HomeMy WebLinkAbout20141208 GregoireAgency Accident Number
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Reportable Accident On Emergency Amended GZDZNDP
DOT Document Number Document Override Number
14120801
14
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2
0
8
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14120801
14
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8
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1
12/08/2014
4 - Accident Date
0642
5 - Time of Accident (Military Time)
01
6 - Total Units
01
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County LENROOT - 08, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
077
14 - On Hwy No.
EB
14 - On Street Name 14 - Bus/Frnt/Rmp
357 FT15 - Est. Distance WEST15 - Hwy. Dir
02716 - Fr/At Hwy No.16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
46.055588
12 - Latitude -91.51088613 - Longitude
DITCH80 - First Harmful Event NO COLLISION WITH MOTOR VEHICLE IN TRANSPORT93 - Manner of Collision
NO CONTROL
112 - Access Control
STRAIGHT
113 - Road Curvature
LEVEL/FLAT
113 - Road Terrain
BLACKTOP, BITUMINOUS, OR ASPHALT - 2
Surface Type
NOT-PHYSICALLY-DIVIDED-(2-WAY TRAFFIC)115 - Traffic Way
OUTSIDE-SHOULDER-RIGHT
117 - Relation To Roadway
DAWN114 - Light Condition SNOW/SLUSH116 - Road Surface Condition BLOWING-SAND-SOIL-DIRT-SNOW118 - Weather
Hit and Run
9
Government Property
9
Fire
9
Photos Taken
9
Trailer or Towed
9
Truck, Bus, or Hazardous Materials
9
Load Spillage
9
Construction Zone
9
Names Exchanged
9
Supplemental Reports
101
Witness Statements
102
Measurements Taken
103 79 - E M S Number
Operator/Pedestrian
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Unit Status
DITCH
81 - Most Harmful Event: Collision With
WEST
23 - Dir Of Travel
5524 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
29 - Driver's License Number
WI
30 - State
2017
31 - Expiration Year 34 - On Duty Accident
GREGOIRE
25 - Operator/Pedestrian Last Name
JODI
25 - First Name
L
25 - Middle Initial 25 - Suffix
09/18
32 - Date Of Birth
FEMALE
33 - Sex
26 - Address Street & Number 26 - PO Box
HAYWARD
27 - City
WI
27 - State
54843
27 - Zip Code 28 - Telephone Number
FRONT-SEAT-LEFT-SIDE-(MC/BIKE DRIVER, TRAIN CONDUCTOR)
39 - Seat Position
SHOULDER-BELT-AND-LAP-BELT-USED
40 - Safety Equipment
C - POSSIBLE INJURY
38 - Injury Severity
NON-DEPLOYED
41 - Airbag
NOT-EJECTED
42 - Ejected 44
Medical Transport
TRAPPED/EXTRICATED
43 - Trapped/Extricated 92 - Pedestrian Location 92 - Pedestrian Action
GOING-STRAIGHT
119 - What Driver Was Doing
NO-CONTROL
120 - Traffic Control 062 - No. of Citations Issued
64 - 1st Statute No.64 - 2nd Statute No.64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
NOT-APPLICABLE
122 - Driver Factors
APPEARED NORMAL88 - Driver or Pedestrian Cond NEITHER-ALCOHOL-NOR-DRUGS-PRESENT
89 - Substance Presence
TEST NOT GIVEN90 - Alcohol Test 90 - Alcohol Content TEST NOT GIVEN91 - Drug Test
01
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDZNDP 1 4
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Vehicle
Vehicle Owner
Insurance
School Bus
IN
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91 - Drugs Reported
SNOW,-ICE,-OR-WET
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
594UXP
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2015
59 - Exp Year
2472
55 - Vehicle Identification Number
2004
50 - Year
FORD
51 - Make
EXPLORER
52 - Model
4D - 4DR
53 - Body Style
BLK
54 - Color
50100 - Skidmarks to Impact (Ft)
FRONT, FRONT PASSENGER SIDE, MIDDLE PASSENGER SIDE, REAR PASSENGER SIDE
94 - Vehicle Damage
MODERATE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96 97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
GREGOIRE
46 - Vehicle Owner Last Name
JODI
46 - First Name
L
46 - Middle Initial 46 - Suffix
09/18
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
STATE-FARM63 - Liability Insurance Company Policy Holder Same As Owner60
GREGOIRE
61 - Policy Holder Last Name
JODI
61 - Policy Holder First Name
61 - Policy Holder Company
01
01
01
01
BU
S
FromTo
Bus Travelling to/from School Name Body Make Seating Capacity
School District Contracted With
Trailer
01
TR
L
106 - Power Unit Number License Plate Number Plate Type State Expiration Year
Trailer Make Unit Type Vehicle Identification Number
Accident Report
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MV4000e 01/2005
Page
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Wisconsin Motor Vehicle
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDZNDP 2 424
Fixed Objects Struck
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Property
UNKNOWN
Organization Type 84 - Property Owner Last Name 84 - First Name 84 - Middle Initial 84 - Suffix
01
84 - Company Name Government Property Type
85 - Address Street & Number 85 - PO Box
86 - City 86 - State 86 - Zip Code 87 - Telephone Number
83 - Government Damage Tag Number
01
82 - Striking Unit
DITCH
82 - Object Struck 82 - Striking Unit 82 - Object Struck
82 - Striking Unit 82 - Object Struck 82 - Striking Unit 82 - Object Struck
82 - Striking Unit 82 - Object Struck 82 - Striking Unit 82 - Object Struck
105 - Photos By
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Diagram and Narrative
SGT J. JOHNSON
ON 12814 AT APPROXIMATELY 0642 HRS, VEHICLE 1 WAS TRAVELING WEST BOUND ON STH 77, JUST WEST OF STH 27 NORTH. THE
DRIVER STATED THAT THE SLUSH ON THE SIDE OF THE LANE OF TRAVEL 'PULLED' HER INTO THE DITCH, CAUSING HER VEHICLE
TO ROLLOVER DUE TO THE DEEP SNOW. THE ROAD CONDITIONS WERE TERRIBLE DUE TO THE SNOW AND SLUSH, AND THE FACT
THAT THAT AREA OF THE HWY HAD NOT BEEN PLOWED YET.
ON 12814 AT APPROXIMATELY 0642 HRS, VEHICLE 1 WAS TRAVELING WEST BOUND ON STH 77, JUST WEST OF STH 27 NORTH. THE
DRIVER STATED THAT THE SLUSH ON THE SIDE OF THE LANE OF TRAVEL 'PULLED' HER INTO THE DITCH, CAUSING HER VEHICLE
TO ROLLOVER DUE TO THE DEEP SNOW. THE ROAD CONDITIONS WERE TERRIBLE DUE TO THE SNOW AND SLUSH, AND THE FACT
THAT THAT AREA OF THE HWY HAD NOT BEEN PLOWED YET.
Officer Information
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDZNDP 3 4
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125 - First Name 125 - Middle Initial
JOHNSON
125 - Officer Last Name
JEFF 322
131 - Officer ID
129 - Law Enforcement Agency No.
SAWYER COUNTY SHERIFFS DEPT
130 - Law Enforcement Agency Name
15880 EAST FIFTH STREET
126 - Law Enforcement Agency Address Street & Number
HAYWARD
127 - City
WI
127 - State
54843
127 - Zip Code
(715) 634-4858 EXT.
128 - Telephone Number
12/08/2014
132 - Date Notified 0643133 - Time Notified (Military Time)0645134 - Time Arrived (Military Time)
12/08/2014
135 - Date Of Report
14120801 14120801 19 - Special Study
18 - Agency Space
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDZNDP 4 4