HomeMy WebLinkAbout20180103 Smith.pdfSAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKRQ Wisconsin Motor Vehicle
Crash Report
Secondary
CrashAmendedCrash Type
DT4000 (Standard Crash)Reportable
TagsSchool Bus Related
NoActive School ZoneGovernment
Property
Trailer or TowedWork ZoneLane ClosureHit and RunOn Emergency
Total Killed
00
Total Injured
00
Total Units
01
Time Notified
04:23 PM
Date Notified
01/03/2018
Time Arrived
04:29 PM
Date Arrived
01/03/2018
Crash Time
04:20 PM
Crash Date
01/03/2018
Investigating Officer/Deputy
DEPUTY NATHAN FREY
Agency Crash Number
18010302
Primary Crash Document #Document Number Override
6V
L
1
3
Z
Q
K
R
Q
Additional InformationNone
Photos By
Reconstruction ByDiagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
UNIT 1 WAS NEGOTIATING RIGHT TURN OFF OF HIGHWAY 77 AND DUE TO ICY CONDITIONS LOST TRACTION. THE OPERATOR WAS UNABLE TO AVOID GOING INTO THE EASTBOUND LANE EMBANKMENT OF PENINSULA ROAD. THE VEHICLE SUSTAINED MINOR DAMAGE TO THE FRONT BUMPER
COVER AND DRIVERS SIDE INNER FENDER WELL. THE OPERATOR WAS NOT CITED. THE VEHICLE WAS REMOVED BY A-1 TOWING.
Crash Time 04:20 PM
Crash Date 01/03/2018Wisconsin Motor Vehicle Crash
Form DT4000 1 of 5
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKRQ Wisconsin Motor Vehicle
Crash Report
Structure Type
Y Coordinate
5105238.5
X Coordinate
158654.375
Longitude
-91.409698515
Latitude
46.015572405
ON PENINSULA RD
73 FT S
OF STH77 EB
IN THE TOWN OF HAYWARD
IN SAWYER COUNTY
Location
Special StudyAccess Control
Full Control
Tribal Land
Crash Classification - Jurisdiction
No Special Jurisdiction
Crash Classification - Location
Public Property
Relation To Trafficway
Trafficway - Not On Road
Animal Type
Weather Condition(s)
Snow
Environment Factor(s)
Weather Conditions
Roadway Factor(s)
Other
Road Surface Condition(s)
Snow, Ice
Light Condition
Daylight
Manner of Collision
No Collision W/Vehicle In Transport
First Harmful Event Location
Shoulder Right
First Harmful Event
Ditch
Crash Scene
Intersection Type
T-Intersection
Junction Location
Intersection
Within Interchange Area
NO
Reporting Threshold
No
Truck Bus or HazMat
No
Road Grade
Downhill
Road Curvature
Curve Right
Surface Type
Blacktop (Bituminous)
Traffic Control Inoperative/Missing
NO
Traffic Control
Stop Sign
Traffic Way
Two-Way, Not Divided
Emergency Motor Vehicle UseNot ApplicableSpecial FunctionNo Special FunctionMost Harmful Event: Collision With
Ditch
Total Lanes
2
Speed Limit
55Pre CrashTire
Mark
Direction Of Travel
Eastbound
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
2
Operating As EndorsementsVehicle Type
Passenger Car
Unit Type
Automobile
Vehicle Operating As Classification
D CLASS
Unit Status
In Transit
UN
I
T
01
Unit Summary
Extent Of Damage
Minor Damage
Vehicle Damage
11--Left Front Corner, 12--Front
Initial Contact Point
12--Front
Bus UseNot A BusBody Style
SD - SEDAN
Color
BGE - Beige
Model
ALTIMA
Year
2014
Make
NISSAN
Vehicle Identification Number
3656
Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - Automobile
License Plate Number
322SZE
VE
H
I
C
L
E
UN
I
T
01
Vehicle
Crash Time 04:20 PM
Crash Date 01/03/2018Wisconsin Motor Vehicle Crash
Form DT4000 2 of 5
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKRQ Wisconsin Motor Vehicle
Crash Report
Driver DistractionsNot Distracted
Driver Actions
Speed Too Fast/Cond
Driver Prior Action Other
Vehicle Factors
Tires
What Driver Was Doing
Right Turn
Vehicle Removed ByTowed Due To Damage
Not Towed
VE
H
I
C
L
E
UN
I
T
01
Address
HAYWARD, WI 54843 , US
Individual
01
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventMotor Veh In Transport01
EventEmbankment02
EventDitch03
Event
04
IndividualInsurance Company
USAA-GENERAL-INDEMNITY-CO
Policy Holder
UN
I
T
Crash Time 04:20 PM
Crash Date 01/03/2018Wisconsin Motor Vehicle Crash
Form DT4000 3 of 5
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKRQ Wisconsin Motor Vehicle
Crash Report
Individual Condition
Appeared Normal
Drug Type
Drug Test ResultsDrug Test TypeDrug Test GivenTest Not Given
Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given
Test Not Given
Suspected Drug UseSuspected Alcohol Use
Action Other
IN
D
I
V
I
D
U
A
L
UN
I
T
Action
To/From SchoolLocationPrior ActionStriking Unit #
00
1
01
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
Not Transported
Trapped/Extricated
Not Trapped
Ejection Path
Not Ejected/Not Applicable
Ejected
Not Ejected
Airbag
Non Deployed
Injury Severity
No Apparent Injury
IN
D
I
V
I
D
U
A
L
UN
I
T
Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
1--Front Seat-Left Side (Driver/Motorcycle/Bicycl
00
1
Safety Equipment
Shoulder & Lap Belt
On Duty Crash
01
ber
State: Wisconsin Country: UNITED STATES
Address
HAYWARD, WI 54843 , US
RaceINDIANDate of Birth
11/01/
Sex
Female
Citations Issued
0
Driver
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 04:20 PM
Crash Date 01/03/2018Wisconsin Motor Vehicle Crash
Form DT4000 4 of 5
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13ZQKRQ Wisconsin Motor Vehicle
Crash Report
Individual Condition
Appeared Normal
Drug Type
Drug Test ResultsDrug Test TypeDrug Test GivenTest Not Given
Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given
Test Not Given
Suspected Drug UseSuspected Alcohol Use
Action Other
IN
D
I
V
I
D
U
A
L
UN
I
T
Action
To/From SchoolLocationPrior ActionStriking Unit #
00
2
01
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
Not Transported
Trapped/Extricated
Not Trapped
Ejection Path
Not Ejected/Not Applicable
Ejected
Not Ejected
Airbag
Non Deployed
Injury Severity
No Apparent Injury
IN
D
I
V
I
D
U
A
L
UN
I
T
Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
3--Front Seat-Right Side (Train Engineers/Right
00
2
Safety Equipment
Shoulder & Lap Belt
On Duty Crash
01
ber
State: Wisconsin Country: UNITED STATES
Address
HAYWARD, WI 54843 , US
RaceDate of Birth
05/30/
Sex
Female
Citations Issued
0
Passenger
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 04:20 PM
Crash Date 01/03/2018Wisconsin Motor Vehicle Crash
Form DT4000 5 of 5
This report does not include any CJIS data.