HomeMy WebLinkAbout20150329 Bross (1)Agency Accident Number
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Reportable Accident On Emergency Amended GZDVPJ6
DOT Document Number Document Override Number
15032903841
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15032902
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03/29/2015
4 - Accident Date
1140
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
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14 - On Hwy No.14 - On Street Name 14 - Bus/Frnt/Rmp
621 FT15 - Est. Distance SOUTH15 - Hwy. Dir
16 - Fr/At Hwy No.PENINSULA RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
46.009931
12 - Latitude -91.38381413 - Longitude
OVERTURN80 - 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 SNOW/SLUSH116 - Road Surface Condition 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
OVERTURN
81 - Most Harmful Event: Collision With
SOUTH
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
2016
31 - Expiration Year 34 - On Duty Accident
BROSS
25 - Operator/Pedestrian Last Name
CATHY
25 - First Name
ANN
25 - Middle Initial 25 - Suffix
04/20/
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
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 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.
SPEED-TOO-FAST-FOR-CONDITIONS
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
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Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDVPJ6 1 3
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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
858NYH
56 - License Plate Number
AUT57 - Plate Type MN
58 - State
2015
59 - Exp Year
6663
55 - Vehicle Identification Number
2004
50 - Year
BMW
51 - Make
4WBX3
52 - Model
UT - SPORT UTILITY
53 - Body Style
BLK
54 - Color
0100 - Skidmarks to Impact (Ft)
TOTAL (DAMAGE TO ALL AREAS)
94 - Vehicle Damage
SEVERE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
OWNER
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
BROSS
46 - Vehicle Owner Last Name
CATHY
46 - First Name
ANN
46 - Middle Initial 46 - Suffix
04/20/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
USAA-CASUALTY-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60
BROSS
61 - Policy Holder Last Name
CATHY
61 - Policy Holder First Name
61 - Policy Holder Company
01
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Bus Travelling to/from School Name Body Make Seating Capacity
School District Contracted With
Trailer
01
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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
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PK2012
Wisconsin Motor Vehicle GZDVPJ6 2 323
105 - Photos By
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Diagram and Narrative
DEPUTY HOUSE
UNIT 1 WAS GOING APPROXIMATELY 35 MPH SOUTH ON COUNTY HWY K AND LOST CONTROL DUE TO THE SNOWSLUSH COVERED
CONDITIONS CROSSING THE ENTIRE ROADWAY AND ENTERING THE DITCH ON THE OPPOSITE SIDE. UNIT 1 THEN ROLLED OVER
AFTER ENTERING THE DITCH.
UNIT 1 WAS GOING APPROXIMATELY 35 MPH SOUTH ON COUNTY HWY K AND LOST CONTROL DUE TO THE SNOWSLUSH COVERED
CONDITIONS CROSSING THE ENTIRE ROADWAY AND ENTERING THE DITCH ON THE OPPOSITE SIDE. UNIT 1 THEN ROLLED OVER
AFTER ENTERING THE DITCH.
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125 - First Name 125 - Middle Initial
Officer Information
POPLIN
125 - Officer Last Name
JAY 352
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
03/29/2015
132 - Date Notified 1140133 - Time Notified (Military Time)1153134 - Time Arrived (Military Time)
03/29/2015
135 - Date Of Report
15032903841 15032902 19 - Special Study
18 - Agency Space
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDVPJ6 3 3