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Misconduct Report
This form is to be used as a recording document following the issuing of a Red Card. It should be submitted within 48 hours of the incident.
13
Questions
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League
*
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Senior Mens
Senior Womens
Junior Mixed
Junior Girls
Non-Competitive
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2
Which Division/Grade/League?
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League 1 Men’s
League 1 Reserves
League 1 Women’s
League 2 Men’s
League 2 Women’s
Youth
Under 18
Under 16
Under 16A
Under 16B
Under 16 Girls
Under 14
Under 14A
Under 14B
Under 14 Girls
Under 13
Under 12
Under 12A
Under 12B
Under 12C
Under 12 Girls
Non-Competitive (Indicate Age Group in Comments)
League 1 Men’s
League 1 Reserves
League 1 Women’s
League 2 Men’s
League 2 Women’s
Youth
Under 18
Under 16
Under 16A
Under 16B
Under 16 Girls
Under 14
Under 14A
Under 14B
Under 14 Girls
Under 13
Under 12
Under 12A
Under 12B
Under 12C
Under 12 Girls
Non-Competitive (Indicate Age Group in Comments)
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3
Match Details
*
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Home Team
Away Team
Venue
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4
Date
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Date
Month
Day
Year
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5
Player Details
*
This field is required.
Name
FFA Number
Shirt Number
Please Select
Border Raiders FC
Castlemaine Goldfields SC
Deniliquin Wanderers
Epsom FC
FC Eaglehawk
Golden City SC
Kyneton District
Latrobe University SC
Shepparton SC
Shepparton Lushi FC
Shepparton South SC
Shepparton United SC
Spring Gully SC
Strathdale SC
Strathfieldsaye Colts United FC
Swan Hill SC
Tatura SC
Please Select
Please Select
Border Raiders FC
Castlemaine Goldfields SC
Deniliquin Wanderers
Epsom FC
FC Eaglehawk
Golden City SC
Kyneton District
Latrobe University SC
Shepparton SC
Shepparton Lushi FC
Shepparton South SC
Shepparton United SC
Spring Gully SC
Strathdale SC
Strathfieldsaye Colts United FC
Swan Hill SC
Tatura SC
Club
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6
Incident Details
What minute did the incident occur?
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How far from the ball did the incident occur?
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How far away from the incident was the referee?
If anyone was injured - Please Specify
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7
Please highlight the applicable box indicating why the Red Card was issued.
*
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R1 - Denying a goal scoring opportunity - Handling the Ball
R2 - Denying a goal scoring opportunity - Foul
R3 - Serious Foul Play
R4 - Spitting
R5 - Violent Conduct
R6 - Offensive, Insulting, Abusive or intimidating language and/or gestures
R7 - Receiving a Second Caution in the same Match
R8 - Offences against Match Officials
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8
Please upload the Official Match Record
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9
What happened? (Please use wording from the GDT, quote and use exact language where applicable)
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10
Were there any problems after the red card was shown?
*
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(If YES please complete a separate incident report with all details)
YES
NO
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11
Referee Name
*
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First Name
Last Name
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12
Contact Details
*
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Please enter your phone
Please enter your email
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13
Electronic Signature
Clear
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