HomeMy WebLinkAbout20150228 DrownAgency Accident Number
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Reportable Accident On Emergency Amended GZDLK2P
DOT Document Number Document Override Number
15022811
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15022811
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02/28/2015
4 - Accident Date
2300
5 - Time of Accident (Military Time)
01
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County HAYWARD - 06, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
027
14 - On Hwy No.
SB
14 - On Street Name 14 - Bus/Frnt/Rmp
109 FT15 - Est. Distance SOUTH15 - Hwy. Dir
16 - Fr/At Hwy No.HOSPITAL RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
46.026584
12 - Latitude -91.48711013 - 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-LEFT
117 - Relation To Roadway
DARK-NOT-LIGHTED114 - 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 79 - E M S Number
Operator/Pedestrian
OP
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Unit Status
DITCH
81 - Most Harmful Event: Collision With
EAST
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
2017
31 - Expiration Year 34 - On Duty Accident
DROWN
25 - Operator/Pedestrian Last Name
LOIS
25 - First Name
M
25 - Middle Initial 25 - Suffix
02/20/1931
32 - Date Of Birth
FEMALE
33 - Sex
26 - Address Street & Number 26 - PO Box
SPRINGBROOK
27 - City
WI
27 - State
54875
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
MAKING-RIGHT-TURN
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 GIVEN90 - Alcohol Test 90 - Alcohol Content TEST NOT GIVEN91 - Drug Test
01
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDLK2P 1 4
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Vehicle
Vehicle Owner
Insurance
School Bus
IN
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91 - Drugs Reported
NOT-APPLICABLE
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
146NRM
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2015
59 - Exp Year
5881
55 - Vehicle Identification Number
2011
50 - Year
TOYT
51 - Make
PRIUS
52 - Model
4H - HATCHBACK 4
53 - Body Style
BLU
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT, UNDERCARRIAGE
94 - Vehicle Damage
MINOR
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
ROADRUNNER TOWING
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
DROWN
46 - Vehicle Owner Last Name
LOIS
46 - First Name
M
46 - Middle Initial 46 - Suffix
02/20/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
SPRINGBROOK48 - City WI48 - State 5487548 - Zip Code 49 - Telephone Number
ACUITY,-A-MUTUAL-INSURANCE-CO63 - Liability Insurance Company Policy Holder Same As Owner60
DROWN
61 - Policy Holder Last Name
LOIS
61 - Policy Holder First Name
61 - Policy Holder Company
01
01
01
01
BU
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FromTo
Bus Travelling to/from School Name Body Make Seating Capacity
School District Contracted With
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
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MV4000e 01/2005
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Wisconsin Motor Vehicle
Accident Report
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZDLK2P 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
I, DEPUTY NICHOLAS AL-MOGHRABI, WAS DISPATCHED TO A VEHICLE IN THE DITCH ON STH 77 NEAR NYMAN AVE ON 022815 AT
23:01. WHILE RESPONDING, CITY OF HAYWARD POLICE OFFICER STANLEY ARRIVED ON SCENE AND ADVISED A TOW TRUCK WAS
NEEDED. UPON MY ARRIVAL, I OBSERVED A TOYOTA PRIUS IN THE DITCH ON THE NORTH SIDE OF STH 77 ACROSS FROM THE
HAYWARD WESLEYAN CHURCH. UPON CONTACT WITH THE OPERATOR, LOIS DROWN, SHE ADVISED SHE WAS LEAVING THE
CHURCH TURNING EAST OR RIGHT ONTO STH 77 HOWEVER TURNED TOO WIDE AND ENTERED THE DITCH BECOMING STUCK. I
OBSERVED THAT UPON COLLIDING WITH THE SNOWBANK THE FRONT BUMPER HAD BROKE NEAR THE DRIVER'S SIDE. I EXPLAINED THAT THE ENTIRE BUMPER WOULD NEED TO BE REPLACED AS IT IS ONE UNIT AND WOULD MOST LIKELY COST OVER
THE $1000 REPORTABLE ACCIDENT LEVEL. DROWN PROVIDED HER INSURANCE INFORMATION FOR ACUITY INSURANCE.
ROADRUNNER TOWING WAS CALLED TO THE SCENE TO REMOVE THE VEHICLE. UPON REMOVAL, I OBSERVED THERE WAS
DAMAGE TO THE PLASTIC SPLASH GUARD UNDER THE VEHICLE. NO CITATIONS WERE ISSUED IN THIS MATTER.
I, DEPUTY NICHOLAS AL-MOGHRABI, WAS DISPATCHED TO A VEHICLE IN THE DITCH ON STH 77 NEAR NYMAN AVE ON 022815 AT
23:01. WHILE RESPONDING, CITY OF HAYWARD POLICE OFFICER STANLEY ARRIVED ON SCENE AND ADVISED A TOW TRUCK WAS
NEEDED. UPON MY ARRIVAL, I OBSERVED A TOYOTA PRIUS IN THE DITCH ON THE NORTH SIDE OF STH 77 ACROSS FROM THE
HAYWARD WESLEYAN CHURCH. UPON CONTACT WITH THE OPERATOR, LOIS DROWN, SHE ADVISED SHE WAS LEAVING THE
CHURCH TURNING EAST OR RIGHT ONTO STH 77 HOWEVER TURNED TOO WIDE AND ENTERED THE DITCH BECOMING STUCK. I
OBSERVED THAT UPON COLLIDING WITH THE SNOWBANK THE FRONT BUMPER HAD BROKE NEAR THE DRIVER'S SIDE. I EXPLAINED THAT THE ENTIRE BUMPER WOULD NEED TO BE REPLACED AS IT IS ONE UNIT AND WOULD MOST LIKELY COST OVER
THE $1000 REPORTABLE ACCIDENT LEVEL. DROWN PROVIDED HER INSURANCE INFORMATION FOR ACUITY INSURANCE.
ROADRUNNER TOWING WAS CALLED TO THE SCENE TO REMOVE THE VEHICLE. UPON REMOVAL, I OBSERVED THERE WAS
DAMAGE TO THE PLASTIC SPLASH GUARD UNDER THE VEHICLE. NO CITATIONS WERE ISSUED IN THIS MATTER.
Officer Information
Accident Report
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Wisconsin Motor Vehicle GZDLK2P 3 4
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125 - First Name 125 - Middle Initial
ALMOGHRABI
125 - Officer Last Name
NICK 392
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
02/28/2015
132 - Date Notified 2301133 - Time Notified (Military Time)2310134 - Time Arrived (Military Time)
02/28/2015
135 - Date Of Report
15022811 15022811 19 - Special Study
18 - Agency Space
Accident Report
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MV4000e 01/2005
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PK2012
Wisconsin Motor Vehicle GZDLK2P 4 4