HomeMy WebLinkAbout20150613 ObryanAgency Accident Number
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Reportable Accident On Emergency Amended GZDLK2S
DOT Document Number Document Override Number
15061304
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15061304
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06/13/2015
4 - Accident Date
1520
5 - Time of Accident (Military Time)
01
6 - Total Units
01
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County RADISSON - 12, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
027
14 - On Hwy No.
NB
14 - On Street Name 14 - Bus/Frnt/Rmp
0.33 MI15 - Est. Distance NORTH15 - Hwy. Dir
16 - Fr/At Hwy No.WIEGOR RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.776436
12 - Latitude -91.27294713 - 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
DAYLIGHT114 - Light Condition WET116 - Road Surface Condition RAIN118 - 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
1506130769479 - E M S Number
Operator/Pedestrian
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Unit Status
DITCH
81 - Most Harmful Event: Collision With
NORTH
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
2017
31 - Expiration Year 34 - On Duty Accident
OBRYAN
25 - Operator/Pedestrian Last Name
ANNIE
25 - First Name
M
25 - Middle Initial 25 - Suffix
04/12/1
32 - Date Of Birth
FEMALE
33 - Sex
26 - Address Street & Number 26 - PO Box
LADYSMITH
27 - City
WI
27 - State
54848
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
B - NON-INCAPACITATING INJURY
38 - Injury Severity
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.
FAILURE-TO-HAVE-CONTROL
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
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PK2012
Wisconsin Motor Vehicle GZDLK2S 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
954UTK
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2016
59 - Exp Year
7917
55 - Vehicle Identification Number
1998
50 - Year
DODG
51 - Make
CARAVAN
52 - Model
VN - VAN
53 - Body Style
WHI
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT, FRONT DRIVER SIDE, FRONT PASSENGER SIDE, MIDDLE DRIVER SIDE, MIDDLE PASSENGER SIDE,
UNDERCARRIAGE
94 - Vehicle Damage
VERY-SEVERE
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
OBRYAN
46 - Vehicle Owner Last Name
ANNIE
46 - First Name
M
46 - Middle Initial 46 - Suffix
04/12
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
LADYSMITH48 - City WI48 - State 5484848 - Zip Code 49 - Telephone Number
GEICO-CASUALTY-CO63 - Liability Insurance Company Policy Holder Same As Owner60
OBRYAN
61 - Policy Holder Last Name
ANNIE
61 - Policy Holder First Name
61 - Policy Holder Company
01
01
01
01
BU
S
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
Accident Report
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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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PK2012
Wisconsin Motor Vehicle GZDLK2S 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
CULVERT
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
SGT NICK ALMOGHRABI
I, SGT. NICK AL-MOGHRABI, WAS DISPATCHED TO A ONE VEHICLE CRASH WITH UNKNOWN INJURIES ON 061315 AT 15:22. THE
LOCATION WAS STH 2770 NEAR THE COUDERAY GOLF COURSE. DEPUTY RASCHKA, SAWYER COUNTY EMS, AND RADISSON FIRE
DEPARTMENT WERE DISPATCHED AS WELL. WHILE ENROUTE, I WAS ADVISED THERE WAS NO ENTRAPMENT AND ONE FEMALE
PARTY WHO WAS INJURED BUT OUT OF THE VEHICLE. UPON MY ARRIVAL, EMS WAS ALREADY ON SCENE AND HAD THE
OPERATOR ON A COT. I OBSERVED A WHITE DODGE CARAVAN IN THE DITCH ON THE SOUTH SIDE OF STH 2770 WEST OF FIRE
NUMBER 11633W. UPON CONTACT WITH THE OPERATOR, SHE WAS ALERT AND CONSCIOUS. SHE PROVIDED ME WITH A WI DL IDENTIFYING HER AS ANNIE OBRYAN, THE OWNER OF THE VEHICLE. OBRYAN TOLD ME SHE HAD INJURED HER LIFT WRIST AND
BELIEVED HER LEFT ANKLE WAS BROKEN. OBRYAN TOLD ME SHE HAD A LOT ON HER MIND REGARDING THE RECENT PASSING OF
HER HUSBAND AND THOUGHT SHE MAY HAVE BLACKED OUT. OBRYAN TOLD ME SHE HAD BEEN TRAVELING AROUND 45 MPH.
UPON FURTHER SCENE OBSERVATION, I FOUND THE VEHICLE HAD BEEN TRAVELING NORTH ON STH 2770, CROSSED THE CENTER
LINE, AND ENTERED THE DITCH. THE VEHICLE CONTINUED THROUGH THE DITCH STRIKING THE CULVERT ON THE EAST SIDE OF
THE DRIVEWAY. NO VEHICLE TRACKS WERE OBSERVED ON THE DRIVEWAY MEANING THE VEHICLE WAS AIRBORNE THEN LANDED ON THE WEST SIDE OF THE DRIVEWAY IN THE DITCH. I OBSERVED VERY SEVERE DAMAGE TO THE FRONT AND BOTH SIDES OF
THE VEHICLE ALONG WITH DRIVER AND PASSENGER AIR BAG DEPLOYMENT. I REQUESTED THE NEXT TOW AND WAS ADVISED
ROADRUNNER TOWING WAS DISPATCHED. I TOOK MULTIPLE PHOTOGRAPHS OF THE VEHICLE AND SCENE WHICH HAVE BEEN
ENTERED INTO EVIDENCE. OBRYAN WAS PROVIDED WITH THE CASE NUMBER AND TOW COMPANY
I, SGT. NICK AL-MOGHRABI, WAS DISPATCHED TO A ONE VEHICLE CRASH WITH UNKNOWN INJURIES ON 061315 AT 15:22. THE
LOCATION WAS STH 2770 NEAR THE COUDERAY GOLF COURSE. DEPUTY RASCHKA, SAWYER COUNTY EMS, AND RADISSON FIRE
DEPARTMENT WERE DISPATCHED AS WELL. WHILE ENROUTE, I WAS ADVISED THERE WAS NO ENTRAPMENT AND ONE FEMALE
PARTY WHO WAS INJURED BUT OUT OF THE VEHICLE. UPON MY ARRIVAL, EMS WAS ALREADY ON SCENE AND HAD THE
OPERATOR ON A COT. I OBSERVED A WHITE DODGE CARAVAN IN THE DITCH ON THE SOUTH SIDE OF STH 2770 WEST OF FIRE
NUMBER 11633W. UPON CONTACT WITH THE OPERATOR, SHE WAS ALERT AND CONSCIOUS. SHE PROVIDED ME WITH A WI DL IDENTIFYING HER AS ANNIE OBRYAN, THE OWNER OF THE VEHICLE. OBRYAN TOLD ME SHE HAD INJURED HER LIFT WRIST AND
BELIEVED HER LEFT ANKLE WAS BROKEN. OBRYAN TOLD ME SHE HAD A LOT ON HER MIND REGARDING THE RECENT PASSING OF
HER HUSBAND AND THOUGHT SHE MAY HAVE BLACKED OUT. OBRYAN TOLD ME SHE HAD BEEN TRAVELING AROUND 45 MPH.
UPON FURTHER SCENE OBSERVATION, I FOUND THE VEHICLE HAD BEEN TRAVELING NORTH ON STH 2770, CROSSED THE CENTER
LINE, AND ENTERED THE DITCH. THE VEHICLE CONTINUED THROUGH THE DITCH STRIKING THE CULVERT ON THE EAST SIDE OF
THE DRIVEWAY. NO VEHICLE TRACKS WERE OBSERVED ON THE DRIVEWAY MEANING THE VEHICLE WAS AIRBORNE THEN LANDED ON THE WEST SIDE OF THE DRIVEWAY IN THE DITCH. I OBSERVED VERY SEVERE DAMAGE TO THE FRONT AND BOTH SIDES OF
THE VEHICLE ALONG WITH DRIVER AND PASSENGER AIR BAG DEPLOYMENT. I REQUESTED THE NEXT TOW AND WAS ADVISED
ROADRUNNER TOWING WAS DISPATCHED. I TOOK MULTIPLE PHOTOGRAPHS OF THE VEHICLE AND SCENE WHICH HAVE BEEN
ENTERED INTO EVIDENCE. OBRYAN WAS PROVIDED WITH THE CASE NUMBER AND TOW COMPANY
Accident Report
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZDLK2S 3 4
CONTACT INFORMATION. WHILE WAITING FOR THE TWO TO ARRIVE, EMS CONTACTED ME AND REQUESTED I LOOK FOR A SMALL DOG IN THE VEHICLE. I LOCATED A SMALL DOG WHICH WAS DECEASED ON THE FLOOR UNDER A BLANKET BEHIND THE DRIVER'S
SEAT. DEPUTY RASCHKA TRANSPORTED THE DOG TO OBRYAN'S DAUGHTER. NO CITATIONS WERE ISSUED IN THIS MATTER.
CONTACT INFORMATION. WHILE WAITING FOR THE TWO TO ARRIVE, EMS CONTACTED ME AND REQUESTED I LOOK FOR A SMALL DOG IN THE VEHICLE. I LOCATED A SMALL DOG WHICH WAS DECEASED ON THE FLOOR UNDER A BLANKET BEHIND THE DRIVER'S
SEAT. DEPUTY RASCHKA TRANSPORTED THE DOG TO OBRYAN'S DAUGHTER. NO CITATIONS WERE ISSUED IN THIS MATTER.
OF
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125 - First Name 125 - Middle Initial
Officer Information
ALMOGHRABI125 - Officer Last Name NICK 392131 - Officer ID
129 - Law Enforcement Agency No.
SAWYER COUNTY SHERIFFS DEPT
130 - Law Enforcement Agency Name
15880 EAST FIFTH STREET126 - Law Enforcement Agency Address Street & Number
HAYWARD
127 - City
WI
127 - State
54843
127 - Zip Code
(715) 634-4858 EXT.
128 - Telephone Number
06/13/2015132 - Date Notified 1522133 - Time Notified (Military Time)1534134 - Time Arrived (Military Time)06/13/2015135 - Date Of Report
15061304 15061304 19 - Special Study
18 - Agency Space
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDLK2S 4 4