HomeMy WebLinkAbout20160116 Johnstone-MuellerAgency Accident Number
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Reportable Accident On Emergency Amended GZDC4V7
DOT Document Number Document Override Number
16011004
16
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01/10/2016
4 - Accident Date
1127
5 - Time of Accident (Military Time)
01
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County HAYWARD - 06, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
14 - On Hwy No.
LEIN RD
14 - On Street Name 14 - Bus/Frnt/Rmp
323 FT15 - Est. Distance SOUTH15 - Hwy. Dir
16 - Fr/At Hwy No.CO HILL RD16 - From/At Street Name 16 - Business/Frontage/Ramp
FIRE #
17 - Structure Type
10496N
17 - Structure Number
46.011351
12 - Latitude -91.51437113 - Longitude
MAILBOX80 - 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
OUTSIDE-SHOULDER-LEFT
117 - Relation To Roadway
DAYLIGHT114 - Light Condition ICE116 - 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
OP
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Unit Status
MAILBOX
81 - Most Harmful Event: Collision With
SOUTH
23 - Dir Of Travel
2524 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
J
29 - Driver's License Number
WI
30 - State
2020
31 - Expiration Year 34 - On Duty Accident
JOHNSTONE-MUELLER
25 - Operator/Pedestrian Last Name
TERESA
25 - First Name
L
25 - Middle Initial 25 - Suffix
05/07/1
32 - Date Of Birth
FEMALE
33 - Sex
26 - Address Street & Number 26 - PO Box
HAYWARD
27 - City
WI
27 - State
54843
27 - Zip Code
(216) 978-9622 EXT.
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
MAKING-LEFT-TURN
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.
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 GZDC4V7 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
686JVZ
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2016
59 - Exp Year
702
55 - Vehicle Identification Number
2005
50 - Year
BUIC
51 - Make
RAINIER
52 - Model
4H - HATCHBACK 4
53 - Body Style
TAN
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT, FRONT PASSENGER SIDE
94 - Vehicle Damage
MODERATE
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
JOHNSTONE-MUELLER
46 - Vehicle Owner Last Name
TERESA
46 - First Name
L
46 - Middle Initial 46 - Suffix
05/07/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code (216) 978-9622 EXT.49 - Telephone Number
SECURA-INS-A-MUTUAL-CO63 - Liability Insurance Company Policy Holder Same As Owner60
JOHNSTONE-MUELLER
61 - Policy Holder Last Name
TERESA
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
L
106 - Power Unit Number License Plate Number Plate Type State Expiration Year
Trailer Make Unit Type Vehicle Identification Number
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Wisconsin Motor Vehicle GZDC4V7 2 424
Fixed Objects Struck
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Property
INDIVIDUAL
Organization Type
DILLER
84 - Property Owner Last Name
EDITH
84 - First Name 84 - Middle Initial 84 - Suffix
01
84 - Company Name Government Property Type
85 - PO Box
HAYWARD
86 - City
WI
86 - State
54843
86 - Zip Code
(715) 634-6859 EXT.
87 - Telephone Number
83 - Government Damage Tag Number
01
82 - Striking Unit
MAILBOX
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 1-10-16 AT 1126 DEPUTY NELSON WAS DISPATCHED FOR A VEHICLE IN THE DITCH AT LEIN RD AND COUNTY HILL RD. DEPUTY
NELSON ARRIVED ONSCENE AT 1130 DEPUTY NELSON OBSERVED A VEHICLE IN THE DITCH ON LEIN RD JUST OFF OF COUNTY
HILLL RD. DEPUTY NELSON MADE CONTACT WITH THE DRIVER OF THE VEHICLE ID AS TERESA JOHNSTON-MUELLER. TERESA
ADVISED DEPUTY NELSON THAT SHE WAS TURNING ONTO LEIN RD OFF OF COUNTY HILL RD WHEN HER VEHICLE SPUN AROUND
AND SHE WEN INTO THE DITCH. DEPUTY NELSON NOTED THAT THE ROAD WAS ICE COVERED. DEPUTY NELSON LOOK AT THE
FRONT END OF HE VEHICLE AND OBSERVED MODERATE DAMAGE TO THE FRONT AND THAT THERE WAS ALSO A MAILBOX THAT HAD BEEN RUN OVER. DEPUTY NELSON WAITED ONSCENE UNTIL THE TOW TRUCK REMOVED THE VEHCIEL END OF REPORT
ON 1-10-16 AT 1126 DEPUTY NELSON WAS DISPATCHED FOR A VEHICLE IN THE DITCH AT LEIN RD AND COUNTY HILL RD. DEPUTY
NELSON ARRIVED ONSCENE AT 1130 DEPUTY NELSON OBSERVED A VEHICLE IN THE DITCH ON LEIN RD JUST OFF OF COUNTY
HILLL RD. DEPUTY NELSON MADE CONTACT WITH THE DRIVER OF THE VEHICLE ID AS TERESA JOHNSTON-MUELLER. TERESA
ADVISED DEPUTY NELSON THAT SHE WAS TURNING ONTO LEIN RD OFF OF COUNTY HILL RD WHEN HER VEHICLE SPUN AROUND
AND SHE WEN INTO THE DITCH. DEPUTY NELSON NOTED THAT THE ROAD WAS ICE COVERED. DEPUTY NELSON LOOK AT THE
FRONT END OF HE VEHICLE AND OBSERVED MODERATE DAMAGE TO THE FRONT AND THAT THERE WAS ALSO A MAILBOX THAT HAD BEEN RUN OVER. DEPUTY NELSON WAITED ONSCENE UNTIL THE TOW TRUCK REMOVED THE VEHCIEL END OF REPORT
Officer Information
Accident Report
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Wisconsin Motor Vehicle GZDC4V7 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
01/10/2016
132 - Date Notified 1126133 - Time Notified (Military Time)1130134 - Time Arrived (Military Time)
01/12/2016
135 - Date Of Report
16011004 19 - Special Study
18 - Agency Space
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Wisconsin Motor Vehicle GZDC4V7 4 4