehicle
Crash Time 01:30 AM
Crash Date 07/13/2017Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
17071302
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13QBC3J Wisconsin Motor Vehicle
Crash Report
Driver DistractionsNot Distracted
Driver ActionsUnsafe Backing, Ran Off Roadway, Failed To Keep In Designated Lane, Other Contributing Action
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Backing
Vehicle Removed By
OWNER
Towed Due To Damage
Towed But Not Due To Disabling Damage
VE
H
I
C
L
E
UN
I
T
01
Extent Of Damage
Functional Damage
Vehicle Damage
12--Front
Initial Contact Point
12--Front
Bus UseNot A BusBody Style
4D - 4DR
Color
BLU - Blue
VE
H
I
C
L
E
UN
I
T
Address
STONE LAKE, WI 54876 , US
IndividualMELANIE A ANDREN01
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventDitch01
Event
02
Event
03
Event
04
Individual
MELANIE ANDREN
Insurance Company
STATE-FARM-GENERAL-INS-CO
Policy Holder
UN
I
T
Crash Time 01:30 AM
Crash Date 07/13/2017Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
17071302
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13QBC3J 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
To/From SchoolLocationPrior ActionStriking Unit #
00
1
01
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
Not Transported
Trapped/Extricated
Not Applicable
Ejection Path
Not Ejected/Not Applicable
Ejected
Not Applicable
Airbag
Not Applicable
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
Restraint Use Unknown
On Duty Crash
01
mber
State: Minnesota Country: UNITED STATES
Address
STONE LAKE, WI 54876 , US
RaceWHITEDate of Birth
11/02/
Sex
Male
Citations Issued
0
DriverKEVEN J FORREST
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 01:30 AM
Crash Date 07/13/2017Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.