20171228 Kahl Lapointe.pdf17122802
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8W7 Wisconsin Motor Vehicle
Crash Report
Secondary
CrashAmendedCrash Type
Private Property/Parking LotReportable
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
08:52 AM
Date Notified
12/28/2017
Time Arrived
09:09 AM
Date Arrived
12/28/2017
Crash Time
08:52 AM
Crash Date
12/28/2017
Investigating Officer/Deputy
DEPUTY JEFF CAIN
Agency Crash Number
17122802
Primary Crash Document #Document Number Override
6V
L
1
3
M
V
8
W
7
Additional InformationNone, Photos
Photos ByDEPUTY JEFF CAIN
Reconstruction ByDiagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
UNIT 1 DROVE INTO A PRIVATE DRIVEWAY TO TURN AROUND. AS IT STOPPED TO BACK UP, UNIT 2 BEGAN BACKING UP TO TURN AND EXIT THE DRIVEWAY AND COLLIDED WITH UNIT 1.
Structure Type
Fire
Y Coordinate
5098622.5
X Coordinate
151817.234375
Longitude
-91.492937384
Latitude
45.95277231
PRIVATE PROPERTY
8790W STH27 NB
(FIRE 8790W)
IN THE TOWN OF BASS LAKE
IN SAWYER COUNTY
Location
Crash Time 08:52 AM
Crash Date 12/28/2017Wisconsin Motor Vehicle Crash
Form DT4000 1 of 7
This report does not include any CJIS data.
17122802
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8W7 Wisconsin Motor Vehicle
Crash Report
Special StudyAccess Control
No Control
Tribal Land
Crash Classification - Jurisdiction
Private Property
Crash Classification - Location
Private Property
Relation To Trafficway
Non Trafficway - Other
Animal Type
Weather Condition(s)
Snow
Environment Factor(s)
Weather Conditions
Roadway Factor(s)
None
Road Surface Condition(s)
Snow
Light Condition
Daylight
Manner of Collision
07--Rear To Side
First Harmful Event Location
Off Roadway, Location Unknown
First Harmful Event
Motor Veh In Transport
Crash Scene
Intersection Type
Not an Intersection
Junction Location
Non-Junction
Within Interchange Area
NO
Reporting Threshold
No
Truck Bus or HazMat
Any vehicle designed to carry 9 or more ppl, including driver
Road Grade
Level
Road Curvature
Straight
Surface Type
Slag, Gravel, or Stone
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
Motor Veh In Transport
Total LanesSpeed 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 # Injured
0
Total Occs
2
Operating As Endorsements
P - PASSENGER BUS
Vehicle Type
Passenger Bus/Transit Bus
Unit Type
Bus
Vehicle Operating As Classification
C CLASS
Unit Status
In Transit
UN
I
T
01
Unit Summary
Driver Actions
Driver Prior Action Other
STOPPED/PREPAIRING TO BACK
Vehicle Factors
Not Applicable
What Driver Was Doing
Other
Vehicle Removed By
OPERATOR
Towed Due To Damage
Not Towed01
Extent Of Damage
No Damage
Vehicle Damage
No Damage
Initial Contact Point
8--Left Side Rear
Bus UseTransit/CommuterBody Style
BU - BUS
Color
WHI - White
Model
E450 SUPER
Year
2011
Make
FORD
Vehicle Identification Number
0041
Country of Issuance
UNITED STATES
St
WI
Plate Type
MUN - Municipal
License Plate Number
89503
VE
H
I
C
L
E
UN
I
T
01
Vehicle
Crash Time 08:52 AM
Crash Date 12/28/2017Wisconsin Motor Vehicle Crash
Form DT4000 2 of 7
This report does not include any CJIS data.
17122802
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8W7 Wisconsin Motor Vehicle
Crash Report
Driver DistractionsNot Distracted
Other Contributing Action
VE
H
I
C
L
E
UN
I
T
Address
HAYWARD, WI 54843 , US
Government
01
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
GovernmentInsurance Company
TRANSIT-MUTUAL-INS-CORP-OF-WISCONSIN
Policy Holder
UN
I
T
Crash Time 08:52 AM
Crash Date 12/28/2017Wisconsin Motor Vehicle Crash
Form DT4000 3 of 7
This report does not include any CJIS data.
17122802
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8W7 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
11/02/
Sex
Male
Citations Issued
0
Driver
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Address
, ,
Name
Source
DriverUse Vehicle Owner Same as Carrier
01
Carrier
Crash Time 08:52 AM
Crash Date 12/28/2017Wisconsin Motor Vehicle Crash
Form DT4000 4 of 7
This report does not include any CJIS data.
17122802
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8W7 Wisconsin Motor Vehicle
Crash Report
Measured WeightMeasured WidthMeasured LengthMeasured Height
Escort Vehicle PresentEscort Vehicle Required
By Permit
Permitted Vehicle On
Permitted Route
WI Permit NumberOS/OW Load
Permitted Load
Not Applicable
Carrier TypeUS DOT #
Cargo Body Type
Bus (Seats For More Than 15 Occupants, Including Driv
Vehicle Configuration
Bus(Seats For More Than 15 Occupants, Includi
GVWR
Not Applicable
TR
U
C
K
B
U
S
UN
I
T
Reporting Threshold
No
Truck Bus or HazMat
No
Road Grade
Level
Road Curvature
Straight
Surface Type
Slag, Gravel, or Stone
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
Motor Veh In Transport
Total LanesSpeed 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
1
Operating As EndorsementsVehicle Type
Passenger Car
Unit Type
Automobile
Vehicle Operating As Classification
D CLASS
Unit Status
In Transit
UN
I
T
02
Unit Summary
Driver Distractions
Driver Actions
Operated Motor Vehicle In Inattentive, Careless or Erratic Manner
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Backing
Vehicle Removed By
OPERATOR
Towed 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
4D - 4DR
Color
SIL - Silver (Aluminum)
Model
JETTA SE
Year
2011
Make
VOLKSWAGEN
Vehicle Identification Number
7262
Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - Automobile
License Plate Number
616VMB
VE
H
I
C
L
E
UN
I
T
02
Vehicle
Crash Time 08:52 AM
Crash Date 12/28/2017Wisconsin Motor Vehicle Crash
Form DT4000 5 of 7
This report does not include any CJIS data.
17122802
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8W7 Wisconsin Motor Vehicle
Crash Report
Unknown If Distracted
Address
BAYFIELD, WI 54814 , US
Individual
02
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
IndividualInsurance Company
STATE-FARM-GENERAL-INS-CO
Policy Holder
UN
I
T
Crash Time 08:52 AM
Crash Date 12/28/2017Wisconsin Motor Vehicle Crash
Form DT4000 6 of 7
This report does not include any CJIS data.
17122802
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8W7 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
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
2
Safety Equipment
Shoulder & Lap Belt
On Duty Crash
02
ber
State: Wisconsin Country: UNITED STATES
Address
HAYWARD, WI 54843 , US
RaceINDIANDate of Birth
12/29/
Sex
Female
Citations Issued
0
Driver
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 08:52 AM
Crash Date 12/28/2017Wisconsin Motor Vehicle Crash
Form DT4000 7 of 7
This report does not include any CJIS data.