HomeMy WebLinkAbout20151012 StroufAgency Accident Number
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Reportable Accident On Emergency Amended GZDRQMH
DOT Document Number Document Override Number
15101202
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15101202
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10/12/2015
4 - Accident Date
0839
5 - Time of Accident (Military Time)
01
6 - Total Units
01
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County WINTER - 55, VILLAGE3 - Municipality INTERSECTION11 - Accident Location
14 - On Hwy No.
HAZEL AVE
14 - On Street Name 14 - Bus/Frnt/Rmp 15 - Est. Distance 15 - Hwy. Dir
16 - Fr/At Hwy No.ELLEN ST16 - From/At Street Name 16 - Business/Frontage/Ramp
FIRE #
17 - Structure Type
5158N
17 - Structure Number
45.821571
12 - Latitude -91.00999913 - Longitude
TRAFFIC SIGN POST80 - 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
ON-ROADWAY
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 79 - E M S Number
Operator/Pedestrian
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Unit Status
FIRE/EXPLOSION
81 - Most Harmful Event: Collision With
EAST
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
2016
31 - Expiration Year 34 - On Duty Accident
STROUF
25 - Operator/Pedestrian Last Name
WILLIAM
25 - First Name
J
25 - Middle Initial 25 - Suffix
11/06/
32 - Date Of Birth
MALE
33 - Sex
26 - Address Street & Number 26 - PO Box
WINTER
27 - City
WI
27 - State
54896
27 - Zip Code 28 - Telephone Number
FRONT-SEAT-LEFT-SIDE-(MC/BIKE DRIVER, TRAIN CONDUCTOR)
39 - Seat Position
RESTRAINT-USE-UNKNOWN
40 - Safety Equipment
B - NON-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
BACKING-MANEUVER
119 - What Driver Was Doing
STOP-SIGN
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 UNKNOWN
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 GZDRQMH 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
56 - License Plate Number
LTK57 - Plate Type WI
58 - State
2016
59 - Exp Year
6566
55 - Vehicle Identification Number
2000
50 - Year
CHEV
51 - Make
1500
52 - Model
TK - TRUCK
53 - Body Style
TAN
54 - Color
20100 - 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
BRAKE-SYSTEM
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
STROUF
46 - Vehicle Owner Last Name
WILLIAM
46 - First Name
J
46 - Middle Initial 46 - Suffix
11/06
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
WINTER48 - City WI48 - State 5489648 - Zip Code 49 - Telephone Number
HARTFORD-CASUALTY-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60
STROUF
61 - Policy Holder Last Name
WILLIAM
61 - Policy Holder First Name
61 - Policy Holder Company
01
01
01
01
BU
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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
Page
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Wisconsin Motor Vehicle
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDRQMH 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
LAKEWOODS CAFE
84 - Company Name Government Property Type
85 - Address Street & Number 85 - PO Box
WINTER
86 - City
WI
86 - State
54896
86 - Zip Code 87 - Telephone Number
83 - Government Damage Tag Number
01
82 - Striking Unit
OTHER-FIXED-OBJECT
82 - Object Struck
01
82 - Striking Unit
OTHER-POST
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 GREG RIPCZINSKI
UNIT # 1 WAS PARKED ACROSS THE STREET, PERFORMING A BACKING MANEUVER, OPERTOR STATED THAT HIS FOOT GOT
CAUGHT ON THE ACCELERATOR AND HE LOST CONTROL OF THE VEHICLE. UNIT # 1 BACKED UP AT MODERATE SPEED THROUGH
THE INTERSECTION WHERE IT COLLIDED WITH A STOP SIGN POST, AND CORNER OF THE LAKEWOOD CAFE BUILDING, UNIT # 1
THEN IGNITED IN FLAMES, OPERATOR ATTEMPTED TO DRIVE VEHICLE FROM THE SIDE OF THE BUILDING DOWN MAIN STREET,
WHERE THE VEHICLE THEN BECAME FULLY ENGULFED. OPERATOR HAD TO BE PULLED FROM THE VEHICLE BY A PASSERBY.
UNIT # 1 WAS PARKED ACROSS THE STREET, PERFORMING A BACKING MANEUVER, OPERTOR STATED THAT HIS FOOT GOT
CAUGHT ON THE ACCELERATOR AND HE LOST CONTROL OF THE VEHICLE. UNIT # 1 BACKED UP AT MODERATE SPEED THROUGH
THE INTERSECTION WHERE IT COLLIDED WITH A STOP SIGN POST, AND CORNER OF THE LAKEWOOD CAFE BUILDING, UNIT # 1
THEN IGNITED IN FLAMES, OPERATOR ATTEMPTED TO DRIVE VEHICLE FROM THE SIDE OF THE BUILDING DOWN MAIN STREET,
WHERE THE VEHICLE THEN BECAME FULLY ENGULFED. OPERATOR HAD TO BE PULLED FROM THE VEHICLE BY A PASSERBY.
Officer Information
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDRQMH 3 4
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125 - First Name 125 - Middle Initial
RIPCZINSKI
125 - Officer Last Name
GREG 326
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
10/12/2015
132 - Date Notified 0841133 - Time Notified (Military Time)0852134 - Time Arrived (Military Time)
10/12/2015
135 - Date Of Report
15101202 15101202 19 - Special Study
18 - Agency Space
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDRQMH 4 4