Basketball Victoria Report Form

Basketball Victoria Report Form
DATE OF MATCH*

DayMonthYear
Date
Association / Location*
Where the offense happened (ex. BSC, Court 1)
Time*

Hour Minutes

AM/PM Option
Reported Person*
Details of person who has committed the offense
Team
Playing Number
Type*
OFFENCE WITH WHICH PERSON/TEAM CHARGED (TICK APPROPRIATE BOXES)
TICK “A” FOR AN OFFENCE AGAINST A PERSON OTHER THAN AN OFFICIAL

TICK “B” FOR OFFENCE AGAINST AN OFFICIAL
Attempt to Elbow (10*)(52*)

AB
Attempt to Kick (10*)(52*)

AB
Attempt to Strike (10*)(52*)

AB
Attempt to Trip (10*)(52*)

AB
Bring Basketball into disrepute (19*)

Yes
Cause Damage (52*)

Yes
Cause injury (52*)

Yes
Dispute Decisions (6*)

Yes
Elbowing (52*) (Life*)

AB
Endanger with blood, etc. (LIFE*)

Yes
Fighting (52*)

Yes
Gross Breach of Code (6*)

Yes
Kicking (52*) (LIFE*)

AB
Obscene Gesture (10*)(20*)

AB
Obscene Language (10*)(20*)

AB
Participate while Suspended (2-5*)

Yes
Putting in Fear (52*)(104*)

AB
Spitting (20*)(52*)

AB
Striking (52*) (LIFE*)

AB
Threatening (52*) (104*)

AB
Tripping (52*) (LIFE*)

AB
Tunneling (104*)

Yes
Unsportsmanlike Behaviour (6*)

Yes
Assault (52*) (LIFE*)

AB
Avoidable Contact with Official (52*)

Yes
Cheating (LIFE*)

Yes
DESCRIPTION OF CHARGES

Write all details of the event and incidents being reported on. Please indicate if any of the offences occurred multiple times (e.g. the player reported swore at you on two different occasions would be 2x offensive language B)
Description of Charges:*
Write a description of incidents that occurred with as much detail as possible
Reporting Official believes this to be minor and suitable for Alternative Procedure*
CONTACT INFORMATION

Be sure to have accurate information for all parties present, details are not passed onto reporting players.
Reporting Official:*

First NameLast Name
Reporting Official's Email*
example@example.com
Second Official:

First NameLast Name
Second Official's Email
example@example.com
Scorekeeper / Timer
Name / phone number or email
Any other observer of the incident
Name / phone number or email
Further witnesses
SIGNATURE OF REPORTING OFFICIAL*

Clear
By signing this, you agree that all reported incidents are truthful to your knowledge and witnessed by yourself
Should be Empty:

Basketball Victoria Report Form

OFFENCE WITH WHICH PERSON/TEAM CHARGED (TICK APPROPRIATE BOXES)

DESCRIPTION OF CHARGES

CONTACT INFORMATION