HomeMy WebLinkAbout20181112 VISOCKY-BJORK.pdfSAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKS3 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Secondary
CrashAmendedCrash Type
DT4000 (STANDARD CRASH)Reportable
TagsSchool Bus Related
NOActive School ZoneGovernment
Property
Reporting
ThresholdTrailer or TowedWork ZoneLane ClosureHit and RunOn Emergency
Total Killed
00
Total Injured
01
Total Units
02
Time Notified
10:53 AM
Date Notified
11/12/2018
Time Arrived
11:01 AM
Date Arrived
11/12/2018
Crash Time
10:53 AM
Crash Date
11/12/2018
Investigating Officer/Deputy
DEPUTY NATHAN FREY
Agency Crash Number
18111204
Primary Crash Document #Document Number Override
6V
L
1
3
Z
Q
K
S
3
Additional InformationNONE
Photos By
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
UNIT ONE WAS NEGOTIATING RIGHT TURN AND LOST TRACTION TO STEERING TIRES. UNIT ONE CROSSED THE CENTER OF THE ROAD, STRIKING
UNIT 2 ON THE DRIVERS SIDE STEER TIRE. UNIT 1 HAD AIRBAG DEPLOYMENT AND CAME TO REST IN OPPOSITE LANE DITCH.
Crash Time 10:53 AM
Crash Date 11/12/2018Wisconsin Motor Vehicle Crash
Form DT4000 1 of 7
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKS3 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
Y Coordinate
5112789
X Coordinate
175478.28125
Longitude
-91.198104561
Latitude
46.091521835
ON UPPER A RD
0.44 MI S
OF SOUTH RD
IN THE TOWN OF SPIDER LAKE
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
Environment Factor(s)
WEATHER CONDITIONS
Roadway Factor(s)
NONE
Road Surface Condition(s)
SNOW, ICE
Light Condition
DAYLIGHT
Manner of Collision
06--SIDESWIPE/OPPOSITE DIRECTION
First Harmful Event Location
ON ROADWAY
First Harmful Event
MOTOR VEH IN TRANSPORT
Crash Scene
Intersection Type
NOT AN INTERSECTION
Junction Location
NON-JUNCTION
Within Interchange Area
NO
Truck Bus or HazMat
NO
Road Grade
SAG(BOTTOM)
Road Curvature
CURVE RIGHT
Surface Type
BLACKTOP (BITUMINOUS)
Traffic Control Inoperative/Missing
NO
Traffic Control
NO CONTROL
Traffic Way
TWO-WAY, NOT DIVIDED
Emergency Motor Vehicle Use
NOT APPLICABLE
Special Function
NO SPECIAL FUNCTIONMost Harmful Event: Collision With
MOTOR VEH IN TRANSPORT
Total Lanes
2
Speed Limit
55Pre CrashTire
Mark
Direction Of Travel
NORTHBOUND
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 TRUCK01
Unit Type
TRUCK
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UN
IT
Extent Of Damage
DISABLING DAMAGE
Vehicle Damage
11--LEFT FRONT CORNER, 12--FRONT
Initial Contact Point
12--FRONT
Bus UseNOT A BUSBody Style
PK - PICKUP
Color
GLD - GOLD
Model
SONOMA
Year
1998
Make
GENERAL MOTORS COR
Vehicle Identification Number
32330101
Country of Issuance
UNITED STATES
St
WI
Plate Type
LTK - LIGHT TRUCK
License Plate Number
VE
H
I
C
L
E
UN
I
T
Vehicle
Crash Time 10:53 AM
Crash Date 11/12/2018Wisconsin Motor Vehicle Crash
Form DT4000 2 of 7
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKS3 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
CABLE, WI 54821 , US
Owner Name
01
Driver DistractionsNOT DISTRACTED, UNKNOWN IF DISTRACTED
01
Driver Actions
FAILURE TO CONTROL
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
NEGOTIATING CURVE
Vehicle Removed ByTowed Due To Damage
TOWED DUE TO DISABLING DAMAGE
UN
I
T
VE
H
I
C
L
E
Sequence Of Events
EventMOTOR VEH IN TRANSPORT01
EventRIGHT TURN02
Event
03
Event
04
IndividualInsurance Company
FEDERATED-MUTUAL-INS-CO
Policy Holder
UN
I
T
Injury
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABL
Ejected
NOT EJECTED
Airbag
DEPLOYED-FRONT
Injury Severity
POSSIBLE INJURY00
1
01
Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
CABLE, WI 54821 , US
Race
WHITE
Date of Birth
05/23/
Sex
MALE
Citations Issued
0
Driver
IT
Equipment
Individual
UN
IN
D
I
V
ID
U
A
L
Crash Time 10:53 AM
Crash Date 11/12/2018Wisconsin Motor Vehicle Crash
Form DT4000 3 of 7
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKS3 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00
1
01
Drug Test ResultsDrug Test TypeDrug Test GivenTEST NOT GIVEN
Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given
TEST NOT GIVEN
Suspected Drug Use
NO
Suspected Alcohol Use
NO
Action Other
Action
To/From SchoolLocationPrior ActionStriking Unit #
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
UN
I
T
Non Motorist
IN
D
I
V
I
D
U
A
L
Truck Bus or HazMat
TRUCK OR TRUCK COMBINATION > 10,000LBS GVWR/GCWR
Road Grade
SAG(BOTTOM)
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 Use
NOT APPLICABLE
Special Function
NO SPECIAL FUNCTIONMost Harmful Event: Collision With
MOTOR VEH IN TRANSPORT
Total Lanes
2
Speed Limit
55Pre CrashTire
Mark
Direction Of Travel
SOUTHBOUND
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
2
Operating As EndorsementsVehicle Type
TRUCK TRACTOR (NOT ATTACHED)02
Unit Type
TRUCK
Vehicle Operating As Classification
B CLASS
Unit Status
IN TRANSIT
Unit Summary
UN
IT
Extent Of Damage
MINOR DAMAGE
Vehicle Damage
1--RIGHT FRONT CORNER
Initial Contact Point
11--LEFT FRONT CORNER
Bus UseNOT A BUSBody Style
CB - CAB CHASSIS
Color
RED - RED
Model
NO DATA FO
Year
2007
Make
STERLING
Vehicle Identification Number
34760202
Country of Issuance
UNITED STATES
St
WI
Plate Type
TOR - TRACTOR
License Plate Number
VE
H
I
C
L
E
UN
I
T
Vehicle
Crash Time 10:53 AM
Crash Date 11/12/2018Wisconsin Motor Vehicle Crash
Form DT4000 4 of 7
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKS3 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
CABLE, WI 54821 , US
Owner Name
02
Driver DistractionsUNKNOWN IF DISTRACTED
02
Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
NEGOTIATING CURVE
Vehicle Removed By
OPERATOR
Towed Due To Damage
NOT TOWED
UN
I
T
VE
H
I
C
L
E
Sequence Of Events
EventMOTOR VEH IN TRANSPORT01
EventLEFT TURN02
Event
03
Event
04
Organization/CompanyInsurance Company
UNITED-FIRE-&-CASUALTY-CO
Policy Holder
UN
I
T
Injury
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABL
Ejected
NOT EJECTED
Airbag
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00
2
02
Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
EMT/FIRST-RESPONDER
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
CABLE, WI 54821 , US
Race
WHITE
Date of Birth
03/25/
Sex
MALE
Citations Issued
0
Driver
IT
Equipment
Individual
UN
IN
D
I
V
ID
U
A
L
Crash Time 10:53 AM
Crash Date 11/12/2018Wisconsin Motor Vehicle Crash
Form DT4000 5 of 7
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKS3 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00
2
02
Drug Test ResultsDrug Test TypeDrug Test GivenTEST NOT GIVEN
Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given
TEST NOT GIVEN
Suspected Drug Use
NO
Suspected Alcohol Use
NO
Action Other
Action
To/From SchoolLocationPrior ActionStriking Unit #
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
UN
I
T
Non Motorist
IN
D
I
V
I
D
U
A
L
Injury
To/From SchoolLocationPrior ActionStriking Unit #
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABL
Ejected
NOT EJECTED
Airbag
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00
3
02
Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
3--FRONT SEAT-RIGHT SIDE (TRAIN ENGINEER
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
CABLE, WI 54821 , US
Race
WHITEDate of Birth
08/12/
Sex
MALE
Citations Issued
0
Passenger
IT
Equipment
Non Motorist
Individual
UN
IN
D
I
V
ID
U
A
L
Crash Time 10:53 AM
Crash Date 11/12/2018Wisconsin Motor Vehicle Crash
Form DT4000 6 of 7
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKS3 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00
3
02
Drug Test ResultsDrug Test TypeDrug Test Given
TEST NOT GIVEN
Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given
TEST NOT GIVEN
Suspected Drug Use
NO
Suspected Alcohol Use
NO
Action Other
Action
UN
I
T
IN
D
I
V
I
D
U
A
L
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 Type
OTHER OPERATION/NOT SPECIFIED
US DOT #
1356325
Cargo Body Type
DUMP
Vehicle Configuration
SINGLE-UNIT TRUCK (2-AXLE AND GVWR MORE THA
GVWR
MORE THAN 26,000 LB
01
Address
CABLE, WI 54821 , US
Name
USDOT# 1356325
02
Source
DRIVERUse Vehicle Owner Same as Carrier
Carrier
CK
BU
S
UN
IT
TR
U
Crash Time 10:53 AM
Crash Date 11/12/2018Wisconsin Motor Vehicle Crash
Form DT4000 7 of 7
This report does not include any CJIS data.