20171229 Quaderer.pdf17122904
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13SSFB2 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
02:57 PM
Date Notified
12/29/2017
Time Arrived
02:59 PM
Date Arrived
12/29/2017
Crash Time
02:57 PM
Crash Date
12/29/2017
Investigating Officer/Deputy
DEPUTY CRAIG DEPEW
Agency Crash Number
17122917697
Primary Crash Document #Document Number Override
6V
L
1
3
S
S
F
B
2
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.
UNIT #1 WAS TRAVELING EAST ON CTH K. DRIVER STATED THAT HE WAS TRYING TO PUT HIS GLOVE ON AND LEFT THE ROAD WAY STRIKING SEVERAL SMALL TREES IN THE DITCH AND CAME TO REST IN THE DRIVEWAY AT FOX AVE.
Structure Type
No Structure
Y Coordinate
5093973
X Coordinate
158590.546875
Longitude
-91.402489479
Latitude
45.914448265
INTERSECTION
ON CTHK
AT FOX AVE
IN THE TOWN OF BASS LAKE
IN SAWYER COUNTY
Location
Crash Time 02:57 PM
Crash Date 12/29/2017Wisconsin Motor Vehicle Crash
Form DT4000 1 of 5
This report does not include any CJIS data.
17122904
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13SSFB2 Wisconsin Motor Vehicle
Crash Report
Special StudyAccess Control
Full Control
Tribal Land
Crash Classification - Jurisdiction
Unknown
Crash Classification - Location
Private Property
Relation To Trafficway
Trafficway - On Road
Animal Type
Weather Condition(s)
Cloudy, Snow
Environment Factor(s)
None
Roadway Factor(s)
None
Road Surface Condition(s)
Snow
Light Condition
Daylight
Manner of Collision
No Collision W/Vehicle In Transport
First Harmful Event Location
Roadside
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
Ditch
Total Lanes
2
Speed Limit
35Pre 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
Passenger Car
Unit Type
Automobile
Vehicle Operating As Classification
D CLASS
Unit Status
In Transit
UN
I
T
01
Unit Summary
Driver Actions
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Going Straight
Vehicle Removed ByTowed Due To Damage
Towed Due To Disabling Damage01
Extent Of Damage
Disabling Damage
Vehicle Damage
1--Right Front Corner, 11--Left Front Corner, 12--Front
Initial Contact Point
12--Front
Bus UseNot A BusBody Style
4D - 4DR
Color
BGE - Beige
Model
BONNEVILLE
Year
2001
Make
PONTIAC
Vehicle Identification Number
8624
Country of Issuance
UNITED STATES
St
WI
Plate Type
LCO - Lac Courte Oreilles
License Plate Number
B070
VE
H
I
C
L
E
UN
I
T
01
Vehicle
Crash Time 02:57 PM
Crash Date 12/29/2017Wisconsin Motor Vehicle Crash
Form DT4000 2 of 5
This report does not include any CJIS data.
17122904
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13SSFB2 Wisconsin Motor Vehicle
Crash Report
Driver DistractionsDistraction/Inattention
Speed Too Fast/Cond
VE
H
I
C
L
E
UN
I
T
Address
HAYWARD, WI 54843 , US
Individual
01
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventDitch01
Event
02
Event
03
Event
04
IndividualInsurance Company
STATE-FARM-GENERAL-INS-CO
Policy Holder
UN
I
T
Crash Time 02:57 PM
Crash Date 12/29/2017Wisconsin Motor Vehicle Crash
Form DT4000 3 of 5
This report does not include any CJIS data.
17122904
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13SSFB2 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
HAYWARD, WI 54843 , US
RaceWHITEDate of Birth
11/14/
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
HAYWARD, WI 54843 , US
PR
O
P
OW
N
E
R
01
Property Owner
Fixed Objects Struck
Crash Time 02:57 PM
Crash Date 12/29/2017Wisconsin Motor Vehicle Crash
Form DT4000 4 of 5
This report does not include any CJIS data.
17122904
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13SSFB2 Wisconsin Motor Vehicle
Crash Report
Damage Tag NumberStruck Object
Other Post, Pole or Support
Striking Unit
0101
Damage Tag NumberStruck Object
Tree
Striking Unit
0102
Crash Time 02:57 PM
Crash Date 12/29/2017Wisconsin Motor Vehicle Crash
Form DT4000 5 of 5
This report does not include any CJIS data.