Referee's Discipline Report

Referee's Discipline Report

This form is for referees to submit any disciplinary actions taken during a match. The referee will receive a copy of this report. The referee may wish to referee the 2023-2024 Game Management Guidelines, page 7, charts around foul play.
THIS SECTION IS ABOUT THE REFEREE
Referee Name*

First NameLast Name
Referee Email*
example@example.com
THIS SECTION IS ABOUT THE MATCH
Match Level*

Men's ClubWomen's ClubMen's CollegeWomen's CollegeBoys HS Div IBoys HS Div IIGirls HS Div IGirls HS Div IIBoys Grade 7/8Girls Grade 7/8Coed Grad 5/6Flag Grade 2/3/4
Date of Match*

MonthDayYear
Date
Venue*
Home Team*
Away Team*
if out of state team, please note state in parenthesis (CA)
Final Score*
THIS SECTION IS ABOUT THE INCIDENT
Player Name*
Player Team*
Action Taken*

Yellow Card2nd Yellow Card / Red CardRed Card
Time elapsed in match when incident occurred*
Was the incident reported by an Assistant Referee?*

NoYes
If Yes, please include AR Name and Email Address
Select ALL applicable laws*

9.1-9.6 Obstruction9.7 Unfair Play9.8-9.10 Repeated Infringements9.11 Dangerous Play (dangerous or reckless play)9.12 Dangerous Play (physical abuse)9.12 Dangerous Play (verbal abuse)9.13 Dangerous Play (dangerous tackle)9.14-915 Tackling Player Without The Ball9.16 No Wrap Tackle or Tackle Attempt9.17 Playing Person In The Air9.18 Tip/Dump Tackle9.19 Dangerous Play In The Scrum9.20 Dangerous Play In Ruck Or Maul9.21 Retaliation9.22 Cavalry Charge or Flying Wedge9.23 Kicking Ball From Ball Carriers Hands9.24 Dangerous Fend or Fend To The Face9.25 Charge or Obstruct Kicker9.29 Not Safely Lowering Lifted Teammate9.27 Misconduct9.28 Match Official AbuseOther
Description of incident*
Was there direct contact with the head?*

YesNoUnsureDoes not apply
Was it? (Check all that apply)*

IntentionalRecklessAvoidableAccidentalDirect ContactIndirect ContactHigh ForceLow ForceRepeated InfringementOther
How would you rate the level of severity of the incident?*

MinimalModerateSevere
Was the other player injured?*

YesNoUsure
What was the player's reaction to being cautioned/suspended (yellow) or sent off (red)?*
include reaction when returning from yellow. Did they apologize, accept reasonability, show concern for another player, were they defiant, abusive, etc.?
Please report any aggravating factors, if any
Please report any mitigating factors, if any
Upload Picture(s) / Video

Cancelof
Link to Picture(s) / Video
Is there another discipline report for this match?*

YesNo
Should be Empty: