6VL13ZQKRQ Document Number Override Crash Date /3/28 Date tified /3/28 On Emergency Government Property Reportable Description Diagram Primary Crash Document # Crash Time 4:2 PM Time tified 4:23 PM Hit and Run Active School Zone Lane Closure Crash Type DT4 (Standard Crash) Agency Crash Number 1832 Date Arrived /3/28 Total Units School Bus Related Work Zone Time Arrived 4:29 PM Total Injured Tags Investigating Officer/Deputy DEPUTY NATHAN FREY Trailer or Towed Amended Total Killed Reconstruction By Secondary Crash Photos By Additional Information ne Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report. 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 SUSTAINED MINOR DAMAGE TO THE FRONT BUMPER COVER AND DRIVERS SIDE INNER FENDER WELL. THE OPERATOR WAS NOT CITED. THE WAS REMOVED BY A-1 TOWING. Form DT4 1 of 5 Crash Date /3/28
ON PENINSULA RD 73 FT S OF STH77 EB IN THE TOWN OF HAYWARD IN SAWYER COUNTY Latitude 46.557245 X Coordinate 158654.375 Structure Type Longitude -91.49698515 Y Coordinate 515238.5 Crash Scene First Harmful Manner of Collision Collision W/Vehicle In Transport Road Surface Condition(s) Snow, Ice Environment Factor(s) Weather Conditions First Harmful Shoulder Right Light Condition Daylight Roadway Factor(s) Other Weather Condition(s) Snow Animal Type Crash Classification - Public Property Tribal Land Within Interchange Area NO Unit Summary Unit Status In Transit Vehicle Type Passenger Car Total Occs 2 Insurance? YES Most Harmful : Collision With Traffic Way Two-Way, t Divided Surface Type Blacktop (Bituminous) Truck Bus or HazMat Vehicle License Plate Number 322SZE Vehicle Identification Number 3656 Color BGE - Beige Initial Contact Point 12--Front Extent Of Damage Minor Damage Junction Intersection Train/Bus # Injured Direction Of Travel Eastbound Traffic Control Stop Sign Road Curvature Curve Right Intersection Type T-Intersection Total # Citations Issued Pre CrashTire Mark Special Function Special Function Relation To Trafficway Trafficway - t On Road Crash Classification - Jurisdiction Special Jurisdiction Access Control Full Control Vehicle Operating As Classification D CLASS Plate Type AUT - Automobile Make NISSAN Body Style SD - SEDAN Vehicle Damage Reporting Threshold 11--Left Front Corner, 12--Front Total Trailers Speed Limit 55 St WI Year 24 Unit Type Automobile Operating As Endorsements Emergency Motor Vehicle Use t Applicable Road Grade Downhill Total Lanes 2 Special Study Total HazMat Types Traffic Control Inoperative/Missing NO Country of Issuance ED STATES Model ALTIMA Bus Use t A Bus Form DT4 2 of 5 Crash Date /3/28
Towed Due To Damage t Towed What Driver Was Doing Right Turn Driver Prior Action Other Driver Actions Speed Too Fast/Cond Vehicle Removed By Vehicle Factors Tires Driver Distractions t Distracted OWNER 2 3 Vehicle Owner Sequence Of s Motor Veh In Transport Embankment, US 4 Policy Holder Insurance Company USAA-GENERAL-INDEMNITY-CO Form DT4 3 of 5 Crash Date /3/28
Driver, US Citations Issued Date of Birth 11// ber Sex Female Race INDIAN State: Wisconsin Country: ED STATES Equipment Helmet Use On Duty Crash Seat Position 1--Front Seat-Left Side (Driver/Motorcycle/Bicycl Safety Equipment Shoulder & Lap Belt Helmet Compliance Eye Protection Tint Compliance Ejected t Ejected Medical Transport t Transported Hospital Injury Severity Apparent Injury Airbag n Deployed Ejection Path t Ejected/t Applicable EMS Agency Identifier Date of Death Trapped/Extricated t Trapped EMS Run # Time of Death Striking Unit # Prior Action To/From School Action Injury n Motorist Action Other Drug & Alcohol Alcohol Test Given Drug Test Given Suspected Alcohol Use Suspected Drug Use Alcohol Test Type Drug Test Type Alcohol Test Results Drug Test Results Drug Type Condition Appeared rmal Form DT4 4 of 5 Crash Date /3/28
Passenger, US Citations Issued Date of Birth 5/3/ ber Sex Female Race State: Wisconsin Country: ED STATES 2 Equipment Helmet Use On Duty Crash Seat Position 3--Front Seat-Right Side (Train Engineers/Right Safety Equipment Shoulder & Lap Belt Helmet Compliance Eye Protection Tint Compliance Ejected t Ejected Medical Transport t Transported Hospital Injury Severity Apparent Injury Airbag n Deployed Ejection Path t Ejected/t Applicable EMS Agency Identifier Date of Death Trapped/Extricated t Trapped EMS Run # Time of Death Striking Unit # Prior Action To/From School Action 2 Injury n Motorist Action Other Drug & Alcohol Alcohol Test Given Drug Test Given Suspected Alcohol Use Suspected Drug Use Alcohol Test Type Drug Test Type Alcohol Test Results Drug Test Results Drug Type Condition Appeared rmal Form DT4 5 of 5 Crash Date /3/28