HomeMy WebLinkAbout20150701 OlsonAgency Accident Number
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Reportable Accident On Emergency Amended GZDC4V3
DOT Document Number Document Override Number
15070107
15
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7
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07/01/2015
4 - Accident Date
1652
5 - Time of Accident (Military Time)
01
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County WINTER - 17, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
W
14 - On Hwy No.14 - On Street Name 14 - Bus/Frnt/Rmp
707 FT15 - Est. Distance SOUTH15 - Hwy. Dir
16 - Fr/At Hwy No.WEST LN16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.767996
12 - Latitude -90.76051213 - Longitude
GUARDRAIL END80 - 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-LEFT
117 - Relation To Roadway
DAYLIGHT114 - Light Condition DRY116 - Road Surface Condition CLEAR118 - 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
GUARDRAIL END
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
2021
31 - Expiration Year 34 - On Duty Accident
OLSON
25 - Operator/Pedestrian Last Name
ROBERT
25 - First Name
O
25 - Middle Initial 25 - Suffix
03/06/
32 - Date Of Birth
MALE
33 - Sex
26 - Address Street & Number 26 - PO Box
EXELAND
27 - City
WI
27 - State
54835
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
NEGOTIATING-CURVE
119 - What Driver Was Doing
NO-CONTROL
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.
NOT-APPLICABLE
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 GZDC4V3 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
292TJR
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2015
59 - Exp Year
2880
55 - Vehicle Identification Number
2012
50 - Year
MITS
51 - Make
OUTLANDER
52 - Model
4D - 4DR
53 - Body Style
BLU
54 - Color
0100 - Skidmarks to Impact (Ft)
REAR DRIVER SIDE, UNDERCARRIAGE
94 - Vehicle Damage
MODERATE
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
OLSON
46 - Vehicle Owner Last Name
ROBERT
46 - First Name
O
46 - Middle Initial 46 - Suffix
03/06/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
EXELAND48 - City WI48 - State 5483548 - Zip Code 49 - Telephone Number
PEKIN-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60
OLSON
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
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
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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Wisconsin Motor Vehicle GZDC4V3 2 424
Fixed Objects Struck
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Property
GOVERNMENT
Organization Type 84 - Property Owner Last Name 84 - First Name 84 - Middle Initial 84 - Suffix
01
SAWYER COUNTY
84 - Company Name
COUNTY/MUNICIPAL
Government Property Type
14688W CTH B
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
GUARDRAIL-END
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
ON 070115 AT 16:52 DEPUTY NELSON WAS DISPATCHED TO CTH W NEAR THE FLAMBEAU RIVER BRIDGE FOR A ONE VEHICLE
ACCIDENT. DEPUTY NELSON WAS ADVISED THAT A FOREST RANGER WAS OUT WITH ACCIDENT. DEPUTY NELSON ARRIVED ON
SCENE AND MADE CONTACT WITH THE RANGER AND THE DRIVER OF THE VEHICLE ROBERT OLSON. ROBERT OLSON ADVISED
DEPUTY NELSON THAT HE WAS HEADED NORTH ON CTH W WHEN A DEER RAN ONTO THE ROAD. ROBERT OLSON ADVISED THAT
HE SWERVED AND HIT THE GUARDRAIL. DEPUTY NELSON OBSERVED THAT THE REAR DRIVER SIDE TIRE WAS BROKEN OFF AND
THAT FOUR POST OF THE GUARDRAIL WAS BROKEN. DEPUTY NELSON TOOK PICTURES OF THE DAMAGE AND HAD THE VEHICLE REMOVED.
ON 070115 AT 16:52 DEPUTY NELSON WAS DISPATCHED TO CTH W NEAR THE FLAMBEAU RIVER BRIDGE FOR A ONE VEHICLE
ACCIDENT. DEPUTY NELSON WAS ADVISED THAT A FOREST RANGER WAS OUT WITH ACCIDENT. DEPUTY NELSON ARRIVED ON
SCENE AND MADE CONTACT WITH THE RANGER AND THE DRIVER OF THE VEHICLE ROBERT OLSON. ROBERT OLSON ADVISED
DEPUTY NELSON THAT HE WAS HEADED NORTH ON CTH W WHEN A DEER RAN ONTO THE ROAD. ROBERT OLSON ADVISED THAT
HE SWERVED AND HIT THE GUARDRAIL. DEPUTY NELSON OBSERVED THAT THE REAR DRIVER SIDE TIRE WAS BROKEN OFF AND
THAT FOUR POST OF THE GUARDRAIL WAS BROKEN. DEPUTY NELSON TOOK PICTURES OF THE DAMAGE AND HAD THE VEHICLE REMOVED.
Officer Information
Accident Report
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZDC4V3 3 4
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125 - First Name 125 - Middle Initial
NELSON
125 - Officer Last Name
DENNIS 382
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
07/01/2015
132 - Date Notified 1652133 - Time Notified (Military Time)1746134 - Time Arrived (Military Time)
07/12/2015
135 - Date Of Report
15070107 19 - Special Study
18 - Agency Space
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDC4V3 4 4