HomeMy WebLinkAbout20150920 RogersAgency Accident Number
AC
C
I
D
E
N
T
#
PO
L
I
C
E
#
Police Number
GE
N
E
R
A
L
I
N
F
O
R
M
A
T
I
O
N
Reportable Accident On Emergency Amended GZD7FQP
DOT Document Number Document Override Number
15092013533
15
0
9
2
0
1
3
5
3
3
09/20/2015
4 - Accident Date
0400
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
0.39 MI15 - Est. Distance SOUTH15 - Hwy. Dir
16 - Fr/At Hwy No.IRVINE DR16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.734444
12 - Latitude -91.11168913 - Longitude
TREE80 - First Harmful Event NO COLLISION WITH MOTOR VEHICLE IN TRANSPORT93 - Manner of Collision
FULL CONTROL
112 - Access Control
STRAIGHT
113 - Road Curvature
HILL
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
114 - Light Condition DRY116 - Road Surface Condition UNKNOWN118 - 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
OP
E
R
A
T
O
R
/
P
E
D
E
S
T
R
I
A
N
Unit Status
TREE
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
2020
31 - Expiration Year 34 - On Duty Accident
ROGERS
25 - Operator/Pedestrian Last Name
EDWARD
25 - First Name
J
25 - Middle Initial 25 - Suffix
07/10/1985
32 - Date Of Birth
MALE
33 - Sex
26 - Address Street & Number 26 - PO Box
CHIPPEWA FALLS
27 - City
WI
27 - State
54729
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
GOING-STRAIGHT
119 - What Driver Was Doing
NO-CONTROL
120 - Traffic Control 262 - No. of Citations Issued
346.63(1)(A)
64 - 1st Statute No.
343.44(1)(A)
64 - 2nd Statute No.64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
OTHER
122 - Driver Factors
ABILITY IMPAIRED88 - Driver or Pedestrian Cond UNKNOWN
89 - Substance Presence
TEST GIVEN90 - Alcohol Test 90 - Alcohol Content TEST NOT GIVEN91 - Drug Test
01
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZD7FQP 1 4
VE
H
I
C
L
E
VE
H
O
W
N
E
R
Vehicle
Vehicle Owner
Insurance
School Bus
IN
S
91 - Drugs Reported
NOT-APPLICABLE
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
AB2700
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2016
59 - Exp Year
46462
55 - Vehicle Identification Number
2005
50 - Year
FORD
51 - Make
F150
52 - Model
TK - TRUCK
53 - Body Style
GRY
54 - Color
0100 - Skidmarks to Impact (Ft)
FRONT, FRONT DRIVER SIDE, UNDERCARRIAGE
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
ROGERS
46 - Vehicle Owner Last Name
EDWARD
46 - First Name
J
46 - Middle Initial 46 - Suffix
07/10/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
CHIPPEWA FALLS48 - City WI48 - State 5472948 - Zip Code 49 - Telephone Number
NONE63 - Liability Insurance Company Policy Holder Same As Owner60
ROGERS
61 - Policy Holder Last Name
EDWARD
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
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZD7FQP 2 424
Fixed Objects Struck
PR
O
P
E
R
T
Y
O
W
N
E
R
Property
INDIVIDUAL
Organization Type
FELSKIE
84 - Property Owner Last Name
DONALD
84 - First Name 84 - Middle Initial 84 - Suffix
01
84 - Company Name Government Property Type
85 - Address Street & Number 85 - PO Box
COUDERAY
86 - City
WI
86 - State
54828
86 - Zip Code 87 - Telephone Number
83 - Government Damage Tag Number
02
82 - Striking Unit
TREE
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
DI
A
G
R
A
M
A
N
D
N
A
R
R
A
T
I
V
E
Diagram and Narrative
DEPUTY C DEPEW
VEHICLE WAS TRAVELING NORTH ON STH 27 AND LEFT ROADWAY FOR APPROXIMATELY 300 FEET OPERATING IN THE DITCH
UNTIL IT STRUCK A SMALL TREE NEAR A DRIVEWAY. VEHICLE OWNER STATED THAT HE SWERVED TO MISS A DEER AND WENT IN
THE DITCH. DRIVER OF VEHICLE WAS WALKING AWAY FROM THE SCENE WHEN HE WAS INTERVIEWED.
VEHICLE WAS TRAVELING NORTH ON STH 27 AND LEFT ROADWAY FOR APPROXIMATELY 300 FEET OPERATING IN THE DITCH
UNTIL IT STRUCK A SMALL TREE NEAR A DRIVEWAY. VEHICLE OWNER STATED THAT HE SWERVED TO MISS A DEER AND WENT IN
THE DITCH. DRIVER OF VEHICLE WAS WALKING AWAY FROM THE SCENE WHEN HE WAS INTERVIEWED.
Officer Information
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZD7FQP 3 4
OF
F
I
C
E
R
I
N
F
O
R
M
A
T
I
O
N
125 - First Name 125 - Middle Initial
DEPEW
125 - Officer Last Name
CRAIG 344
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
09/20/2015
132 - Date Notified 0712133 - Time Notified (Military Time)0715134 - Time Arrived (Military Time)
09/21/2015
135 - Date Of Report
15092013533 19 - Special Study
18 - Agency Space
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZD7FQP 4 4