20170724 Nelson Moe17072403
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN04 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
11:28 AM
Date Notified
07/24/2017
Time Arrived
11:43 AM
Date Arrived
07/24/2017
Crash Time
11:25 AM
Crash Date
07/24/2017
Investigating Officer/Deputy
DEPUTY KEVIN GILLIS
Agency Crash NumberPrimary Crash Document #Document Number Override
6V
L
1
2
X
V
N
0
4
Additional InformationNone
Photos By
Reconstruction ByDiagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
WASHBURN COUNTY HIGHWAY DEPARTMENT WAS PAINTING LINES ON STATE HWY 27 AT THE INTERSECTION OF COUNTY HWY K. ONE OF THE HIGHWAY DEPARTMENT TRUCK, OPERATED BY TURNER MOE, NEEDED TO BACK UP, BUT DID NOT SEE THE MINI COOPER, DRIVEN BY JANET
NELSON, THAT WAS BEHIND HIM. MR. MOE BACKED INTO MS. NELSON'S VEHICLE CAUSING VERY MINOR DAMAGES TO BOTH VEHICLES.
Crash Time 11:25 AM
Crash Date 07/24/2017Wisconsin Motor Vehicle Crash
Form DT4000 1 of 9
This report does not include any CJIS data.
17072403
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN04 Wisconsin Motor Vehicle
Crash Report
Structure Type
No Structure
Y Coordinate
5094363.5
X Coordinate
151230.484375
Longitude
-91.497388702
Latitude
45.91425954
ON STH27 NB
57 FT S
OF CTHK
IN THE TOWN OF BASS LAKE
IN SAWYER COUNTY
Location
Special StudyAccess Control
Partial 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
02--Front To Rear
First Harmful Event Location
On Roadway
First Harmful Event
Motor Veh In Transport
Crash Scene
Intersection Type
T-Intersection
Junction Location
Intersection-Related
Within Interchange Area
NO
Normal Posted Speed Limit
55
Advisory/Regulatory Speed Limit
Regulatory
Work Zone Speed Limit
55
Law Enforcement Present
No
Workers Present
YES
Work Zone Crash Type
Work on Shoulder or Median
Work Zone Crash Location
Transition 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
Divided Hwy W/O Traffic Barrier
Emergency Motor Vehicle UseNot ApplicableSpecial FunctionNo Special FunctionMost Harmful Event: Collision With
Motor Veh In Transport
Total Lanes
2
Speed Limit
55Pre CrashTire
Mark
Direction Of Travel
Northbound
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
2
Operating As EndorsementsVehicle Type
Passenger Car
Unit Type
Automobile
Vehicle Operating As Classification
D CLASS
Unit Status
In Transit
UN
I
T
01
Unit Summary
Model
COOPER
Year
2013
Make
MINI
Vehicle Identification Number
517
Country of Issuance
UNITED STATES
St
WI
Plate Type
TMP - Temporary Plate
License Plate Number
N8990J01
Vehicle
Crash Time 11:25 AM
Crash Date 07/24/2017Wisconsin Motor Vehicle Crash
Form DT4000 2 of 9
This report does not include any CJIS data.
17072403
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN04 Wisconsin Motor Vehicle
Crash Report
Driver DistractionsNot Distracted
Driver ActionsFollowing Too Close
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Going Straight
Vehicle Removed ByTowed Due To Damage
Not Towed
VE
H
I
C
L
E
UN
I
T
01
Extent Of Damage
Minor Damage
Vehicle Damage
12--Front
Initial Contact Point
12--Front
Bus UseNot A BusBody Style
SW - STATIONWAGON
Color
BRO - Brown
VE
H
I
C
L
E
UN
I
T
Address
ELK MOUND, WI 54739 , US
IndividualJANET E NELSON01
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
JANET NELSON
Insurance Company
STATE-FARM-GENERAL-INS-CO
Policy Holder
UN
I
T
Crash Time 11:25 AM
Crash Date 07/24/2017Wisconsin Motor Vehicle Crash
Form DT4000 3 of 9
This report does not include any CJIS data.
17072403
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN04 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
ELK MOUND, WI 54739 , US
RaceWHITEDate of Birth
01/01
Sex
Female
Citations Issued
0
DriverJANET E NELSON
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 11:25 AM
Crash Date 07/24/2017Wisconsin Motor Vehicle Crash
Form DT4000 4 of 9
This report does not include any CJIS data.
17072403
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN04 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
ber
State: Wisconsin Country: UNITED STATES
Address
ELK MOUND, WI 54739 , US
RaceWHITEDate of Birth
08/15/1
Sex
Female
Citations Issued
0
PassengerDEBRA K OBERMEYER
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 11:25 AM
Crash Date 07/24/2017Wisconsin Motor Vehicle Crash
Form DT4000 5 of 9
This report does not include any CJIS data.
17072403
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN04 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
Divided Hwy W/O Traffic Barrier
Emergency Motor Vehicle UseNon-Emergency, Non-TransportSpecial FunctionNo Special FunctionMost Harmful Event: Collision With
Motor Veh In Transport
Total Lanes
2
Speed Limit
55Pre CrashTire
Mark
Direction Of Travel
Northbound
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
1
Operating As EndorsementsVehicle Type
Straight Truck (Insert Truck)
Unit Type
Truck
Vehicle Operating As Classification
A CLASS
Unit Status
In Transit
UN
I
T
02
Unit Summary
Driver DistractionsLooked But Did Not See
Driver ActionsNo Contributing Action
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Backing
Vehicle Removed ByTowed Due To Damage
Not Towed
VE
H
I
C
L
E
UN
I
T
02
Extent Of Damage
Minor Damage
Vehicle Damage
6--Rear
Initial Contact Point
6--Rear
Bus UseNot A BusBody Style
OT - OTHER
Color
RED - Red
Model
NO DATA
Year
2007
Make
STERLING
Vehicle Identification Number
1021
Country of Issuance
UNITED STATES
St
WI
Plate Type
MUN - Municipal
License Plate Number
70870
VE
H
I
C
L
E
UN
I
T
02
Vehicle
Address
SPOONER, WI 54801 , US
GovernmentWASHBURN COUNTY HIGHWAY DEPT02
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventMotor Veh In Transport01
Crash Time 11:25 AM
Crash Date 07/24/2017Wisconsin Motor Vehicle Crash
Form DT4000 6 of 9
This report does not include any CJIS data.
17072403
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN04 Wisconsin Motor Vehicle
Crash Report
Event
02
Event
03
Event
04
Government
WASHBURN COUNTY HIGHWAY DEPT
Insurance Company
COUNTRY-MUTUAL-INSURANCE-CO
Policy Holder
UN
I
T
Crash Time 11:25 AM
Crash Date 07/24/2017Wisconsin Motor Vehicle Crash
Form DT4000 7 of 9
This report does not include any CJIS data.
17072403
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN04 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
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
3
Safety Equipment
Shoulder & Lap Belt
On Duty Crash
02
ber
State: Wisconsin Country: UNITED STATES
Address
SHELL LAKE, WI 54871 , US
RaceWHITEDate of Birth
03/04
Sex
Male
Citations Issued
0
DriverTURNER J MOE
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
US
GovernmentWASHBURN COUNTY HIGHWAY DEPARTMENT
PR
O
P
OW
N
E
R
01
Property Owner
Fixed Objects Struck
Crash Time 11:25 AM
Crash Date 07/24/2017Wisconsin Motor Vehicle Crash
Form DT4000 8 of 9
This report does not include any CJIS data.
17072403
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN04 Wisconsin Motor Vehicle
Crash Report
Damage Tag NumberStruck Object
Other Object - Not Fixed
Striking Unit
0201
Crash Time 11:25 AM
Crash Date 07/24/2017Wisconsin Motor Vehicle Crash
Form DT4000 9 of 9
This report does not include any CJIS data.