HomeMy WebLinkAbout20181105 CARLSON.pdf18110505
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN0N 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
01
Time Notified
04:44 PM
Date Notified
11/05/2018
Time Arrived
04:49 PM
Date Arrived
11/05/2018
Crash Time
04:42 PM
Crash Date
11/05/2018
Investigating Officer/Deputy
DEPUTY KEVIN GILLIS
Agency Crash NumberPrimary Crash Document #Document Number Override
6V
L
1
2
X
V
N
0
N
Additional InformationNONE
Photos By
Reconstruction BySAWYER COUNTY SHERIFFDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
VEHICLE WAS TRAVELING EAST ON STH 77 WHEN IT STRUCK A DEER CAUSING DISABLING DAMAGE TO THE VEHICLE. THE DRIVER WAS
TRANSPORTED TO HAMH TO BE TREATED FOR POSSIBLE MINOR INJURIES.
Crash Time 04:42 PM
Crash Date 11/05/2018Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
18110505
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN0N WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
Y Coordinate
5110246.5
X Coordinate
148819.0625
Longitude
-91.540044545
Latitude
46.055537881
ON STH77 EB
66 FT E
OF OLSEN RD
IN THE TOWN OF LENROOT
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
DEER
Weather Condition(s)
CLOUDY, RAIN, SNOW
Environment Factor(s)
ANIMAL (S) IN ROADWAY
Roadway Factor(s)
NONE
Road Surface Condition(s)
WET
Light Condition
DUSK
Manner of Collision
NO COLLISION W/VEHICLE IN TRANSPORT
First Harmful Event Location
ON ROADWAY
First Harmful Event
NON DOMESTICATED ANIMAL (ALIVE)
Crash Scene
Intersection Type
NOT AN INTERSECTION
Junction Location
NON-JUNCTION
Within Interchange Area
NO
Truck Bus or HazMat
NO
Road Grade
LEVEL
Road Curvature
STRAIGHT
Surface Type
BLACKTOP (BITUMINOUS)
Traffic Control Inoperative/Missing
NO
Traffic Control
NO CONTROL
Traffic Way
DIVIDED HWY W/O TRAFFIC BARRIER
Emergency Motor Vehicle Use
EMERGENCY OPERATION, EMERGEN
Special Function
NO SPECIAL FUNCTIONMost Harmful Event: Collision With
NON DOMESTICATED ANIMAL (ALIVE)
Total Lanes
2
Speed Limit
55Pre 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 CAR01
Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UN
IT
Extent Of Damage
DISABLING DAMAGE
Vehicle Damage
12--FRONT
Initial Contact Point
12--FRONT
Bus UseNOT A BUSBody Style
4D - 4DR
Color
BLK - BLACK
Model
MAZDA3I
Year
2008
Make
MAZDA
Vehicle Identification Number
60570101
Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
VE
H
I
C
L
E
UN
I
T
Vehicle
Crash Time 04:42 PM
Crash Date 11/05/2018Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
18110505
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN0N WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
HAYWARD, WI 54843 , US
Owner Name
01
Driver DistractionsUNKNOWN IF DISTRACTED
01
Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
GOING STRAIGHT
Vehicle Removed By
A-1 TOWING
Towed Due To Damage
TOWED DUE TO DISABLING DAMAGE
UN
I
T
VE
H
I
C
L
E
Sequence Of Events
EventMOTOR VEH IN TRANSPORT01
EventNON DOMESTICATED ANIMAL (ALIVE)02
Event
03
Event
04
IndividualInsurance Company
GEICO-GENERAL-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
SUSPECTED MINOR 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
HAYWARD, WI 54843 , US
Race
WHITE
Date of Birth
03/18/
Sex
FEMALE
Citations Issued
0
Driver
IT
Equipment
Individual
UN
IN
D
I
V
ID
U
A
L
Crash Time 04:42 PM
Crash Date 11/05/2018Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
18110505
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN0N WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
EMOTIONAL (DEPRESSED, ANGRY, DISTURBED, ETC)
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
HAYWARD AREA MEM HOSP
EMS Run #
18110515824
EMS Agency Identifier
6000954
Medical Transport
EMS GROUND
UN
I
T
Non Motorist
IN
D
I
V
I
D
U
A
L
Crash Time 04:42 PM
Crash Date 11/05/2018Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.