HomeMy WebLinkAbout20150421 RheaAgency Accident Number
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Reportable Accident On Emergency Amended GZDHL62
DOT Document Number Document Override Number
15042105
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04/21/2015
4 - Accident Date
1100
5 - Time of Accident (Military Time)
01
6 - Total Units
01
7 - Total Injured 8 - Total Killed
SAWYER - 572 - County SPIDER LAKE - 15, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
14 - On Hwy No.
ROSS' RD
14 - On Street Name 14 - Bus/Frnt/Rmp
131 FT15 - Est. Distance NORTH15 - Hwy. Dir
07716 - Fr/At Hwy No.16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
46.070888
12 - Latitude -91.10486313 - Longitude
DITCH80 - First Harmful Event NO COLLISION WITH MOTOR VEHICLE IN TRANSPORT93 - Manner of Collision
PARTIAL 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 WET116 - Road Surface Condition SLEET-HAIL-(FREEZING RAIN OR DRIZZLE)118 - 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
2524 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
29 - Driver's License Number
WI
30 - State
2022
31 - Expiration Year 34 - On Duty Accident
RHEA
25 - Operator/Pedestrian Last Name
JEREMEY
25 - First Name
M
25 - Middle Initial 25 - Suffix
06/18
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
NONE-USED-VEHICLE-DRIVER/OCCUPANT
40 - Safety Equipment
C - POSSIBLE 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
NEGOTIATING-CURVE
119 - What Driver Was Doing
STOP-SIGN
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.
SPEED-TOO-FAST-FOR-CONDITIONS
122 - Driver Factors
APPEARED NORMAL88 - Driver or Pedestrian Cond NEITHER-ALCOHOL-NOR-DRUGS-PRESENT
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 GZDHL62 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
TRUCK
21 - Unit Type
PICKUP/UTILITY-TRUCK
Vehicle Type
1
22 - Total Occupants
JJ8679
56 - License Plate Number
LTK57 - Plate Type WI
58 - State 59 - Exp Year
6241
55 - Vehicle Identification Number
2003
50 - Year
CHEV
51 - Make
SILVERADO
52 - Model
2D - 2DR
53 - Body Style
RED
54 - Color
50100 - Skidmarks to Impact (Ft)
TOTAL (DAMAGE TO ALL AREAS)
94 - Vehicle Damage
SEVERE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96 97 - Vehicle Removed By
TIRES
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
ROSS
46 - Vehicle Owner Last Name
VICTORIA
46 - First Name
E
46 - Middle Initial 46 - Suffix
10/19
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
PROGRESSIVE-SPECIALTY-INS-CO-(ATTN:-AUTO-UNDERWRTN63 - Liability Insurance Company Policy Holder Same As Owner60
ROSS
61 - Policy Holder Last Name
VICTORIA
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
L
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 GZDHL62 2 424
Fixed Objects Struck
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Property
ORGANIZATION
Organization Type 84 - Property Owner Last Name 84 - First Name 84 - Middle Initial 84 - Suffix
01
SPIDER LAKE TOWNSHIP
84 - Company Name Government Property Type
85 - Address Street & Number 85 - PO Box
HAYWARD
86 - City
WI
86 - State
54843
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
N. RASCHKA
ON TUESDAY APRIL 21, 2015 AT APPROXIMATELY 11:15 AM I, DEPUTY RASCHKA RESPONDED TO THE INTERSECTION OF ROSS RD
AND STATE HWY 77 IN THE SPIDER LAKE TOWNSHIP FOR A ONE VEHICLE ROLLOVER. I ARRIVED ON-SCENE AND OBSERVED A RED
CHEVROLET PICK UP TRUCK FLIPPED ON ITS TOP. THE FRONT END OF THE TRUCK WAS FACING SOUTHBOUND, TOWARDS STATE
HWY 77. I WAS MET BY THE DRIVER, JEREMY RAY AND HIS WIFE VICTORIA ROSS. MR. RAY STATED THAT HE HAD BEEN UPSET
THIS MORNING AND TOOK THE CORNER TOO FAST. THE WEATHER CONDITIONS WERE RAINSNOW MIX AND THE ROADWAY WAS
WET AND HAD LOOSE GRAVEL. MR. RAY STATED HE CAME INTO THE CURVE TOO FAST AND LOST CONTROL. HE STATED HE HIT THE WEST SHOULDER OF ROSS RD AND HIS VEHICLE THEN FLIPPED OVER. HE ADVISED HE WAS NOT WEARING HIS SEAT BELT
AND THAT HE WAS ABLE TO ROLL DOWN THE DRIVERS SIDE WINDOW AND CRAWL OUT OF IT. HE ADMITTED THAT HE WAS
PROBABLY GOING TOO FAST FOR ROAD CONDITIONS AND THAT HIS TIRES ON HIS VEHICLE NEEDED TO BE REPLACED. THERE IS
SEVERE DAMAGE TO THE FRONT END, TOP AND SIDES OF THE VEHICLE. THERE WAS APPROXIMATELY 50 FT OF SKID MARKS
SOUTH BOUND ON ROSS RD TO IMPACT WHERE THE TRUCK CAME TO A FINAL STOP. MR RAY WAS THEN TAKEN TO THE HOSPITAL
BY HIS WIFE TO BE CHECKED OUT BY HIS DOCTOR. FOR FULL REPORT SEE CASE NUMBER 15042105
ON TUESDAY APRIL 21, 2015 AT APPROXIMATELY 11:15 AM I, DEPUTY RASCHKA RESPONDED TO THE INTERSECTION OF ROSS RD
AND STATE HWY 77 IN THE SPIDER LAKE TOWNSHIP FOR A ONE VEHICLE ROLLOVER. I ARRIVED ON-SCENE AND OBSERVED A RED
CHEVROLET PICK UP TRUCK FLIPPED ON ITS TOP. THE FRONT END OF THE TRUCK WAS FACING SOUTHBOUND, TOWARDS STATE
HWY 77. I WAS MET BY THE DRIVER, JEREMY RAY AND HIS WIFE VICTORIA ROSS. MR. RAY STATED THAT HE HAD BEEN UPSET
THIS MORNING AND TOOK THE CORNER TOO FAST. THE WEATHER CONDITIONS WERE RAINSNOW MIX AND THE ROADWAY WAS
WET AND HAD LOOSE GRAVEL. MR. RAY STATED HE CAME INTO THE CURVE TOO FAST AND LOST CONTROL. HE STATED HE HIT THE WEST SHOULDER OF ROSS RD AND HIS VEHICLE THEN FLIPPED OVER. HE ADVISED HE WAS NOT WEARING HIS SEAT BELT
AND THAT HE WAS ABLE TO ROLL DOWN THE DRIVERS SIDE WINDOW AND CRAWL OUT OF IT. HE ADMITTED THAT HE WAS
PROBABLY GOING TOO FAST FOR ROAD CONDITIONS AND THAT HIS TIRES ON HIS VEHICLE NEEDED TO BE REPLACED. THERE IS
SEVERE DAMAGE TO THE FRONT END, TOP AND SIDES OF THE VEHICLE. THERE WAS APPROXIMATELY 50 FT OF SKID MARKS
SOUTH BOUND ON ROSS RD TO IMPACT WHERE THE TRUCK CAME TO A FINAL STOP. MR RAY WAS THEN TAKEN TO THE HOSPITAL
BY HIS WIFE TO BE CHECKED OUT BY HIS DOCTOR. FOR FULL REPORT SEE CASE NUMBER 15042105
Officer Information
Accident Report
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Wisconsin Motor Vehicle GZDHL62 3 4
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125 - First Name 125 - Middle Initial
RASCHKA
125 - Officer Last Name
NICOLE 388
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
04/21/2015
132 - Date Notified 1115133 - Time Notified (Military Time)1151134 - Time Arrived (Military Time)
04/21/2015
135 - Date Of Report
15042105 19 - Special Study
18 - Agency Space
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MV4000e 01/2005
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PK2012
Wisconsin Motor Vehicle GZDHL62 4 4