20171224 Sabin.pdfSAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL14VWD6W 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
08:45 AM
Date Notified
12/24/2017
Time Arrived
09:20 AM
Date Arrived
12/24/2017
Crash Time
08:44 AM
Crash Date
12/24/2017
Investigating Officer/Deputy
DEPUTY MICHAEL SIMPSON
Agency Crash NumberPrimary Crash Document #Document Number Override
6V
L
1
4
V
W
D
6
W
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.
DRIVER LOST CONTROL ON CURVE WHILE TRAVELING EAST. ROADWAY WAS ICE COVERED. VEHICLE SUSTAINED FRONT DAMAGE TO BUMPER AND RADIATOR GRILL.
Structure Type
No Structure
Y Coordinate
5098781.5
X Coordinate
152417.40625
Longitude
-91.485332078
Latitude
45.954501783
ON WILLIAMS RD
432 FT W
OF BROWNS RD
IN THE TOWN OF BASS LAKE
IN SAWYER COUNTY
Location
Crash Time 08:44 AM
Crash Date 12/24/2017Wisconsin Motor Vehicle Crash
Form DT4000 1 of 5
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL14VWD6W Wisconsin Motor Vehicle
Crash Report
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)
None
Road Surface Condition(s)
Ice
Light Condition
Daylight
Manner of Collision
No Collision W/Vehicle In Transport
First Harmful Event Location
Shoulder Left
First Harmful Event
Tree
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
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
Tree
Total Lanes
2
Speed Limit
35Pre 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
Driver Actions
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Negotiating Curve
Vehicle Removed By
OWNER
Towed Due To Damage
Towed Due To Disabling Damage01
Extent Of Damage
Functional Damage
Vehicle Damage
12--Front
Initial Contact Point
12--Front
Bus UseNot A BusBody Style
4D - 4DR
Color
RED - Red
Model
F350
Year
2000
Make
FORD
Vehicle Identification Number
68672
Country of Issuance
UNITED STATES
St
WI
Plate Type
HTK - Heavy Truck
License Plate Number
XD14398
VE
H
I
C
L
E
UN
I
T
01
Vehicle
Crash Time 08:44 AM
Crash Date 12/24/2017Wisconsin Motor Vehicle Crash
Form DT4000 2 of 5
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL14VWD6W Wisconsin Motor Vehicle
Crash Report
Driver DistractionsNot Distracted
No Contributing Action
VE
H
I
C
L
E
UN
I
T
Address
HAYWARD, WI 54843 , US
Organization/Company
01
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventTree01
Event
02
Event
03
Event
04
Organization/CompanyInsurance Company
HISCOX-INSURANCE-COMPANY,-INC
Policy Holder
UN
I
T
Crash Time 08:44 AM
Crash Date 12/24/2017Wisconsin Motor Vehicle Crash
Form DT4000 3 of 5
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL14VWD6W 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
02/10/
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
, ,
Unknown
PR
O
P
OW
N
E
R
01
Property Owner
Fixed Objects Struck
Crash Time 08:44 AM
Crash Date 12/24/2017Wisconsin Motor Vehicle Crash
Form DT4000 4 of 5
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL14VWD6W Wisconsin Motor Vehicle
Crash Report
Damage Tag NumberStruck Object
Tree
Striking Unit
0101
Crash Time 08:44 AM
Crash Date 12/24/2017Wisconsin Motor Vehicle Crash
Form DT4000 5 of 5
This report does not include any CJIS data.