20171215 Baranczyk Town of Hayward.pdf17121517091
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HKH 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
12/15/2017
Time Arrived
12:10 PM
Date Arrived
12/15/2017
Crash Time
12:00 PM
Crash Date
12/15/2017
Investigating Officer/Deputy
DEPUTY AMBER ALMOGHRABI
Agency Crash Number
17121504
Primary Crash Document #Document Number Override
6V
L
1
3
W
8
H
K
H
Additional InformationPhotos
Photos ByDEPUTY AMBER AL-MOGHRABI
Reconstruction ByDiagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
ON DECEMBER 15, 2017 I DEPUTY AMBER AL-MOGHRABI WAS WORKING PATROL FOR THE SAWYER COUNTY SHERIFF'S DEPT. AT APPROXIMATELY 12:05 I WAS DISPATCHED TO 15910 COMPANY LAKE ROAD FOR A REPORT OF A TWO CAR ACCIDENT WITH NO INJURIES. UPON ARRIVAL I WAS
WAVED OVER BY A FEMALE IN A BLUE SEDAN. SHE STATED SHE WAS BACKING OUT OF HER PARKING SPOT AND DIDNT SEE THE FIRE TRUCK AND
SHE BACKED INTO IT. I RAN THE LICENSE PLATE ON THE VEHICLE WHICH CAME BACK TO DONNA BARANCZYK. SHE INFORMED ME THAT SHE WAS
DONNA, SO I ASKED DISPATCH TO RUN HER ALSO. I LOOKED AT HER VEHICLE AND NOTICED A LARGE DENT AND CRACK ON THE DRIVERS SIDE
BACK BUMPER AND TOOK PICTURES OF IT. I THEN LOOKED AT THE FIRE TRUCK AND DIDNT SEE ANY DAMAGE. I RAN THE MUNICIPAL PLATE
THROUGH DISPATCH WHICH CAME BACK TO THE TOWN OF HAYWARD FIRE AND RESCUE DEPT. AT THAT TIME TAYLOR HEINZEL WITH THE TOWN OF HAYWARD FIRE DEPT CAME WALKING OUT OF THE BUILDING. HE STATED HE WAS ON DUTY DOING FIRE INSPECTIONS AND WHEN HE CAME
OUT DONNA TOLD HIM THAT SHE HIT THE FIRE TRUCK. HE STATED THAT HE ALSO DID NOT SEE DAMAGE TO THE FIRE TRUCK. BOTH DRIVERS
WERE ABLE TO DRIVE THEIR VEHICLES FROM THE SCENE AND I CLEARED AT 12:27.
Crash Time 12:00 PM
Crash Date 12/15/2017Wisconsin Motor Vehicle Crash
Form DT4000 1 of 6
This report does not include any CJIS data.
17121517091
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HKH Wisconsin Motor Vehicle
Crash Report
Structure Type
House/Building
Y Coordinate
5106838
X Coordinate
152630.578125
Longitude
-91.488441465
Latitude
46.026901211
ON 15910 COMPANY LAKE RD
53 FT W
OF COMPANY LAKE RD
(HOUSE/BUILDING 15910)
IN THE TOWN OF HAYWARD
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)
Wet
Light Condition
Daylight
Manner of Collision
02--Front To Rear
First Harmful Event Location
In Parking Lane or Zone
First Harmful Event
Parked Motor Vehicle
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
Straight
Surface Type
Blacktop (Bituminous)
Traffic Control Inoperative/Missing
NO
Traffic Control
No Control
Traffic Way
Parking Lot or Private Property
Emergency Motor Vehicle UseNot ApplicableSpecial FunctionNo Special FunctionMost Harmful Event: Collision With
Parked Motor Vehicle
Total Lanes
0
Speed Limit
N/APre CrashTire
Mark
Direction Of Travel
Not On Roadway
Insurance?
UNKNOWN
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
1
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
Extent Of Damage
Minor Damage
Vehicle Damage
7--Left Rear Corner
Initial Contact Point
7--Left Rear Corner
Bus UseNot A BusBody Style
4D - 4DR
Color
BLU - Blue
Model
COROLLA
Year
2013
Make
TOYOTA
Vehicle Identification Number
1597
Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - Automobile
License Plate Number
250EVP
VE
H
I
C
L
E
UN
I
T
01
Vehicle
Crash Time 12:00 PM
Crash Date 12/15/2017Wisconsin Motor Vehicle Crash
Form DT4000 2 of 6
This report does not include any CJIS data.
17121517091
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HKH 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
Backing
Vehicle Removed By
OWNER
Towed Due To Damage
Not Towed
VE
H
I
C
L
E
UN
I
T
01
Address
SOLON SPRINGS, WI 54873 , US
IndividualDONNA M BARANCZYK01
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventParked Motor Vehicle01
Event
02
Event
03
Event
04
Crash Time 12:00 PM
Crash Date 12/15/2017Wisconsin Motor Vehicle Crash
Form DT4000 3 of 6
This report does not include any CJIS data.
17121517091
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HKH 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
SOLON SPRINGS, WI 54873 , US
RaceWHITEDate of Birth
03/09/
Sex
Female
Citations Issued
0
DriverDONNA M BARANCZYK
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 12:00 PM
Crash Date 12/15/2017Wisconsin Motor Vehicle Crash
Form DT4000 4 of 6
This report does not include any CJIS data.
17121517091
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HKH 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
Parking Lot or Private Property
Emergency Motor Vehicle UseNon-Emergency, Non-TransportSpecial FunctionFire TruckMost Harmful Event: Collision With
Motor Veh In Transport
Total Lanes
0
Speed Limit
N/APre CrashTire
Mark
Direction Of Travel
Not On Roadway
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
0
Operating As EndorsementsVehicle Type
Utility Truck/Pickup Truck
Unit Type
Truck
Vehicle Operating As Classification
D CLASS
Unit Status
Legally Parked
UN
I
T
02
Unit Summary
Driver DistractionsNot Distracted
Driver ActionsNo Contributing Action
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Legally Parked
Vehicle Removed By
OPERATOR
Towed Due To Damage
Not Towed
VE
H
I
C
L
E
UN
I
T
02
Extent Of Damage
No Damage
Vehicle Damage
No Damage
Initial Contact Point
12--Front
Bus UseNot A BusBody Style
PK - PICKUP
Color
RED - Red
Model
RAM 5500
Year
2012
Make
DODGE
Vehicle Identification Number
4268
Country of Issuance
UNITED STATES
St
WI
Plate Type
MUN - Municipal
License Plate Number
82786
VE
H
I
C
L
E
UN
I
T
02
Vehicle
Address
HAYWARD, WI 54843 , US
GovernmentHAYWARD TOWN OF FIRE AND RESCUE
(
Vehicle Owner
Sequence Of Events
EventParked Motor Vehicle01
Crash Time 12:00 PM
Crash Date 12/15/2017Wisconsin Motor Vehicle Crash
Form DT4000 5 of 6
This report does not include any CJIS data.
17121517091
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HKH Wisconsin Motor Vehicle
Crash Report
Event
02
Event
03
Event
04
Government
HAYWARD TOWN OF FIRE AND RESCUE
Insurance Company
GOVERNMENT
Policy Holder
UN
I
T
HAYWARD, WI 54843 , US
Organization/CompanyNORTHLAKES COMMUNITY CLINIC
(01
Property Owner
Fixed Objects Struck
Damage Tag NumberStruck Object
Other Object - Not Fixed
Striking Unit
0101
Crash Time 12:00 PM
Crash Date 12/15/2017Wisconsin Motor Vehicle Crash
Form DT4000 6 of 6
This report does not include any CJIS data.