HomeMy WebLinkAbout20180911 ORSZULAK.pdf18091102
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN0M WISCONSIN MOTOR VEHICLE
CRASH REPORT
Secondary
CrashAmendedCrash Type
DT4000 (STANDARD CRASH)Reportable
TagsSchool Bus Related
NOActive School ZoneGovernment
Property
Reporting
ThresholdTrailer or TowedWork ZoneLane ClosureHit and RunOn Emergency
Total Killed
00
Total Injured
01
Total Units
01
Time Notified
07:50 AM
Date Notified
09/11/2018
Time Arrived
07:52 AM
Date Arrived
09/11/2018
Crash Time
07:47 AM
Crash Date
09/11/2018
Investigating Officer/Deputy
DEPUTY KEVIN GILLIS
Agency Crash Number
18091102
Primary Crash Document #Document Number Override
6V
L
1
2
X
V
N
0
M
Additional InformationPHOTOS, RECONSTRUCTION
Photos ByDEPUTY KEVIN GILLIS
Reconstruction BySAWYER COUNTY SHERIFFDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
MOTORCYCLE WAS NEGOTIATING A LEFT TURN TO TRAVEL SOUTH ON CTH E. THE MOTORCYCLE WENT OFF THE ROADWAY AND WENT INTO THE
DITCH. THE MOTORCYCLE LAID DOWN ON IT'S RIGHT SIDE AND CAME TO A REST ON IT'S SIDE FACING NORTH.
Crash Time 07:47 AM
Crash Date 09/11/2018Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
18091102
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN0M WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
Y Coordinate
5088522
X Coordinate
152302.171875
Longitude
-91.479388397
Latitude
45.862388484
ON CTHE SB
619 FT N
OF THORS LN
IN THE TOWN OF SAND LAKE
IN SAWYER COUNTY
Location
Special Study
1
Access Control
NO CONTROL
Tribal Land
Crash Classification - Jurisdiction
NO SPECIAL JURISDICTION
Crash Classification - Location
PUBLIC PROPERTY
Relation To Trafficway
TRAFFICWAY - 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
ON ROADWAY
First Harmful Event
DITCH
Crash Scene
Intersection Type
NOT AN INTERSECTION
Junction Location
NON-JUNCTION
Within Interchange Area
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 Use
EMERGENCY OPERATION, EMERGEN
Special Function
NO SPECIAL FUNCTIONMost Harmful Event: Collision With
DITCH
Total Lanes
2
Speed Limit
55Pre CrashTire
Mark
Direction Of Travel
SOUTHBOUND
Insurance?
UNKNOWN
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
1
Operating As EndorsementsVehicle Type
MOTORCYCLE01
Unit Type
MOTORCYCLE
Vehicle Operating As Classification
M CLASS
Unit Status
IN TRANSIT
Unit Summary
UN
IT
Extent Of Damage
DISABLING DAMAGE
Vehicle Damage
1--RIGHT FRONT CORNER, 2--RIGHT SIDE FRONT
Initial Contact Point
UNKNOWN
Bus UseNOT A BUSBody Style
MC - MOTORCYCLE
Color
RED - RED
Model
FLSTCI
Year
2005
Make
HARLEY DAVIDSON
Vehicle Identification Number
16270101
Country of Issuance
UNITED STATES
St
WI
Plate Type
CYC - CYCLE
License Plate Number
VE
H
I
C
L
E
UN
I
T
Vehicle
Crash Time 07:47 AM
Crash Date 09/11/2018Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
18091102
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN0M WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
STONE LAKE, WI 54876 , US
Owner Name
01
Driver DistractionsUNKNOWN IF DISTRACTED
01
Driver Actions
UNKNOWN
Driver Prior Action Other
Vehicle Factors
UNKNOWN
What Driver Was Doing
NEGOTIATING CURVE
Vehicle Removed By
ROADRUNNER TOWING
Towed Due To Damage
TOWED DUE TO DISABLING DAMAGE
UN
I
T
VE
H
I
C
L
E
Sequence Of Events
EventDITCH01
EventOVERTURN/ROLLOVER02
Event
03
Event
04
Injury
EMS Run #EMS Agency Identifier
6001349
Medical Transport
EMS AIR
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABL
Ejected
NOT APPLICABLE
Airbag
NON DEPLOYED
Injury Severity
SUSPECTED SERIOUS INJUR00
1
01
Tint Compliance
UNKNOWN
Eye Protection
UNKNOWN
Helmet Compliance
UNKNOWN
Helmet Use
NO
Seat Position
1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY
Protective Gear
JACKET, LONG PANTS
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
STONE LAKE, WI 54876 , US
Race
WHITEDate of Birth
09/04
Sex
MALE
Citations Issued
0
Driver
IT
Equipment
Individual
UN
IN
D
I
V
ID
U
A
L
Crash Time 07:47 AM
Crash Date 09/11/2018Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
18091102
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN0M WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
CONFUSED OR DISORIENTED (NON LUCID)
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 Use
NO
Suspected Alcohol Use
NO
Action Other
Action
To/From SchoolLocationPrior ActionStriking Unit #
Time of DeathDate of DeathHospital
MAYO CLINIC HEALTH SYS-EAU CLAIRE
UN
I
T
Non Motorist
IN
D
I
V
I
D
U
A
L
Crash Time 07:47 AM
Crash Date 09/11/2018Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.