HomeMy WebLinkAbout20150125 VerhovenAgency Accident Number
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Reportable Accident On Emergency Amended GZDSGV2
DOT Document Number Document Override Number
15012503
15
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1
2
5
0
3
380
38
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01/25/2015
4 - Accident Date
1140
5 - Time of Accident (Military Time)
01
6 - Total Units
01
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County RADISSON - 12, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
027
14 - On Hwy No.
SB
14 - On Street Name 14 - Bus/Frnt/Rmp
695 FT15 - Est. Distance WEST15 - Hwy. Dir
16 - Fr/At Hwy No.HELSING RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.786290
12 - Latitude -91.17663313 - Longitude
TREE80 - 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
DAYLIGHT114 - Light Condition DRY116 - Road Surface Condition CLEAR118 - 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
1501250108679 - E M S Number
Operator/Pedestrian
OP
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Unit Status
TREE
81 - Most Harmful Event: Collision With
EAST
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
MI
30 - State
2018
31 - Expiration Year 34 - On Duty Accident
VERHOVEN
25 - Operator/Pedestrian Last Name
WILLIAM
25 - First Name
WALTER
25 - Middle Initial 25 - Suffix
01/12
32 - Date Of Birth
MALE
33 - Sex
26 - Address Street & Number
35
26 - PO Box
ALPHA
27 - City
MI
27 - State
49902
27 - Zip Code
28 - Telephone Number
FRONT-SEAT-LEFT-SIDE-(MC/BIKE DRIVER, TRAIN CONDUCTOR)
39 - Seat Position
NONE-USED-VEHICLE-DRIVER/OCCUPANT
40 - Safety Equipment
N - NO APPARENT INJURY
38 - Injury Severity
NON-DEPLOYED
41 - Airbag
NOT-EJECTED
42 - Ejected 44
Medical Transport
NOT-TRAPPED
43 - Trapped/Extricated 92 - Pedestrian Location 92 - Pedestrian Action
GOING-STRAIGHT
119 - What Driver Was Doing
NO-CONTROL
120 - Traffic Control 0162 - No. of Citations Issued
346.89(1)
64 - 1st Statute No.64 - 2nd Statute No.64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
FAILURE-TO-HAVE-CONTROL, INATTENTIVE-DRIVING
122 - Driver Factors
APPEARED NORMAL88 - Driver or Pedestrian Cond UNKNOWN
89 - Substance Presence
TEST NOT GIVEN90 - Alcohol Test 90 - Alcohol Content TEST NOT GIVEN91 - Drug Test
01
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Vehicle
Vehicle Owner
Insurance
School Bus
IN
S
91 - Drugs Reported
NOT-APPLICABLE
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
05
22 - Total Occupants
DV1363R
56 - License Plate Number
AUT57 - Plate Type MI
58 - State
2018
59 - Exp Year
6004
55 - Vehicle Identification Number
2005
50 - Year
GMC
51 - Make
ENVOY SUV
52 - Model
UT - SPORT UTILITY
53 - Body Style
GRY
54 - Color
00100 - Skidmarks to Impact (Ft)
FRONT DRIVER SIDE, FRONT, FRONT PASSENGER SIDE, MIDDLE PASSENGER SIDE, REAR PASSENGER SIDE
94 - Vehicle Damage
MODERATE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
OPERATOR
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
VERHOVEN
46 - Vehicle Owner Last Name
WILLIAM
46 - First Name
WALTER
46 - Middle Initial 46 - Suffix
01/12
Date Of Birth
46 - Company Name
47- Address Street & Number
35
47 - PO Box
ALPHA48 - City MI48 - State 4990248 - Zip Code . 49 - Telephone Number
HOME-OWNERS-INSURANCE-CO63 - Liability Insurance Company Policy Holder Same As Owner60
VERHOVEN
61 - Policy Holder Last Name
WILLIAM
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
Occupant
Address Same As Operator
OC
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01
65 - Unit No
VERHOVEN
66 - Occupant Last Name
KIM
66 - First Name
MARIE
66 - Middle Initial 66 - Suffix
01
68 - Address Street & Number 3568 - PO Box
ALPHA
68 - City
MI
68 - State
49902
68 - Zip Code
06/1967 - Date of Birth F69 - Sex
FRONT-SEAT-RIGHT-SIDE-(TRAIN ENGINEER)
71 - Seat Position
NONE-USED-VEHICLE-DRIVER/OCCUPANT
72 - Safety Equipment
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N - NO APPARENT INJURY
70 - Injury Severity
NON-DEPLOYED
73 - Airbag
NOT-EJECTED
75 - Ejected
Medical Transport
77
NOT-TRAPPED
76 - Trapped/Extricated 78 - Agency Space
Occupant
Address Same As Operator
OC
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U
P
A
N
T
01
65 - Unit No
VERHOVEN
66 - Occupant Last Name 66 - First Name 66 - Middle Initial 66 - Suffix
02
68 - Address Street & Number
35
68 - PO Box
ALPHA
68 - City
MI
68 - State
49902
68 - Zip Code
09/06
67 - Date of Birth
F
69 - Sex
SECOND-SEAT-LEFT-SIDE-(MC/BIKE PASSENGER, TRAIN BREAKMA
71 - Seat Position
NONE-USED-VEHICLE-DRIVER/OCCUPANT
72 - Safety Equipment
N - NO APPARENT INJURY
70 - Injury Severity
NON-DEPLOYED
73 - Airbag
NOT-EJECTED
75 - Ejected
Medical Transport
77
NOT-TRAPPED
76 - Trapped/Extricated 78 - Agency Space
Occupant
Address Same As Operator
OC
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U
P
A
N
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01
65 - Unit No
VERHOVEN
66 - Occupant Last Name
MARIAH
66 - First Name
MARIE
66 - Middle Initial 66 - Suffix
03
68 - Address Street & Number 68 - PO Box
ALPHA
68 - City
MI
68 - State
49902
68 - Zip Code
10/24
67 - Date of Birth
F
69 - Sex
SECOND-SEAT-MIDDLE
71 - Seat Position
NONE-USED-VEHICLE-DRIVER/OCCUPANT
72 - Safety Equipment
N - NO APPARENT INJURY
70 - Injury Severity
NON-DEPLOYED
73 - Airbag
NOT-EJECTED
75 - Ejected
Medical Transport
77
NOT-TRAPPED
76 - Trapped/Extricated 78 - Agency Space
Occupant
Address Same As Operator
OC
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U
P
A
N
T
01
65 - Unit No
MANN
66 - Occupant Last Name
COREY
66 - First Name
ALLEN
66 - Middle Initial 66 - Suffix
04
68 - Address Street & Number 68 - PO Box
IRON RIVER
68 - City
MI
68 - State
49935
68 - Zip Code
11/18
67 - Date of Birth
M
69 - Sex
SECOND-SEAT-RIGHT
71 - Seat Position
NONE-USED-VEHICLE-DRIVER/OCCUPANT
72 - Safety Equipment
B - NON-INCAPACITATING INJURY
70 - Injury Severity
NON-DEPLOYED
73 - Airbag
NOT-EJECTED
75 - Ejected
Medical Transport
77
NOT-TRAPPED
76 - Trapped/Extricated 78 - Agency Space
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Trailer
01
TR
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106 - Power Unit Number License Plate Number Plate Type State Expiration Year
Trailer Make Unit Type Vehicle Identification Number
Fixed Objects Struck
PR
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Property
GOVERNMENT
Organization Type 84 - Property Owner Last Name 84 - First Name 84 - Middle Initial 84 - Suffix
01
RADISSON TOWNSHIP84 - Company Name COUNTY/MUNICIPALGovernment 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
TREE
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
DEPUTY MALCOLM HAAG #380
(SEE CASE 15012503) ON JANUARY 25TH, 2015 AT APPROXIMATELY 1146 AM, I DEPUTY MALCOLM HAAG, WAS CONTACTED BY SAWYER COUNTY DISPATCH FOR A ONE VEHICLE CRASH WITH INJURIES. DISPATCH INFORMED ME THAT THE VEHICLE WAS IN
THE DITCH ON STH 2770 NEAR HELSING RD. I ACTIVATED MY EMERGENCY LIGHTS AND SIRENS AND RESPONDED TO THE SCENE.
I ARRIVED ON SCENE AT APPROXIMATELY 1209 PM. I WAS ALERTED THAT THE AMBULANCE TRANSPORTED ONE OF THE MALE
PASSENGERS TO THE HOSPITAL FOR INJURIES HE HAD SUSTAINED. I SPOKE TO THE VEHICLE'S OPERATOR AND HE STATED THAT
AS HE WAS DRIVING HE FELL ASLEEP. THE OPERATOR SAID THAT HE LOST CONTROL OF THE VEHICLE AND WOKE UP AS HIS
VEHICLE WAS SLIDING INTO THE DITCH. UNIT 01 STRUCK SOME NEARBY TREES IN THE DITCH AND SUSTAINED MODERATE DAMAGE. I PHOTOGRAPHED THE SCENE AND WAITED FOR THE TOW WITH THE VEHICLE'S OCCUPANTS. THE DRIVER WAS CITED
FOR INATTENTIVE DRIVING. NONE
(SEE CASE 15012503) ON JANUARY 25TH, 2015 AT APPROXIMATELY 1146 AM, I DEPUTY MALCOLM HAAG, WAS CONTACTED BY SAWYER COUNTY DISPATCH FOR A ONE VEHICLE CRASH WITH INJURIES. DISPATCH INFORMED ME THAT THE VEHICLE WAS IN
THE DITCH ON STH 2770 NEAR HELSING RD. I ACTIVATED MY EMERGENCY LIGHTS AND SIRENS AND RESPONDED TO THE SCENE.
I ARRIVED ON SCENE AT APPROXIMATELY 1209 PM. I WAS ALERTED THAT THE AMBULANCE TRANSPORTED ONE OF THE MALE
PASSENGERS TO THE HOSPITAL FOR INJURIES HE HAD SUSTAINED. I SPOKE TO THE VEHICLE'S OPERATOR AND HE STATED THAT
AS HE WAS DRIVING HE FELL ASLEEP. THE OPERATOR SAID THAT HE LOST CONTROL OF THE VEHICLE AND WOKE UP AS HIS
VEHICLE WAS SLIDING INTO THE DITCH. UNIT 01 STRUCK SOME NEARBY TREES IN THE DITCH AND SUSTAINED MODERATE DAMAGE. I PHOTOGRAPHED THE SCENE AND WAITED FOR THE TOW WITH THE VEHICLE'S OCCUPANTS. THE DRIVER WAS CITED
FOR INATTENTIVE DRIVING. NONE
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OF THE OCCUPANTS HAD ANY FURTHER QUESTIONS OR INFORMATION FOR ME. THE VEHICLE WAS ABLE TO BE DRIVEN FROM THE SCENE. I CONTACTED DISPATCH THAT I WAS CLEAR OF THE SCENE.OF THE OCCUPANTS HAD ANY FURTHER QUESTIONS OR INFORMATION FOR ME. THE VEHICLE WAS ABLE TO BE DRIVEN FROM THE SCENE. I CONTACTED DISPATCH THAT I WAS CLEAR OF THE SCENE.
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125 - First Name 125 - Middle Initial
Officer Information
HAAG
125 - Officer Last Name
MALCOLM 380
131 - Officer ID
129 - Law Enforcement Agency No.SAWYER COUNTY SHERIFFS DEPT130 - Law Enforcement Agency Name
15880 EAST FIFTH STREET
126 - Law Enforcement Agency Address Street & Number
HAYWARD127 - City WI127 - State 54843127 - Zip Code (715) 634-4858 EXT. 128 - Telephone Number
01/25/2015
132 - Date Notified 1145133 - Time Notified (Military Time)1209134 - Time Arrived (Military Time)
01/27/2015
135 - Date Of Report
15012503 380 19 - Special Study
18 - Agency Space
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MV4000e 01/2005
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