HomeMy WebLinkAbout20180706 smith.pdf18070606
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN0J 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
01
Total Units
01
Time Notified
03:16 PM
Date Notified
07/06/2018
Time Arrived
03:31 PM
Date Arrived
07/06/2018
Crash Time
03:00 PM
Crash Date
07/06/2018
Investigating Officer/Deputy
DEPUTY KEVIN GILLIS
Agency Crash NumberPrimary Crash Document #Document Number Override
6V
L
1
2
X
V
N
0
J
Additional InformationPhotos, Reconstruction
Photos ByDEPUTY KEVIN GILLIS
Reconstruction BySAWYER COUNTY SHERIFFDiagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
VEHICLE WAS TRAVELING NORTH ON CTH NN BY WORLDS END RD. THE DRIVER AVOIDED A BEAR AND BY DOING SO THE VEHICLE'S PASSENGER SIDE TIRES HIT THE EAST SIDE GRAVEL SHOULDER. THE VEHICLE LOST CONTROL AND ROLLED AN UNKNOWN AMOUNT OF TIMES BEFORE COMING
TO REST ON ITS TOP APPROX 330 FEET FROM THE INITIAL CONTACT POINT WITH THE SHOULDER.
Crash Time 03:00 PM
Crash Date 07/06/2018Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
18070606
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN0J Wisconsin Motor Vehicle
Crash Report
Structure Type
Y Coordinate
5100002
X Coordinate
165602.28125
Longitude
-91.316540084
Latitude
45.972001801
INTERSECTION
ON CTHNN
AT WORLDS END RD
IN THE TOWN OF HAYWARD
IN SAWYER COUNTY
Location
Special StudyAccess Control
Partial Control
Tribal Land
Crash Classification - Jurisdiction
No Special Jurisdiction
Crash Classification - Location
Public Property
Relation To Trafficway
Trafficway - On Road
Animal Type
Bear
Weather Condition(s)
Clear
Environment Factor(s)
Animal (s) in roadway
Roadway Factor(s)
None
Road Surface Condition(s)
Dry
Light Condition
Daylight
Manner of Collision
No Collision W/Vehicle In Transport
First Harmful Event Location
On Roadway
First Harmful Event
Overturn/Rollover
Crash Scene
Intersection Type
Not an Intersection
Junction Location
Non-Junction
Within Interchange Area
NO
Reporting Threshold
No
Truck Bus or HazMat
No
Road Grade
Level
Road Curvature
Curve Left
Surface Type
Blacktop (Bituminous)
Traffic Control Inoperative/Missing
NO
Traffic Control
No Control
Traffic Way
Divided Hwy W/O Traffic Barrier
Emergency Motor Vehicle UseNot ApplicableSpecial FunctionNo Special FunctionMost Harmful Event: Collision With
Overturn/Rollover
Total Lanes
2
Speed Limit
55Pre CrashTire
Mark
Direction Of Travel
Northbound
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
1
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
Disabling Damage
Vehicle Damage
All Areas
Initial Contact Point
Unknown
Bus UseNot A BusBody Style
4D - 4DR
Color
BLU - Blue
Model
ACCORD
Year
2006
Make
HONDA
Vehicle Identification Number
1HGCM56166A
Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - Automobile
License Plate Number
VE
H
I
C
L
E
UN
I
T
01
Vehicle
Crash Time 03:00 PM
Crash Date 07/06/2018Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
18070606
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN0J Wisconsin Motor Vehicle
Crash Report
Driver DistractionsUnknown If Distracted
Driver Actions
No Contributing Action
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Going Straight
Vehicle Removed By
ROADRUNNER TOWING
Towed Due To Damage
Towed Due To Disabling Damage
VE
H
I
C
L
E
UN
I
T
01
Address
RICE LAKE, WI 54868 , US
Individual
01
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventOverturn/Rollover01
Event
02
Event
03
Event
04
IndividualInsurance Company
PEKIN-INS-CO
Policy Holder
UN
I
T
Crash Time 03:00 PM
Crash Date 07/06/2018Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
18070606
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN0J 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
HAYWARD AREA MEMORIAL HOSPITAL
EMS Run #EMS Agency IdentifierMedical Transport
Other
Trapped/Extricated
Not Trapped
Ejection Path
Not Ejected/Not Applicable
Ejected
Not Ejected
Airbag
Unknown
Injury Severity
Possible 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
Driver License NumberS5302050016907
State: Wisconsin Country: UNITED STATES
Address2626 15TH ST
RICE LAKE, WI 54868 , US
RaceWHITEDate of Birth
05/09/2000
Sex
Male
Citations Issued
0
DriverETHAN E SMITH
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 03:00 PM
Crash Date 07/06/2018Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.