Incident and Injury Report Form
The form will show further options as you start adding information. If you have any problems using the form email: R.Griffiths@englandlacrosse.co.uk
Game Details
Name
*
First Name
Last Name
Email
*
example@example.com
Date and Start Time of Game
*
-
Day
-
Month
Year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Type of Game
*
Men's Lacrosse
Women's Lacrosse
Mixed Lacrosse
BOX
Sixes
Which Region was the game played in?
*
North Women
South West Women
South East Women
Mixed
Indoor
Other Women
University Women
Schools
Juniors (not school)
Which Region was the game played in?
*
North Men
South Men
Midlands Men
Indoor
Other Men
Other Women
University Men
Schools
Juniors (not school)
What Division/ Event was the game?
*
If juniors also enter region
Home Team
*
Enter Home Team name
Away Team
*
Enter Away Team name
Head/ Lead Official
*
Enter head/lead officials name
Second Official's Name
*
If no second Official type 'None'
Third Official's Name
If no third Official type 'None'
CBO
If no CBO type 'None'
What are you reporting?
expulsion Foul
expulsion Foul (Fighting)
Personal Foul Limit (5 or more)
Participants Banished from game
Injuries
Other Incident
Men's Field
What are you reporting?
Red Card
Red Card Fighting
Red/Yellow Card
Participant Suspended
Injuries
Other Incident
Women's Field
What are you reporting?
Injuries
Other Incident
Fouling out - 3 yellows (9.2.7)
Deliberately striking or attempting to strike (12.1.1)
Leaving benches/pushing past an official to go to a fight (12.2.1)
3rd player into a fight (12.2.2)
Refusal to accept authority/threatening/foul/abusive language (12.2.3)
Fighting (12.2.4)
Deliberate body check of opponent in head/neck or from behind (12.2.5)
Dangerous propel (12.2.6W)
Sixes
What are you reporting?
Injuries
Other Incident
Stick (or part thereof) thrown outside playing area (3.2.7.i)
Obscene gestures seen by or reported to referee (3.2.7.ii)
Altercation between a spectator and a player/nonplaying team member (3.2.7.iii)
Infraction assessed as a match penalty/game misconduct/gross misconduct (3.2.7.iv)
BOX
Expulsion Foul/ Red Card- Fighting
If multiple people involved in a fight list other Names/Numbers/Team in Detail of Incident Area.
Which Official gave the decision?
*
Name the Official that witnessed the incident
Name of player/person being reported
*
If Person is unknown or has not been identified type 'Unknown'
Which team does the player/person being reported affiliate to
If Person is unknown or has not been identified type 'Unknown'
Player's Shirt Number
*
If player is Unknown type 'Unknown'. If Person being reported not a player enter 'N/A'
Please give Details of the incident
*
If struggling to write the incident Report in Word or Notepad and copy over.
Which expulsion offence is being reported?
*
78.1 Deliberately Striking or attempting to Strike.
78.2 When a person from a 'Frozen' bench enters the field.
78.3 When a third person enters an existing fight between two players.
78.4 Refusal to accept the authority of the Officials OR Use of threating, foul, and abusing language/gestures OR flagrant misconduct.
78.5 The use of racist or other discriminatory abuse
78.6 The deliberate and violent targeting of the head, neck, throat or genital area.
Select the expulsion offence that the player committed
Submit
Should be Empty: