HomeMy WebLinkAbout20180731 LEVERTON.pdf18073105
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL151TJN8 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
08:04 PM
Date Notified
07/31/2018
Time Arrived
08:04 PM
Date Arrived
07/31/2018
Crash Time
08:03 PM
Crash Date
07/31/2018
Investigating Officer/Deputy
DEPUTY MATTHEW JEFSON
Agency Crash NumberPrimary Crash Document #Document Number Override
6V
L
1
5
1
T
J
N
8
Additional InformationPHOTOS
Photos ByDEPUTY JEFSON
Reconstruction ByDiagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
I DEPUTY MATTHEW JEFSON OF THE SAWYER COUNTY SHERIFF'S DEPARTMENT WAS PULLING INTO A SIDE ROAD BETWEEN CTH CC AND CTH N TO MEET WITH LCO OFFICER I NOTICED THAT OFFICER LEVERTON WAS TURNING AROUND AND THAT AS HE TURNED AROUND
IN THE HIGH GRASS HE STRUCK SOMETHING. OFFICER THEN BACKED UP AND THE FRONT SKIRT ON THE SQUAD CAR WAS DAMAGED. I
GOT OUT AND NOTICED THAT HE STRUCK A SMALL CAST IRON PIPE THAT WAS HIDDEN IN THE HIGH GRASS. I THEN TOOK PHOTOS OF THE
DAMAGE AND FOLLOWED OFFICER LEVERTON TO THE LCO PD WHERE HE LEFT THE SQUAD.
Crash Time 08:03 PM
Crash Date 07/31/2018This report does not include any CJIS data.
4of1
Wisconsin Motor Vehicle Crash
Form DT4000
18073105
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL151TJN8 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
Y Coordinate
5089239.5
X Coordinate
165832.96875
Longitude
-91.306076834
Latitude
45.875518817
ON CTHCC
470 FT S
OF CTHN
IN THE TOWN OF COUDERAY
IN SAWYER COUNTY
Location
Special StudyAccess Control
NO 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)
CLEAR
Environment Factor(s)
NONE
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
OFF ROADWAY, LOCATION UNKNOWN
First Harmful Event
OTHER FIXED OBJECT
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
UNKNOWN
Surface Type
DIRT
Traffic Control Inoperative/Missing
NO
Traffic Control
NO CONTROL
Traffic Way
UNKNOWN
Emergency Motor Vehicle Use
NON-EMERGENCY, NON-TRANSPORT
Special Function
POLICEMost Harmful Event: Collision With
OTHER FIXED OBJECT
Total Lanes
0
Speed LimitPre CrashTire
Mark
Direction Of Travel
NOT ON ROADWAY
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
1
Operating As EndorsementsVehicle Type
PASSENGER CAR01
Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UN
IT
Extent Of Damage
MINOR DAMAGE
Vehicle Damage
12--FRONT
Initial Contact Point
12--FRONT
Bus UseNOT A BUSBody Style
UT - SPORT UTILITY VEHICLE
Color
BLK - BLACK
Model
TAHOE
Year
2014
Make
CHEVROLET
Vehicle Identification Number
814180101
Country of Issuance
UNITED STATES
St
WI
Plate Type
LCO - LAC COURTE OREI
License Plate Number
VE
H
I
C
L
E
UN
I
T
Vehicle
Crash Time 08:03 PM
Crash Date 07/31/2018This report does not include any CJIS data.
4of2
Wisconsin Motor Vehicle Crash
Form DT4000
18073105
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL151TJN8 WISCONSIN MOTOR VEHICLE
CRASH REPORT
01
Driver DistractionsNOT DISTRACTED
01
Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
LEFT TURN
Vehicle Removed By
OPERATOR
Towed Due To Damage
NOT TOWED
UN
I
T
VE
H
I
C
L
E
Address
HAYWARD, WI 54843 , US
Government
VE
H
I
C
L
E
OW
N
E
R
UN
I
T
Vehicle Owner
Sequence Of Events
EventOTHER FIXED OBJECT01
Event
02
Event
03
Event
04
GovernmentInsurance Company
M3 INSURANCE SOLUTIONS
Policy Holder
UN
I
T
Injury Airbag
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00
1
01
Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
POLICE
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
HAYWARD, WI 54843 , US
Race
WHITE
Date of Birth
06/02/
Sex
MALE
Citations Issued
0
Driver
IT
Equipment
Individual
UN
IN
D
I
V
ID
U
A
L
Crash Time 08:03 PM
Crash Date 07/31/2018This report does not include any CJIS data.
4of3
Wisconsin Motor Vehicle Crash
Form DT4000
18073105
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL151TJN8 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00
1
01
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
Action
To/From SchoolLocationPrior ActionStriking Unit #
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABL
Ejected
NOT EJECTED
UN
I
T
Non Motorist
IN
D
I
V
I
D
U
A
L
Crash Time 08:03 PM
Crash Date 07/31/2018This report does not include any CJIS data.
4of4
Wisconsin Motor Vehicle Crash
Form DT4000