HomeMy WebLinkAbout20150329 ChristopherAgency Accident Number
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Reportable Accident On Emergency Amended GZDT72R
DOT Document Number Document Override Number
15032901
15
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3
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9
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03/29/2015
4 - Accident Date
1140
5 - Time of Accident (Military Time)
01
6 - Total Units
01
7 - Total Injured
01
8 - Total Killed
SAWYER - 572 - County HAYWARD - 06, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
027
14 - On Hwy No.
NB
14 - On Street Name 14 - Bus/Frnt/Rmp
273 FT15 - Est. Distance NORTH15 - Hwy. Dir
16 - Fr/At Hwy No.HOSPITAL DR16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
46.032844
12 - Latitude -91.48838913 - 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
DIVIDED-HIGHWAY-MEDIAN-STRIP-WITHOUT-TRAFFIC-BARRIER115 - Traffic Way
OUTSIDE-SHOULDER-LEFT
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
WEST
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
2021
31 - Expiration Year 34 - On Duty Accident
CHRISTOPHER
25 - Operator/Pedestrian Last Name
ROBERT
25 - First Name
A
25 - Middle Initial 25 - Suffix
11/02/
32 - Date Of Birth
MALE
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
K - FATAL 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
ABILITY IMPAIRED88 - 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 GZDT72R 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
2
22 - Total Occupants
466DGK
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2016
59 - Exp Year
5222
55 - Vehicle Identification Number
2005
50 - Year
CHEV
51 - Make
TRAILBLAZE
52 - Model
UT - SPORT UTILITY
53 - Body Style
WHI
54 - Color
95100 - Skidmarks to Impact (Ft)
TOTAL (DAMAGE TO ALL AREAS)
94 - Vehicle Damage
VERY-SEVERE
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
CHRISTOPHER
46 - Vehicle Owner Last Name
ROBERT
46 - First Name
A
46 - Middle Initial 46 - Suffix
11/02/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
AMERICAN-FAMILY63 - Liability Insurance Company Policy Holder Same As Owner60
CHRISTOPHER
61 - Policy Holder Last Name
ROBERT
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
Occupant
Address Same As Operator
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01
65 - Unit No
CHRISTOPHER
66 - Occupant Last Name
KAREN
66 - First Name
A
66 - Middle Initial 66 - Suffix
01
68 - Address Street & Number 68 - PO Box
HAYWARD
68 - City
WI
68 - State
54843
68 - Zip Code
11/0667 - Date of Birth F69 - Sex
FRONT-SEAT-RIGHT-SIDE-(TRAIN ENGINEER)
71 - Seat Position
SHOULDER-BELT-AND-LAP-BELT-USED
72 - Safety Equipment
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 GZDT72R 2 424
C - POSSIBLE INJURY
70 - Injury Severity
NON-DEPLOYED
73 - Airbag
NOT-EJECTED
75 - Ejected
Medical Transport
77
TRAPPED/EXTRICATED
76 - Trapped/Extricated 78 - Agency Space
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
105 - Photos By
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Diagram and Narrative
DEPUTY AMBER AL-MOGHRABI #340
ON MARCH 29, 2015, I, DEPUTY AMBER AL-MOGHRABI WAS WORKING PATROL FOR THE SAWYER COUNTY SHERIFF'S DEPARTMENT. AT APPROXIMATELY 11:53 I WAS DISPATCHED TO STATE HIGHWAY 2777 AND HOSPITAL AVE FOR A REPORT OF A
ONE VEHICLE ROLLOVER WITH ENTRAPPMENT. UPON ARRIVAL, I WAS MET WITH OFFICER LOGAN FROM THE CITY OF HAYWARD
POLICE DEPARTMENT WHO STATED THERE WERE TWO OCCUPANTS IN THE VEHICLE, THE MALE WAS NOT CONSCIOUS. I NOTICED
THE VEHICLE WAS ON ITS RIGHT SIDE, WITH DAMAGE TO THE WINDSHIELD AND ROOF OF THE VEHICLE ALONG WITH OTHER
PARTS OF THE VEHICLE. I NOTICED THE DRIVER OF THE VEHICLE WAS NOT CONSCIOUS AND STILL IN HIS SEAT BELT, HANGING
INTO THE PASSENGER SIDE OF THE VEHICLE. I ALSO NOTICED THE PASSENGER OF THE VEHICLE HAD HER SEAT BELT REMOVED AND WAS TRYING TO HOLD UP THE MALE SUBJECT. THE CITY OF HAYWARD FIRE DEPARTMENT ARRIVED ON SCENE AND
REMOVED THE ROOF OF THE VEHICLE TO REMOVE THE SUBJECTS. THE MALE SUBJECT WAS TAKEN INTO THE FIRST AMBULANCE
ON SCENE AND TREATED. I ASKED THE WOMAN IF SHE HAD ANY INJURIES. SHE STATED SHE HIT HER HEAD BUT DID NOT FEEL
HURT AT ALL. SHE SEEMED REALLY CONFUSED. I RECOMMENDED HER SEE SOME EMT'S IN THE SECOND AMBULANCE. I SPOKE
TO THE PASSENGER WHO STATED THEY WERE HEADED NORTH ON STATE HIGHWAY 2777 WHEN THE VEHICLE SLID TO THE RIGHT
OF THE ROAD. THE WOMAN STATED HER HUSBAND THEN TRIED TO OVERTURN THE WHEEL TO KEEP THE VEHICLE ON THE ROAD
BUT DID TOO MUCH AND SLID INTO THE DITCH ON THE OTHER SIDE OF THE ROAD. AT THAT POINT THE VEHICLE OVERTURNED ONTO ITS RIGHT SIDE. SHE STATED BOTH PARTIES WERE WEARING THEIR SEAT BELTS AND HER HUSBAND WAS DRIVING ABOUT
35 IN A 45 MPH SPEED ZONE. BOTH AMBULANCES LEFT THE SCENE EN ROUTE TO THE HOSPITAL. THE VEHICLE WAS TOWED BY
A-1 TOWING. I CLEARED THE SCENE AT 12:41 AND WENT TO THE HOSPITAL TO CHECK ON THE FEMALE SUBJECT.
ON MARCH 29, 2015, I, DEPUTY AMBER AL-MOGHRABI WAS WORKING PATROL FOR THE SAWYER COUNTY SHERIFF'S DEPARTMENT. AT APPROXIMATELY 11:53 I WAS DISPATCHED TO STATE HIGHWAY 2777 AND HOSPITAL AVE FOR A REPORT OF A
ONE VEHICLE ROLLOVER WITH ENTRAPPMENT. UPON ARRIVAL, I WAS MET WITH OFFICER LOGAN FROM THE CITY OF HAYWARD
POLICE DEPARTMENT WHO STATED THERE WERE TWO OCCUPANTS IN THE VEHICLE, THE MALE WAS NOT CONSCIOUS. I NOTICED
THE VEHICLE WAS ON ITS RIGHT SIDE, WITH DAMAGE TO THE WINDSHIELD AND ROOF OF THE VEHICLE ALONG WITH OTHER
PARTS OF THE VEHICLE. I NOTICED THE DRIVER OF THE VEHICLE WAS NOT CONSCIOUS AND STILL IN HIS SEAT BELT, HANGING
INTO THE PASSENGER SIDE OF THE VEHICLE. I ALSO NOTICED THE PASSENGER OF THE VEHICLE HAD HER SEAT BELT REMOVED AND WAS TRYING TO HOLD UP THE MALE SUBJECT. THE CITY OF HAYWARD FIRE DEPARTMENT ARRIVED ON SCENE AND
REMOVED THE ROOF OF THE VEHICLE TO REMOVE THE SUBJECTS. THE MALE SUBJECT WAS TAKEN INTO THE FIRST AMBULANCE
ON SCENE AND TREATED. I ASKED THE WOMAN IF SHE HAD ANY INJURIES. SHE STATED SHE HIT HER HEAD BUT DID NOT FEEL
HURT AT ALL. SHE SEEMED REALLY CONFUSED. I RECOMMENDED HER SEE SOME EMT'S IN THE SECOND AMBULANCE. I SPOKE
TO THE PASSENGER WHO STATED THEY WERE HEADED NORTH ON STATE HIGHWAY 2777 WHEN THE VEHICLE SLID TO THE RIGHT
OF THE ROAD. THE WOMAN STATED HER HUSBAND THEN TRIED TO OVERTURN THE WHEEL TO KEEP THE VEHICLE ON THE ROAD
BUT DID TOO MUCH AND SLID INTO THE DITCH ON THE OTHER SIDE OF THE ROAD. AT THAT POINT THE VEHICLE OVERTURNED ONTO ITS RIGHT SIDE. SHE STATED BOTH PARTIES WERE WEARING THEIR SEAT BELTS AND HER HUSBAND WAS DRIVING ABOUT
35 IN A 45 MPH SPEED ZONE. BOTH AMBULANCES LEFT THE SCENE EN ROUTE TO THE HOSPITAL. THE VEHICLE WAS TOWED BY
A-1 TOWING. I CLEARED THE SCENE AT 12:41 AND WENT TO THE HOSPITAL TO CHECK ON THE FEMALE SUBJECT.
Officer Information
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDT72R 3 4
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125 - First Name 125 - Middle Initial
ALMOGHRABI
125 - Officer Last Name
AMBER 340
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 1153133 - Time Notified (Military Time)1153134 - Time Arrived (Military Time)
03/29/2015
135 - Date Of Report
15032901 19 - Special Study
18 - Agency Space
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDT72R 4 4