HomeMy WebLinkAbout20181130 ZUCK.pdf18113008
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL151TJND 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
00
Total Units
01
Time Notified
10:15 PM
Date Notified
11/30/2018
Time Arrived
10:19 PM
Date Arrived
11/30/2018
Crash Time
10:10 PM
Crash Date
11/30/2018
Investigating Officer/Deputy
DEPUTY MATTHEW JEFSON
Agency Crash NumberPrimary Crash Document #Document Number Override
6V
L
1
5
1
T
J
N
D
Additional InformationPHOTOS
Photos ByM. JEFSON
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
I WAS DISPATCHED TO A CAR VS BEAR. I ARRIVED ON SCENE AND TOOK PHOTOS OF THE VEHICLE. I THEN GATHERED INFORMATION FOR DRIVER
AND VEHICLE. I THEN HELPED MAKE THE VEHICLE DRIVABLE. I THEN CLEARED.
Crash Time 10:10 PM
Crash Date 11/30/2018Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
18113008
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL151TJND WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
Y Coordinate
5077416.5
X Coordinate
172504.203125
Longitude
-91.21232326
Latitude
45.772599318
ON STH27 SB
0.25 MI E
OF JOSEPH AVE N
IN THE TOWN OF RADISSON
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
BEAR
Weather Condition(s)
FOG
Environment Factor(s)
WEATHER CONDITIONS, ANIMAL (S) IN ROADWAY
Roadway Factor(s)
NONE
Road Surface Condition(s)
WET
Light Condition
DARK/UNLIT
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
TWO-WAY, DIVIDED, UNPROTECTED (PAINTED >
Emergency Motor Vehicle Use
NOT APPLICABLE
Special Function
NO SPECIAL FUNCTIONMost Harmful Event: Collision With
NON DOMESTICATED ANIMAL (ALIVE)
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
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
FUNCTIONAL DAMAGE
Vehicle Damage
8--LEFT SIDE REAR, 9--LEFT SIDE MIDDLE, 10--LEFT SIDE FRONT, 11--LEFT
FRONT CORNER, 12--FRONT
Initial Contact Point
11--LEFT FRONT CORNER
Bus UseNOT A BUSBody Style
SD - SEDAN
Color
SIL - SILVER (ALUMINUM)
Model
3
Year
2016
Make
MAZDA
Vehicle Identification Number
56200101
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 10:10 PM
Crash Date 11/30/2018Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
18113008
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL151TJND WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
STONE LAKE, WI 54876 , US
Owner Name
01
Driver DistractionsNOT DISTRACTED
01
Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
GOING STRAIGHT
Vehicle Removed By
OPERATOR
Towed Due To Damage
NOT TOWED
UN
I
T
VE
H
I
C
L
E
Sequence Of Events
EventNON DOMESTICATED ANIMAL (ALIVE)01
Event
02
Event
03
Event
04
IndividualInsurance Company
DAIRYLAND-INS-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
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
STONE LAKE, WI 54876 , US
Race
WHITE
Date of Birth
08/11/
Sex
FEMALE
Citations Issued
0
Driver
IT
Equipment
Individual
UN
IN
D
I
V
ID
U
A
L
Crash Time 10:10 PM
Crash Date 11/30/2018Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
18113008
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL151TJND 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
Crash Time 10:10 PM
Crash Date 11/30/2018Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.