20171209 Larson-Ehn.pdf17120903
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL14VWD6V 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
12:08 PM
Date Notified
12/09/2017
Time Arrived
12:20 PM
Date Arrived
12/09/2017
Crash Time
12:08 PM
Crash Date
12/09/2017
Investigating Officer/Deputy
DEPUTY MICHAEL SIMPSON
Agency Crash NumberPrimary Crash Document #Document Number Override
6V
L
1
4
V
W
D
6
V
Additional InformationNone, Photos
Photos ByDEPUTY MICHAEL SIMPSON
Reconstruction ByDiagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
DEPUTY SIMPSON RESPONDED TO A CALL FOR A TRUCK ROLLOVER WITH NO INJURIES ON POLISH RD APPROXIMATELY 1/2 MILE WEST OF STATE HWY 40. DEPUTY SIMPSON RESPONDED TO THE AREA AND SAW THAT A PICK-UP TRUCK WAS ON IT'S PASSENGER SIDE DOWN A SHALLOW
EMBANKMENT. DEPUTY ASKED DRIVER WHAT HAD HAPPENED. DRIVER SAID THAT DUE TO ICE AND SNOW HE LOST CONTROL OF THE VEHICLE,
SPUN 180 DEGREES AND ENDED ON HIS SIDE IN THE EMBANKMENT. THE ROAD WERE ICE AND SNOW COVERED. THE ROAD DOES DON'T APPEAR
TO HAVE BEEN RECENTLY PLOWED.
Crash Time 12:08 PM
Crash Date 12/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
17120903
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL14VWD6V Wisconsin Motor Vehicle
Crash Report
Structure Type
No Structure
Y Coordinate
5076307
X Coordinate
170798.984375
Longitude
-91.233441
Latitude
45.76183091
ON POLISH RD
613 FT E
OF POTTERS RD
IN THE TOWN OF RADISSON
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 - On Road
Animal Type
Weather Condition(s)
Cloudy, Snow
Environment Factor(s)
Weather Conditions
Roadway Factor(s)
Road Surface Condition (Wet, Icy, Snow, Slush, Etc), Soft
Shoulder
Road Surface Condition(s)
Snow, Ice
Light Condition
Daylight
Manner of Collision
No Collision W/Vehicle In Transport
First Harmful Event Location
On Roadway
First Harmful Event
Embankment
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
Uphill
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
Overturn/Rollover
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
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
Extent Of Damage
Disabling Damage
Vehicle Damage
1--Right Front Corner, 2--Right Side Front, 3--Right Side Middle, 4--Right Side
Rear, 5--Right Rear Corner
Initial Contact Point
Non-Collision
Bus UseNot A BusBody Style
TK - TRUCK
Color
GRN - Green
Model
RAM 1500
Year
2003
Make
DODGE
Vehicle Identification Number
195
Country of Issuance
UNITED STATES
St
WI
Plate Type
LTK - Light Truck
License Plate Number
KG5085
VE
H
I
C
L
E
UN
I
T
01
Vehicle
Crash Time 12:08 PM
Crash Date 12/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
17120903
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL14VWD6V 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
Going Straight
Vehicle Removed By
OWNER
Towed Due To Damage
Towed Due To Disabling Damage
VE
H
I
C
L
E
UN
I
T
01
Address
EXELAND, WI 54835 , US
IndividualCHEDRA K WHITE01
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventEmbankment01
EventOverturn/Rollover02
Event
03
Event
04
Individual
CHEDRA WHITE
Insurance Company
ALLSTATE-INS-CO
Policy Holder
UN
I
T
Crash Time 12:08 PM
Crash Date 12/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
17120903
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL14VWD6V 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
WINTER, WI 54896 , US
RaceWHITEDate of Birth
06/04/
Sex
Male
Citations Issued
0
DriverJOHN A.R. LARSON-EHN
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 12:08 PM
Crash Date 12/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.