HomeMy WebLinkAbout20150224 Grube HoytAgency Accident Number
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Reportable Accident On Emergency Amended GZDWFQR
DOT Document Number Document Override Number
15022401
15
0
2
2
4
0
1
02/24/2015
4 - Accident Date
0921
5 - Time of Accident (Military Time)
02
6 - Total Units
00
7 - Total Injured 8 - Total Killed
SAWYER - 572 - County HAYWARD - 06, TOWN3 - Municipality INTERSECTION11 - Accident Location
027
14 - On Hwy No.
NB
14 - On Street Name 14 - Bus/Frnt/Rmp 15 - Est. Distance 15 - Hwy. Dir
16 - Fr/At Hwy No.HOSPITAL DR16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
46.032095
12 - Latitude -91.48837413 - Longitude
MOTOR VEHICLE IN TRANSPORT80 - First Harmful Event SIDESWIPE. OPPOSITE DIRECTION93 - 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
ON-ROADWAY
117 - Relation To Roadway
DAYLIGHT114 - Light Condition SNOW/SLUSH116 - 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 79 - E M S Number
Operator/Pedestrian
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Unit Status
MOTOR VEHICLE IN TRANSPORT
81 - Most Harmful Event: Collision With
NORTH
23 - Dir Of Travel
4524 - Speed Limit
B 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
GRUBE
25 - Operator/Pedestrian Last Name
ORVILLE
25 - First Name
P
25 - Middle Initial 25 - Suffix
09/30/
32 - Date Of Birth
MALE
33 - Sex
26 - Address Street & Number 26 - PO Box
POPLAR
27 - City
WI
27 - State
54864
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
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 62 - 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 UNKNOWN
89 - Substance Presence
TEST NOT GIVEN90 - Alcohol Test 90 - Alcohol Content TEST NOT GIVEN91 - Drug Test
01
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDWFQR 1 5
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Vehicle
Vehicle Owner
Insurance
School Bus
IN
S
91 - Drugs Reported
SNOW,-ICE,-OR-WET
124 - Highway Factors
TRUCK
21 - Unit Type
STRAIGHT-TRUCK-(INSERT TRUCK)
Vehicle Type
1
22 - Total Occupants
TB3658
56 - License Plate Number
HTK57 - Plate Type WI
58 - State
2015
59 - Exp Year
5484
55 - Vehicle Identification Number
2003
50 - Year
WSTR
51 - Make
ST BOOM TR
52 - Model
LD - LOADER
53 - Body Style
BLU
54 - Color 100 - Skidmarks to Impact (Ft)
NONE
94 - Vehicle Damage
NONE
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
GRUBE
46 - Vehicle Owner Last Name
ORVILLE
46 - First Name
P
46 - Middle Initial 46 - Suffix
09/30/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
POPLAR48 - City WI48 - State 5486448 - Zip Code 49 - Telephone Number
SECURA-INS-A-MUTUAL-CO63 - Liability Insurance Company Policy Holder Same As Owner60
GRUBE
61 - Policy Holder Last Name
ORVILLE
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
Operator/Pedestrian
Unit Status
MOTOR VEHICLE IN TRANSPORT
81 - Most Harmful Event: Collision With
SOUTH
23 - Dir Of Travel
4524 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
29 - Driver's License Number
WI
30 - State
2015
31 - Expiration Year 34 - On Duty Accident
HOYT
25 - Operator/Pedestrian Last Name
MISTY
25 - First Name
S
25 - Middle Initial 25 - Suffix
03/2
32 - Date Of Birth
FEMALE
33 - Sex
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDWFQR 2 525
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Vehicle
Vehicle Owner
Insurance
OP
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IN
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26 - Address Street & Number 26 - PO Box
MINONG
27 - City
WI
27 - State
54859
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
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 62 - No. of Citations Issued
64 - 1st Statute No.64 - 2nd Statute No.64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
FAILURE-TO-HAVE-CONTROL
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
91 - Drugs Reported
SNOW,-ICE,-OR-WET
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
2
22 - Total Occupants
872TVZ
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2015
59 - Exp Year
7748
55 - Vehicle Identification Number
2006
50 - Year
CHRY
51 - Make
PT CRUIZER
52 - Model
4D - 4DR
53 - Body Style
DGR
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT
94 - Vehicle Damage
MINOR
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
STANNARD
46 - Vehicle Owner Last Name
WILLIAM
46 - First Name
E
46 - Middle Initial
SR
46 - Suffix
08/01/1
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
MINONG48 - City WI48 - State 5485948 - Zip Code 49 - Telephone Number
ARTISAN-AND-TRUCKERS-CASUALTY-CO63 - Liability Insurance Company Policy Holder Same As Owner60
STANNARD
61 - Policy Holder Last Name
WILLIAM
61 - Policy Holder First Name
61 - Policy Holder Company
02
02
02
02
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDWFQR 3 5
School Bus
02
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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02
65 - Unit No
STANNARD
66 - Occupant Last Name
WILLIAM
66 - First Name
E
66 - Middle Initial
SR
66 - Suffix
01
68 - Address Street & Number 68 - PO Box
MINONG
68 - City
WI
68 - State
54859
68 - Zip Code
08/01/
67 - Date of Birth
M
69 - Sex
FRONT-SEAT-RIGHT-SIDE-(TRAIN ENGINEER)
71 - Seat Position
SHOULDER-BELT-AND-LAP-BELT-USED
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
Trailer
01
TR
L
106 - Power Unit Number License Plate Number Plate Type State Expiration Year
Trailer Make Unit Type Vehicle Identification Number
105 - Photos By
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Diagram and Narrative
DEPUTY JEFF CAIN
UNIT 1 WAS NORTH BOUND ON HWY 27 WHEN UNIT PULLED FROM HOSPITAL DR AND PROCEEDED SOUTH THEN LOST CONTROL
ON THE SNOW AND COLLIDED WITH UNIT ONE IN THE LEFT FRONT TIRE.
UNIT 1 WAS NORTH BOUND ON HWY 27 WHEN UNIT PULLED FROM HOSPITAL DR AND PROCEEDED SOUTH THEN LOST CONTROL
ON THE SNOW AND COLLIDED WITH UNIT ONE IN THE LEFT FRONT TIRE.
Officer Information
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Wisconsin Motor Vehicle GZDWFQR 4 5
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125 - First Name 125 - Middle Initial
CAIN
125 - Officer Last Name
JEFF 314
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
02/24/2015
132 - Date Notified 0921133 - Time Notified (Military Time)0925134 - Time Arrived (Military Time)
02/26/2015
135 - Date Of Report
15022401 19 - Special Study
18 - Agency Space
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDWFQR 5 5