Form Rx5h733 - Wisconsin Motor Vehicle Accident Report
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6Wisconsin Motor Vehicle
Page
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RX5H733
Accident Report
MV4000e 01/2005
PK2012
DOT Document Number
Document Override Number
Reportable Accident
On Emergency
Amended
RX5H733
Agency Accident Number
Police Number
15-007286
15-007286
4 - Accident Date
5 - Time of Accident (Military Time)
6 - Total Units
7 - Total Injured
8 - Total Killed
03/14/2015
0943
02
00
00
2 - County
3 - Municipality
11 - Accident Location
NON-INTERSECTION
KENOSHA - 30
KENOSHA - 52, CITY
14 - On Hwy No.
14 - On Street Name
14 - Bus/Frnt/Rmp
15 - Est. Distance
15 - Hwy. Dir
55TH ST
EAST
16 - Fr/At Hwy No.
16 - From/At Street Name
16 - Business/Frontage/Ramp
22ND AVE
17 - Structure Type
17 - Structure Number
12 - Latitude
13 - Longitude
-87.835421
42.584871
80 - First Harmful Event
93 - Manner of Collision
TREE
SIDESWIPE. SAME DIRECTION
112 - Access Control
113 - Road Curvature
113 - Road Terrain
Surface Type
NO CONTROL
STRAIGHT
LEVEL/FLAT
BLACKTOP, BITUMINOUS, OR ASPHALT - 2
115 - Traffic Way
NOT-PHYSICALLY-DIVIDED-(2-WAY TRAFFIC)
117 - Relation To Roadway
ON-ROADWAY
114 - Light Condition
116 - Road Surface Condition
118 - Weather
DAYLIGHT
DRY
CLEAR
9
9
9
9
9
Hit and Run
Government Property
Fire
Photos Taken
Trailer or Towed
9
9
9
9
Truck, Bus, or Hazardous Materials
Load Spillage
Construction Zone
Names Exchanged
101
102
103
79 - E M S Number
Supplemental Reports
Witness Statements
Measurements Taken
Operator/Pedestrian
Unit Status
81 - Most Harmful Event: Collision With
23 - Dir Of Travel
24 - Speed Limit
H - HIT AND RUN
PARKED MOTOR VEHICLE
EAST
25
36 - Operating as Classified
37 - Endorsements
35
D CLASS
Operating Commercial Motor Vehicle
29 - Driver's License Number
30 - State
31 - Expiration Year
34 - On Duty Accident
WI
2000
25 - Operator/Pedestrian Last Name
25 - First Name
25 - Middle Initial
25 - Suffix
SILER
AARON
M
32 - Date Of Birth
33 - Sex
MALE
26 - Address Street & Number
26 - PO Box
27 - City
27 - State
27 - Zip Code
28 - Telephone Number
KENOSHA
WI
53140
EXT.
39 - Seat Position
40 - Safety Equipment
FRONT-SEAT-LEFT-SIDE-(MC/BIKE DRIVER, TRAIN CONDUCTOR)
RESTRAINT-USE-UNKNOWN
38 - Injury Severity
41 - Airbag
42 - Ejected
44
N - NO APPARENT INJURY
DEPLOYED
NOT-EJECTED
Medical Transport
43 - Trapped/Extricated
92 - Pedestrian Location
92 - Pedestrian Action
NOT-TRAPPED
119 - What Driver Was Doing
120 - Traffic Control
62 - No. of Citations Issued
0
MAKING-LEFT-TURN
NO-CONTROL
64 - 1st Statute No.
64 - 2nd Statute No.
64 - 3rd Statute No.
64 - 4th Statute No.
64 - 5th Statute No.
122 - Driver Factors
EXCEEDING-SPEED-LIMIT, SPEED-TOO-FAST-FOR-CONDITIONS, IMPROPER-TURN
89 - Substance Presence
88 - Driver or Pedestrian Cond
NOT OBSERVED
UNKNOWN
90 - Alcohol Test
90 - Alcohol Content
91 - Drug Test
TEST NOT GIVEN
TEST NOT GIVEN
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