HomeMy WebLinkAbout20151116 HilgendorfAgency Accident Number
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Reportable Accident On Emergency Amended GZDHL6B
DOT Document Number Document Override Number
15111603
15
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1
6
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11/16/2015
4 - Accident Date
1248
5 - Time of Accident (Military Time)
01
6 - Total Units 7 - Total Injured 8 - Total Killed
SAWYER - 572 - County HAYWARD - 06, TOWN3 - Municipality INTERSECTION11 - Accident Location
077
14 - On Hwy No.
EB
14 - On Street Name 14 - Bus/Frnt/Rmp 15 - Est. Distance 15 - Hwy. Dir
16 - Fr/At Hwy No.WHEELER RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
46.011253
12 - Latitude -91.44671113 - 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
ON-ROADWAY
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 79 - E M S Number
Operator/Pedestrian
OP
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Unit Status
DITCH
81 - Most Harmful Event: Collision With
EAST
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
2019
31 - Expiration Year 34 - On Duty Accident
HILGENDORF
25 - Operator/Pedestrian Last Name
GARY
25 - First Name
A
25 - Middle Initial 25 - Suffix
01/09/
32 - Date Of Birth
MALE
33 - Sex
26 - Address Street & Number 26 - PO Box
HAYWARD
27 - City
WI
27 - State
54843
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
GOING-STRAIGHT
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.
DRIVER-CONDITION
122 - Driver Factors
REDUCED ALERTNESS88 - 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
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDHL6B 1 4
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Vehicle
Vehicle Owner
Insurance
School Bus
IN
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91 - Drugs Reported
SNOW,-ICE,-OR-WET
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
421PLS
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2016
59 - Exp Year
79506
55 - Vehicle Identification Number
2014
50 - Year
DODG
51 - Make
CARAVAN
52 - Model
MV - MINI VAN
53 - Body Style
TAN
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT DRIVER SIDE, FRONT, UNDERCARRIAGE, FRONT PASSENGER SIDE, REAR PASSENGER SIDE, REAR
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
HILGENDORF
46 - Vehicle Owner Last Name
GARY
46 - First Name
A
46 - Middle Initial 46 - Suffix
01/09/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
UNKNOWN63 - Liability Insurance Company Policy Holder Same As Owner60
61 - Policy Holder Last Name 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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PK2012
Wisconsin Motor Vehicle
Accident Report
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MV4000e 01/2005
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PK2012
Wisconsin Motor Vehicle GZDHL6B 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
TOWN OF HAYWARD
84 - Company Name
COUNTY/MUNICIPAL
Government Property Type
15460W STATE HWY 77
85 - Address Street & Number 85 - PO Box
HAYWARD
86 - City
WA
86 - State
54843
86 - Zip Code
(715) 634-4123 EXT.
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
N. RASCHKA
ON NOVEMBER 16, 2015 I DEPUTY RASCHKA RESPONDED TO A VEHICLE IN THE DITCH ON STATE HWY 77 AT WHEELER RD. WHEN I
ARRIVED ON-SCENE I OBSERVED A TAN DODGE VAN IN THE NORTHBOUND DITCH OF STATE HWY 77, FACING EASTBOUND. I
SPOKE TO A WITNESS, JOHN R LOUGHREN 2/27/48 WHO STATED HE OBSERVED THE VAN VERE FROM THE EASTBOUND LN INTO
THE WESTBOUND LN AND HIT THE NORTH DITCH, TRAVELING FOR A SHORT DISTANCE BEFORE COMING TO A REST. HE STATED
THE DRIVER WAS A MALE AND THAT HE CHECKED ON HIM. HE STATED HE WAS ALERT HOWEVER APPEARED VERY DISORIENTED. I
RELEASED MR. LOUGHREN. I MADE CONTACT WITH THE OPERATOR, IDENTIFIED AS GARY HILGENDORF. MR. HILGENDORF COULD ONLY GIVE VERY SHORT ANSWERS, AND COULD NOT ANSWER MANY OF MY QUESTIONS. HE STATED HE HAD NOT BEEN
DRINKING, BUT HAD A HARD TIME REMEMBERING WHERE HE WAS COMING FROM OR IF HE WAS TAKING MEDICATION. CHIEF
MROTEK OF TOWN OF HAYWARD ARRIVED ON-SCENE AND ADVISED MR. HILGENDORF HAS A HISTORY OF DIABETIC ISSUES, EMS
ARRIVED AND ADVISED IT WAS A LOW BLOOD SUGAR MEDICAL ISSUE AND TOOK MR. HILGENDORF TO THE HOSPITAL. PHOTOS
WERE TAKEN OF THE SCENE, APPEARED TO ME MODERATE DAMAGE TO MOST AREAS OF THE VEHICLE. A-1 TOWING REMOVED
THE VEHICLE. END OF REPORT.
ON NOVEMBER 16, 2015 I DEPUTY RASCHKA RESPONDED TO A VEHICLE IN THE DITCH ON STATE HWY 77 AT WHEELER RD. WHEN I
ARRIVED ON-SCENE I OBSERVED A TAN DODGE VAN IN THE NORTHBOUND DITCH OF STATE HWY 77, FACING EASTBOUND. I
SPOKE TO A WITNESS, JOHN R LOUGHREN 2/27/48 WHO STATED HE OBSERVED THE VAN VERE FROM THE EASTBOUND LN INTO
THE WESTBOUND LN AND HIT THE NORTH DITCH, TRAVELING FOR A SHORT DISTANCE BEFORE COMING TO A REST. HE STATED
THE DRIVER WAS A MALE AND THAT HE CHECKED ON HIM. HE STATED HE WAS ALERT HOWEVER APPEARED VERY DISORIENTED. I
RELEASED MR. LOUGHREN. I MADE CONTACT WITH THE OPERATOR, IDENTIFIED AS GARY HILGENDORF. MR. HILGENDORF COULD ONLY GIVE VERY SHORT ANSWERS, AND COULD NOT ANSWER MANY OF MY QUESTIONS. HE STATED HE HAD NOT BEEN
DRINKING, BUT HAD A HARD TIME REMEMBERING WHERE HE WAS COMING FROM OR IF HE WAS TAKING MEDICATION. CHIEF
MROTEK OF TOWN OF HAYWARD ARRIVED ON-SCENE AND ADVISED MR. HILGENDORF HAS A HISTORY OF DIABETIC ISSUES, EMS
ARRIVED AND ADVISED IT WAS A LOW BLOOD SUGAR MEDICAL ISSUE AND TOOK MR. HILGENDORF TO THE HOSPITAL. PHOTOS
WERE TAKEN OF THE SCENE, APPEARED TO ME MODERATE DAMAGE TO MOST AREAS OF THE VEHICLE. A-1 TOWING REMOVED
THE VEHICLE. END OF REPORT.
Officer Information
Accident Report
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Wisconsin Motor Vehicle GZDHL6B 3 4
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125 - First Name 125 - Middle Initial
RASCHKA
125 - Officer Last Name
NICOLE 388
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
11/16/2015
132 - Date Notified 1248133 - Time Notified (Military Time)1250134 - Time Arrived (Military Time)
11/16/2015
135 - Date Of Report
15111603 19 - Special Study
18 - Agency Space
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDHL6B 4 4