HomeMy WebLinkAbout20150329 HoveAgency Accident Number
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Reportable Accident On Emergency Amended GZDVPJ5
DOT Document Number Document Override Number
15032903842
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15032903
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03/29/2015
4 - Accident Date
1150
5 - Time of Accident (Military Time)
01
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County BASS LAKE - 01, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
K
14 - On Hwy No.14 - On Street Name 14 - Bus/Frnt/Rmp
0.39 MI15 - Est. Distance EAST15 - Hwy. Dir
16 - Fr/At Hwy No.WURSTER RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.917174
12 - Latitude -91.43062113 - Longitude
OVERTURN80 - First Harmful Event NO COLLISION WITH MOTOR VEHICLE IN TRANSPORT93 - Manner of Collision
NO CONTROL
112 - Access Control
CURVE
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
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
2019
31 - Expiration Year 34 - On Duty Accident
HOVE
25 - Operator/Pedestrian Last Name
HEATHER
25 - First Name
CHARLENE
25 - Middle Initial 25 - Suffix
10/26
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
MAKING-LEFT-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.
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
01
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDVPJ5 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
3
22 - Total Occupants
273WBW
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2016
59 - Exp Year
5857
55 - Vehicle Identification Number
2004
50 - Year
PONT
51 - Make
MONTANA
52 - Model
VN - VAN
53 - Body Style
RED
54 - Color
0100 - Skidmarks to Impact (Ft)
FRONT, TOP OF VEHICLE
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
HOVE
46 - Vehicle Owner Last Name
HEATHER
46 - First Name
CHARLENE
46 - Middle Initial 46 - Suffix
10/26/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
PROGRESSIVE-CASUALTY-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60
HOVE
61 - Policy Holder Last Name
HEATHER
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
Occupant
Address Same As Operator
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01
65 - Unit No 66 - Occupant Last Name 66 - First Name
B
66 - Middle Initial 66 - Suffix
01
68 - Address Street & Number 68 - PO Box
HAYWARD
68 - City
WI
68 - State
54843
68 - Zip Code
03/1167 - Date of Birth M69 - Sex
SECOND-SEAT-RIGHT
71 - Seat Position
CHILD-SAFETY-SEAT-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
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Wisconsin Motor Vehicle GZDVPJ5 2 424
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
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01
65 - Unit No
66 - Occupant Last Name 66 - First Name 66 - Middle Initial 66 - Suffix
02
68 - Address Street & Number 68 - PO Box
HAYWARD
68 - City
WI
68 - State
54843
68 - Zip Code
08/13
67 - Date of Birth
F
69 - Sex
SECOND-SEAT-LEFT-SIDE-(MC/BIKE PASSENGER, TRAIN BREAKMA
71 - Seat Position
CHILD-SAFETY-SEAT-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
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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
POPLIN
UNIT 1 WAS GOING WEST ON COUNTY HWY K AT APPROXIMATELY 35 MPH. DUE TO THE SNOWSLUSH COVERED ROAD
CONDITIONS UNIT 1 LOST CONTROL ENTERING THE DITCH SPINNING AROUND FACING THE OTHER DIRECTION AND ROLLING OVER
ONTO ITS ROOF. NO APPARENT INJURIES WERE OBSERVED AT THE SCENE.
UNIT 1 WAS GOING WEST ON COUNTY HWY K AT APPROXIMATELY 35 MPH. DUE TO THE SNOWSLUSH COVERED ROAD
CONDITIONS UNIT 1 LOST CONTROL ENTERING THE DITCH SPINNING AROUND FACING THE OTHER DIRECTION AND ROLLING OVER
ONTO ITS ROOF. NO APPARENT INJURIES WERE OBSERVED AT THE SCENE.
Officer Information
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDVPJ5 3 4
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125 - First Name 125 - Middle Initial
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 1150133 - Time Notified (Military Time)1232134 - Time Arrived (Military Time)
03/29/2015
135 - Date Of Report
15032903842 15032903 19 - Special Study
18 - Agency Space
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDVPJ5 4 4