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REFEREE SEND OFF REPORT
Interdistrict Joint Competitions
Please provide details of the send off by answering the questions and writing a description of the send off as required. This report must be submitted by 9.00am on the next business day following the match.
Your Name
*
First Name
Last Name
Your Role
*
Please Select
Referee
Club Referee
Assistant Referee 1
Assistant Referee 2
4th Official
Your Email Address
*
example@example.com
Did you witness incident first hand or were you acting on information provided by your assistant (s)?
*
I witnessed incident and acted on the incident as I saw it;
I did not witness the incident and was acting on information provided by my assistant(s);
I witnessed incident and consulted with my assistant(s) to get a second opinion
Please provide the name(s) of the Assistant (s) you consulted
*
MATCH DETAILS
Please provide details of the match here, some of this information can be found on the Official Team Sheet.
Match Date
*
-
Day
-
Month
Year
Date
Minute of Send Off
*
Competition
*
Please Select
Interdistrict 12
Interdistrict 12 Girls
Interdistrict 13
Interdistrict 13 Girls
Interdistrict 14
Interdistrict 14 Girls
Interdistrict 15
Interdistrict 15 Girls
Interdistrict 16
Interdistrict 16 Girls
Interdistrict 17
Interdistrict 18
Interdistrict 18 Girls
Interdistrict 25
Interdistrict All Age
Interdistrict All Age Fri
Interdistrict All Age Women
Interdistrict All Age Women Fri
Interdistrict O/35 Fri
Interdistrict O/35 Sat
Interdistrict O/30 Women
Zone Premier League
Zone League One
Zone League Two
Grade
*
Please Select
A
B
C
D
E
F
G
H
J
K
L
M
N
O
P
Home Team
*
Away Team
*
Venue
*
Details of Send Off
You will now be guided through a series of questions relating to the send off offence. The name of the Player or Team Official can be found on the Official Team Sheet.
Name
*
First Name
Last Name
Club
*
Was the Offence committed by Player or Team Official?
*
Please Select
Player
Team Official
Shirt Number
*
Send Off Charge
*
R1 - Serious foul play
R2 - Violent conduct
R3 - Biting or spitting at someone
R4 - DOGSO (Handball)
R5 - DOGSO (Offence punishable by a free kick)
R6 - Offensive, insulting or abusive language and/or gestures
R7 - Second caution in the same match
R8 - Offences against Match Officials
R9 - Team Official Specific Offences (not covered in R1-R8)
Team Official Specific Offences
*
R-TO1 – violent conduct;
R-TO2 – physical or aggressive behaviour towards an opposing Player, substitute, Team Official, Match Official, spectator or any other person (e.g. security or competition official);
R-TO3 – using offensive, insulting or abusive language and/or gestures;
R-TO4 – biting or spitting at any person;
R-TO5 – entering the field of play to: (a) confront a Match Official (including at half-time and full-time);(b) interfere with play or an opposing Player.
R-TO6 – deliberately leaving the technical area to: (a) show dissent towards or remonstrate with a Match Official; (b) act in a provocative or inflammatory manner; (c) enter the opposing technical area in an aggressive or confrontational manner.
R-TO7 – deliberately throwing/kicking an object onto the field of play;
R-TO8 – delaying the restart of play by the opposing Team e.g. holding onto the ball, kicking the ball away, obstructing the movement of a player
R-TO9 – receiving a second Yellow Card in the same Match
Description of Send Off Charge
*
SEND OFF - Where were you in relation to the incident? Use the pencil Icon to mark with "X" YOUR position and "O" for position of incident. If you make a mistake press clear to start over.
*
R1 | Serious Foul Play
R1 | Serious Foul Play
*
The player attempted to get the ball
The player made no attempt to get the ball
R1 | In the action of Serious Foul Play did the player make contact with the opposition player?
*
Yes
No
R1 | What part of the opposition players body did they make contact with?
*
R1 | What was used to commit the action of Serious Foul Play?
*
R1 | Did the opposition player receive any medical treatment as a result of the incident?
*
YES
NO
R1 | What type of medical assistance was received by the opposition player?
*
On field treatment;
On field treatment & player walked unassisted from field of play;
Player was assisted from field of play (eg: carried; stretcher; ambulance)
Other
R1 | Was the opposition player able to continue in the match?
*
YES - Player continued to play;
YES - Player returned to the match after a rest/medical treatment;
NO - Player took no further part in the match;
Other
R2 | Violent Conduct
R2 | What was used to commit the action of Violent Conduct?
*
R2 | In the action of Violent Conduct was contact made with the other person?
*
Yes
No
R2 | What part of the other persons body was the offender attempting to make contact with?
*
R2 | What part of the other persons body did the offender make contact with?
*
R2 | Did the opposition player receive any medical treatment as a result of the incident?
*
YES
NO
R2 | What type of medical assistance was received by the opposition player?
*
On field treatment;
On field treatment & player walked unassisted from field of play;
Player was assisted from field of play (eg: carried; stretcher; ambulance)
Other
R2 | Was the opposition player able to continue in the match?
*
YES - Player continued to play;
YES - Player returned to the match after a rest/medical treatment;
NO - Player took no further part in the match;
Other
R3 | Biting or Spitting at someone
R3 | Biting or spitting at someone
*
Spitting AT someone or something
Spitting ON someone or something
Biting
R3 | Who or what was spat at?
*
R3 | Who or what was spat on?
*
R3 | Where did spit hit person?
*
Use initial L for Left and R for Right
R3 | Who was bitten?
*
R3 | What part of body was bitten?
*
Use initial L for Left and R for Right
R3 | Did the person receive any medical treatment as a result of the incident?
*
YES
NO
R3 | What type of medical assistance was received by the person?
*
On field treatment;
On field treatment & player walked unassisted from field of play;
Player was assisted from field of play (eg: carried; stretcher; ambulance)
Other
R3 | Was the opposition player able to continue in the match?
*
YES - Player continued to play;
YES - Player returned to the match after a rest/medical treatment;
NO - Player took no further part in the match;
Other
R6 | Offensive, insulting or abusive language and/or gestures
R6 | Who was the language directed at?
*
No-one (said in frustration)
Team-mate(s)
Opposition player(s)
Match Official(s)
Other
R6 | What was said?
*
R7 | Second Yellow Card in same match
R7 | Minute First Yellow Card Issued
*
R7 | What was the first yellow card for?
*
Y1 – unsporting behaviour;
Y2 – dissent by word or action;
Y3 – persistent infringement of the FIFA Laws of the Game;
Y4 – delaying the restart of play;
Y5 – failure to respect the required distance when play is restarted with a corner kick, free kick or thrown in;
Y6 – entering re-entering, or deliberately leaving the field of play without the Referee’s permission
R7 | Minute Second Yellow Card Issued
*
R7 | What was the second yellow card for?
*
Y1 – unsporting behaviour;
Y2 – dissent by word or action;
Y3 – persistent infringement of the FIFA Laws of the Game;
Y4 – delaying the restart of play;
Y5 – failure to respect the required distance when play is restarted with a corner kick, free kick or thrown in;
Y6 – entering re-entering, or deliberately leaving the field of play without the Referee’s permission
R-TO1 | Violent Conduct
R -TO1 | What was used to commit the action of Violent Conduct?
*
R - TO1 | What part of the other persons body did the offender make contact with?
*
R - TO1 | Details of person who was victim of Violent Conduct
*
R - TO1 | Did the other person receive any medical treatment as a result of the incident?
*
YES
NO
R - TO1 | What type of medical assistance was received by the other person?
*
On field treatment;
On field treatment & walked unassisted from field of play or technical area;
Person was assisted from field of play (eg: carried; stretcher; ambulance)
Other
R - TO2 | Physical or aggressive behaviour
R - TO2 | Details of person or persons who the behaviour was directed towards
*
R - TO3 | Language and/or gestures
R- TO3 | Who was the language directed at?
*
No-one (said in frustration)
Team-mate(s)
Opposition player(s) or Team Official(s)
Match Official(s)
Other
R- TO3 | What was said?
*
R- TO4 | Biting or Spitting
R- TO4 | Biting or spitting at any person
*
Spitting AT someone or something
Spitting ON someone or something
Biting
R- TO4 | Who or what was spat at?
*
R - TO4 | Who or what was spat on?
*
R -TO4 | Where did spit hit person?
*
Use initial L for Left and R for Right
R - TO4 | Who was bitten?
*
R - TO4 | What part of body was bitten?
*
Use initial L for Left and R for Right
R - TO4 | Did the other person receive any medical treatment as a result of the incident?
*
YES
NO
R - TO4 | What type of medical assistance was received by the other person?
*
On field treatment;
On field treatment & walked unassisted from field of play or technical area;
Person was assisted from field of play (eg: carried; stretcher; ambulance)
Other
R - TO5 | Entering the field of Play
R - TO5 | What did the Team Official do when entering the Field of play?
*
Confront a Match Official
Interfere with play or an opposing player
R - TO5 | What exactly did the Team Official say or do when confronting the Match Official?
*
R - TO5 | What exactly did the Team Official say or do to interfere with play or an opposing player?
*
R - TO6 | Leaving Technical Area
R - TO6 | Why did the Team Official deliberately leave the Technical Area?
*
Show dissent towards or remonstrate with a Match Official;
act in a provocative or inflammatory manner;
enter the opposing technical area in an aggressive or confrontational manner
Other
R - TO6 | How did the Team Official Show dissent towards or remonstrate with a Match Official?
*
R - TO6 | How did the Team Official act in a provocative or inflammatory manner?
*
R - TO6 | What did the Team Official do when entering the Opposition Technical area manner?
*
R - TO6 | What did the Team Official do?
*
R - TO7 | Deliberately throw or kick object on to field of play
R - TO7 | How did the object get on to the field of play?
*
Thrown
Kicked
Other
R - TO7 | What object was thrown or kicked on to the field of play?
*
R - TO9 | Second Yellow Card
R-TO9 | Team Official Minute First Yellow Card Issued
*
R-TO9 | What Was the First Team Official Yellow Card for?
*
Y-TO1 - dissent by word or action, including throwing / kicking drinks bottles or other objects to show dissent and/or gestures which show a clear lack of respect for the Match Officials (e.g. sarcastic clapping);
Y-TO2 – gesturing or acting in a provocative, derisory or inflammatory way;
Y-TO3 – gesturing for a Red Card or Yellow Card to be shown;
Y-TO4 – clearly / persistently not respecting the confines of their Team’s Technical Area;
Y-TO5 – deliberately entering the Technical Area of the opposing Team (nonconfrontational;
Y-TO6 – delaying the restart of play by their Team;
Y-TO7 – showing a lack of respect for the game;
Y-TO8 – persistent / repeated unacceptable behaviour (including repeated warning offences);
R-TO9 | Team Official Minute Second Yellow Card Issued
*
R-TO9 | What was the Second Team Official Yellow Card for?
*
Y-TO1 - dissent by word or action, including throwing / kicking drinks bottles or other objects to show dissent and/or gestures which show a clear lack of respect for the Match Officials (e.g. sarcastic clapping);
Y-TO2 – gesturing or acting in a provocative, derisory or inflammatory way;
Y-TO3 – gesturing for a Red Card or Yellow Card to be shown;
Y-TO4 – clearly / persistently not respecting the confines of their Team’s Technical Area;
Y-TO5 – deliberately entering the Technical Area of the opposing Team (nonconfrontational;
Y-TO6 – delaying the restart of play by their Team;
Y-TO7 – showing a lack of respect for the game;
Y-TO8 – persistent / repeated unacceptable behaviour (including repeated warning offences);
Others Involved?
Were any other players/team officials involved in this incident?
*
YES
NO
Name
*
First Name
Last Name
CLUB
*
Name
First Name
Last Name
CLUB
Name
First Name
Last Name
CLUB
Name
First Name
Last Name
CLUB
After Send Off
After Send Off
What happened immediately after the Red Card was given. Did the offender leave the field of play or technical area without further incident?
Did the player or team official leave the field of play/technical area without further incident?
*
YES
NO
Description
Description of After Send Off Incident
*
AFTER SEND OFF Where were you in relation to the incident? Use the pencil Icon to mark with "X" YOUR position and "O" for position of incident. If you make a mistake press Clear to start over.
*
How would you generally describe the after send off behaviour?
*
Violent conduct
Biting or spitting at someone
Offensive, insulting or abusive language and/or gestures
Other
After Send Off | Violent Conduct
AFTER SEND OFF | What was used to commit the action of Violent Conduct?
*
AFTER SEND OFF | What part of the other persons body did the offender make contact with?
*
AFTER SEND OFF | Details of person who was victim of Violent Conduct
*
AFTER SEND OFF | Did the other person receive any medical treatment as a result of the incident?
*
YES
NO
AFTER SEND OFF | What type of medical assistance was received by the other person?
*
On field treatment;
On field treatment & walked unassisted from field of play or technical area;
Person was assisted from field of play (eg: carried; stretcher; ambulance)
Other
After Send Off | Biting or Spitting
AFTER SEND OFF | Biting or spitting at any person
*
Spitting AT someone or something
Spitting ON someone or something
Biting
AFTER SEND OFF | Who or what was spat at?
*
AFTER SEND OFF | Where did spit hit person?
*
Use initial L for Left and R for Right
AFTER SEND OFF | Who was bitten?
*
AFTER SEND OFF | What part of body was bitten?
*
Use initial L for Left and R for Right
AFTER SEND OFF | Did the other person receive any medical treatment as a result of the incident?
*
YES
NO
AFTER SEND OFF | What type of medical assistance was received by the other person?
*
On field treatment;
On field treatment & walked unassisted from field of play or technical area;
Person was assisted from field of play (eg: carried; stretcher; ambulance)
Other
After Send Off | Language
AFTER SEND OFF | Who was the language directed at?
*
No-one (said in frustration)
Team-mate(s)
Opposition player(s) or Team Official(s)
Match Official(s)
Other
AFTER SEND OFF | What was said?
*
Acknowledge and Submit
Submit Report
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