HomeMy WebLinkAbout20181116 NELSON.pdf18111601
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13QBC40 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Secondary
CrashAmendedCrash Type
NON-DOMESTICATED ANIMAL W/ NO INJURYReportable
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
12:31 AM
Date Notified
11/16/2018
Time ArrivedDate ArrivedCrash Time
12:30 AM
Crash Date
11/16/2018
Investigating Officer/Deputy
SERGEANT JEFF JOHNSON
Agency Crash Number
18111601
Primary Crash Document #Document Number Override
6V
L
1
3
Q
B
C
4
0
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
Structure Type
NO STRUCTURE
Y Coordinate
5091308
X Coordinate
186708.0625
Longitude
-91.03912673
Latitude
45.903904881
INTERSECTION
ON CTHB WB
AT CIRCLE B RD
IN THE TOWN OF WINTER
IN SAWYER COUNTY
Location
Special StudyAccess ControlTribal Land
Crash Classification - Jurisdiction
NO SPECIAL JURISDICTION
Crash Classification - Location
PUBLIC PROPERTY
Relation To Trafficway
TRAFFICWAY - ON ROAD
Animal Type
DEER
Weather Condition(s)
Environment Factor(s)
Roadway Factor(s)Road Surface Condition(s)
Light ConditionManner of Collision
NO COLLISION W/VEHICLE IN TRANSPORT
First Harmful Event Location
ON ROADWAY
First Harmful Event
NON DOMESTICATED ANIMAL (ALIVE)
Crash Scene
Road GradeRoad CurvatureSurface Type
Traffic Control Inoperative/MissingTraffic ControlTraffic Way
Emergency Motor Vehicle Use
NON-EMERGENCY, NON-TRANSPORT
Special Function
POLICEMost Harmful Event: Collision With
NON DOMESTICATED ANIMAL (ALIVE)
Total LanesSpeed LimitPre CrashTire
Mark
Direction Of Travel
WESTBOUND
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
01
Operating As EndorsementsVehicle Type
(SPORT) UTILITY VEHICLE01
Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UN
IT
Crash Time 12:30 AM
Crash Date 11/16/2018Wisconsin Motor Vehicle Crash
Form DT4000 1 of 3
This report does not include any CJIS data.
18111601
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13QBC40 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Truck Bus or HazMat
NO
Owner AddressOwner Name
01
Driver DistractionsNOT DISTRACTED
01
Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle FactorsWhat Driver Was Doing
Vehicle Removed By
OPERATOR
Towed Due To Damage
NOT TOWED
Extent Of Damage
FUNCTIONAL DAMAGE
Vehicle Damage
1--RIGHT FRONT CORNER, 2--RIGHT SIDE FRONT, 3--RIGHT SIDE MIDDLE, 4--
RIGHT SIDE REAR, 5--RIGHT REAR CORNER
Initial Contact Point
12--FRONT
Bus UseNOT A BUSBody Style
4D - 4DR
Color
BLK - BLACK
Model
EXPLORER
Year
2017
Make
FORD
Vehicle Identification Number
73890101
Country of Issuance
UNITED STATES
St
WI
Plate Type
OFF - MUNICIPAL OFFICI
License Plate Number
VE
H
I
C
L
E
UN
I
T
Vehicle
UN
I
T
VE
H
I
C
L
E
GovernmentInsurance Company
COUNTRY-MUTUAL-INSURANCE-CO
Policy Holder
UN
I
T
Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
POLICE
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
HAYWARD, WI 54843 , US
Race
WHITEDate of Birth
04/24
Sex
MALE
Citations Issued
0
Driver
IT
Equipment
Individual
UN
IN
D
I
V
ID
U
A
L
Crash Time 12:30 AM
Crash Date 11/16/2018Wisconsin Motor Vehicle Crash
Form DT4000 2 of 3
This report does not include any CJIS data.
18111601
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13QBC40 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Injury
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00
1
01
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
To/From SchoolLocationPrior ActionStriking Unit #
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
Trapped/ExtricatedEjection PathEjected
AirbagInjury Severity
NO APPARENT INJURY00
1
01
UN
I
T
Non Motorist
IN
D
I
V
I
D
U
A
L
Crash Time 12:30 AM
Crash Date 11/16/2018Wisconsin Motor Vehicle Crash
Form DT4000 3 of 3
This report does not include any CJIS data.