HomeMy WebLinkAbout20150918 HornAgency Accident Number
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Reportable Accident On Emergency Amended GZDVPJG
DOT Document Number Document Override Number
15091813425
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15091802
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09/18/2015
4 - Accident Date
1023
5 - Time of Accident (Military Time)
01
6 - Total Units
01
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County LENROOT - 08, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
027
14 - On Hwy No.
SB
14 - On Street Name 14 - Bus/Frnt/Rmp
947 FT15 - Est. Distance SOUTH15 - Hwy. Dir
16 - Fr/At Hwy No.EATON RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
46.054564
12 - Latitude -91.49139813 - Longitude
DITCH80 - 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 CLOUDY118 - 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
1509181342579 - E M S Number
Operator/Pedestrian
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Unit Status
DITCH
81 - Most Harmful Event: Collision With
SOUTH
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
HORN
25 - Operator/Pedestrian Last Name
JUSTIN
25 - First Name
G
25 - Middle Initial 25 - Suffix
10/03/
32 - Date Of Birth
MALE
33 - Sex
26 - Address Street & Number 26 - PO Box
MILWAUKEE
27 - City
WI
27 - State
53207
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
A - INCAPACITATING 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 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.
EXCEEDING-SPEED-LIMIT, INATTENTIVE-DRIVING, FAILURE-TO-HAVE-CONTROL
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 GZDVPJG 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
TRUCK
21 - Unit Type
PICKUP/UTILITY-TRUCK
Vehicle Type
1
22 - Total Occupants
JY2221
56 - License Plate Number
LTK57 - Plate Type WI
58 - State
2015
59 - Exp Year
7217
55 - Vehicle Identification Number
2004
50 - Year
DODG
51 - Make
RAM
52 - Model
PK - PICKUP
53 - Body Style
RED
54 - Color 100 - 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
HORN
46 - Vehicle Owner Last Name
JUSTIN
46 - First Name
G
46 - Middle Initial 46 - Suffix
10/03/
Date Of Birth
46 - Company Name
47 - PO Box
MILWAUKEE48 - City WI48 - State 5320748 - Zip Code 49 - Telephone Number
PROGRESSIVE-CASUALTY-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60
HORN
61 - Policy Holder Last Name
JUSTIN
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
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MV4000e 01/2005
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Wisconsin Motor Vehicle
Accident Report
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Wisconsin Motor Vehicle GZDVPJG 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
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
CHIEF CLAPERO
UNIT 1 WAS GOING SOUTH ON STATE HWY 27/77 JUST SOUTH OF EATON ROAD. WHEN THE DRIVER OF UNIT 1 SAID HE RECEIVED
A TEXT MESSAGE ON HIS PHONE AND READ THE MESSAGE CAUSING HIM TO THE LEAVE THE ROADWAY. THE DRIVER SAID HE
OVER CORRECTED AND STARTING ROLLING HE THOUGHT HE ROLLED MULTIPLE TIMES. CHIEF CLAPERO TOOK ALL THE PHOTOS
OF THE SCENE AND TURNED THEM OVER TO ME. THE VEHICLE WAS SEVERELY DAMAGE AND THE DRIVER SUSTAINED INJURIES.
UNIT 1 WAS GOING SOUTH ON STATE HWY 27/77 JUST SOUTH OF EATON ROAD. WHEN THE DRIVER OF UNIT 1 SAID HE RECEIVED
A TEXT MESSAGE ON HIS PHONE AND READ THE MESSAGE CAUSING HIM TO THE LEAVE THE ROADWAY. THE DRIVER SAID HE
OVER CORRECTED AND STARTING ROLLING HE THOUGHT HE ROLLED MULTIPLE TIMES. CHIEF CLAPERO TOOK ALL THE PHOTOS
OF THE SCENE AND TURNED THEM OVER TO ME. THE VEHICLE WAS SEVERELY DAMAGE AND THE DRIVER SUSTAINED INJURIES.
Officer Information
Accident Report
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MV4000e 01/2005
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PK2012
Wisconsin Motor Vehicle GZDVPJG 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
09/18/2015
132 - Date Notified 1023133 - Time Notified (Military Time)1027134 - Time Arrived (Military Time)
09/18/2015
135 - Date Of Report
15091813425 15091802 19 - Special Study
18 - Agency Space
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MV4000e 01/2005
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PK2012
Wisconsin Motor Vehicle GZDVPJG 4 4