20171204 Lee.pdfNarrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
ON DECEMBER 5, 2017, I, DEPUTY AMBER AL-MOGHRABI WAS WORKING PATROL FOR THE SAWYER COUNTY SHERIFF'S DEPT. AT APPROXIMATELY 9:12 AM I WAS DISPATCHED TO WILLIAMS ROAD JUST WEST OF WOODS ROAD FOR A VEHICLE IN A LAKE. I WAS ADVISED BY DISPATCH THAT
DEPUTY FREY HAD BEEN OUT THERE THE NIGHT BEFORE FOR THE ACCIDENT AND THAT I NEEDED TO STAND BY FOR TRAFFIC CONTROL WHILE
THE VEHICLE WAS TOWED OUT OF THE LAKE. UPON ARRIVAL AT 9:33 I MET WITH THE OWNER OF THE VEHICLE BLAINE LEE. HE STATE THAT HE
WAS TRAVELING EASTBOUND ON WILLIAMS ROAD HEADING HOME TO WILLIAMS RESORT ROAD. HE STATED HE WAS TRAVELING APPROXIMATELY
10-15MPH WHILE NEGOTIATING A CURVE AND HE LOST CONTROL OF THE VEHICLE. BLAINE STATED THAT THE ROADS WERE SNOW COVERED AND
ICY AND THAT THE VEHICLE SLID OFF THE ROADWAY. HE SAID HE HAD THE OPTION TO EITHER HIT THE TREE TO STOP THE VEHICLE FROM GOING INTO THE LAKE OR GO RIGHT INTO THE LAKE AND HE FIGURED THAT WOULD HURT LESS. BLAINE STATED THAT THIS WAS AROUND 11 PM LAST
NIGHT AND THAT DEPUTY FREY SHOWED UP AND DROVE HIM HOME. HE STATED SINCE THE WEATHER WAS SO BAD THAT THEY DECIDED ON
HAVING THE VEHICLE TOWED TODAY INSTEAD. BLAINE STATED THAT HE WAS WEARING HIS SEATBELT AND THAT HE HAD PROGRESSIVE FOR
INSURANCE. I ADVISED BLAINE TO CALL HIS INSURANCE COMPANY RIGHT AWAY IF HE HASNT ALREADY. WHEN THE VEHICLE WAS REMOVED
FROM THE WATER I WAS ABLE TO GET PICTURES OF IT. THE VEHICLE HAD BEEN LAYING ON THE PASSENGER SIDE AND WAS COVERED IN WATER.
17120416627
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HKF 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
11:04 PM
Date Notified
12/04/2017
Time Arrived
11:21 PM
Date Arrived
12/04/2017
Crash Time
11:00 PM
Crash Date
12/04/2017
Investigating Officer/Deputy
DEPUTY AMBER ALMOGHRABI
Agency Crash Number
17120505
Primary Crash Document #Document Number Override
6V
L
1
3
W
8
H
K
F
Additional InformationPhotos
Photos ByDEPUTY AMBER AL-MOGHRABI
Reconstruction ByDiagram
Description
Crash Time 11:00 PM
Crash Date 12/04/2017Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
THERE WAS ALSO MAJOR DAMAGE TO THE FRONT AND REAR PASSENGER SIDE. THE VEHICLE WAS REMOVED BY ROADRUNNER TOWING, WHO
ALSO GAVE BLAINE A RIDE BACK HOME. I CLEARED FROM THE CALL AT 10:33 AND ENTERED THE PICTURES INTO EVIDENCE AS ITEM NUMBER
1700896-0001.
17120416627
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HKF Wisconsin Motor Vehicle
Crash Report
Structure Type
No Structure
Y Coordinate
5098607.5
X Coordinate
154854.984375
Longitude
-91.453848066
Latitude
45.954172645
ON WILLIAMS RD
1095 FT E
OF HIGHLINE RD
IN THE TOWN OF BASS 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)
Snow, Freezing Rain or Freezing Drizzle
Environment Factor(s)
Weather Conditions
Roadway Factor(s)
Not Applicable
Road Surface Condition(s)
Snow, Ice
Light Condition
Dark/Unlit
Manner of Collision
No Collision W/Vehicle In Transport
First Harmful Event Location
Shoulder Right
First Harmful Event
Ditch
Crash Scene
Intersection Type
Not an Intersection
Junction Location
Non-Junction
Within Interchange Area
NO
Reporting Threshold
No
Truck Bus or HazMat
No
Road Grade
Level
Road Curvature
Curve Left
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
Overturn/Rollover
Total Lanes
2
Speed Limit
45Pre 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
Utility Truck/Pickup Truck
Unit Type
Truck
Vehicle Operating As Classification
D CLASS
Unit Status
In Transit
UN
I
T
01
Unit Summary
Vehicle DamageInitial Contact Point
1--Right Front Corner
Bus UseNot A BusBody Style
PK - PICKUP
Color
MAR - Maroon (Burgundy)
Model
SILVERADO
Year
2002
Make
CHEVROLET
Vehicle Identification Number
2GCEK19T721239569
Country of Issuance
UNITED STATES
St
WI
Plate Type
LTK - Light Truck
License Plate Number
JD5783
VE
H
I
C
L
E
01
Vehicle
Crash Time 11:00 PM
Crash Date 12/04/2017Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
17120416627
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HKF Wisconsin Motor Vehicle
Crash Report
Driver DistractionsNot Distracted
Driver ActionsNo Contributing Action
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Negotiating Curve
Vehicle Removed By
ROADRUNNER TOWING
Towed Due To Damage
Towed Due To Disabling Damage
VE
H
I
C
L
E
UN
I
T
01
Extent Of Damage
Disabling Damage
All Areas
UN
I
T
Address
MONDOVI, WI 54755 , US
IndividualBLAINE R LEE
(
Vehicle Owner
Sequence Of Events
EventDitch01
EventOverturn/Rollover02
Event
03
Event
04
Individual
BLAINE LEE
Insurance Company
PROGRESSIVE-CASUALTY-INS-CO
Policy Holder
UN
I
T
Crash Time 11:00 PM
Crash Date 12/04/2017Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
17120416627
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HKF 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
MONDOVI, WI 54755 , US
RaceWHITEDate of Birth
02/21/
Sex
Male
Citations Issued
0
DriverBLAINE R LEE
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 11:00 PM
Crash Date 12/04/2017Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.