AFL Goulburn Murray - Notice of Report & MRO Request

AFL GM Notice of Report Form
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Date*

MonthDayYear
Date
I was officiating as a
Venue*
League*
GVL Grade*
MFL Grade*
KDL Grade*
NCWL Grade*
GMJL Grade*

Report or MRO Request*

Match Review Request
GVL Home Team*
GVL Away Team*
MFL Home Team*
MFL Away Team*
KDL Home Team*
KDL Away Team*
GMJL Home Team*
GMJL Away Team*
NCWL Home Team*
NCWL Away Team*
Quarter*
Time*
Approximate time in the quarter. (Playing time, not real time)
Where on the ground did the incident take place*
Describe the incident.*
Type a question

Reported Player & Offended Player details
Reported Player Club GVL*
Reported Player Club MFL*
Reported Player Club KDL*
Reported Player Club GMJL*
Reported Player Club NCWL*
Player/official Reported Name*
Player/official Reported Number/role*
Offended Player Club GVL*
Offended Player Club MFL*
Offended Player Club KDL*
Offended Player Club GMJL*
Offended Player Club NCWL*
Name of Offended Player/official*
Offended Player/official Number/Role*

Reportable Offence Details
Offence*
Did the player receive a Yellow or Red Card*
Quarter*
Time*
Approximate time in the quarter. (Playing time, not real time)
Where on the ground did the incident take place*
Describe the incident.*
1.Location of the ball at the time. 2.Specify the number of players in the vicinity 3. Your approximate distance from the incident 4. State if you had a clear view of the incident 5. If a striking offence, which fist did the player use. 6. How many times was the player struck. 7. Where did the punches strike the player 8. Describe the result of the blow a. The punch knocked him violently to the ground b. The punch caused blood to flow freely from his nose. 9. What comments were made by the offender, offended player, surrounding players. 10. What was the reaction of other players; did a melee occur. 11. State if you believe the contact could be avoided 12. Were the eyes of the offending player looking at the offended player. 13. If it is a misconduct offence; describe the conduct reported.
Contact Offences

Striking, Kicking, Front on contact, charge etc.
Conduct*
Contact*
Impact*
Auditory Offence
Comments were*
Comments were directed at*
The volume of comments were*
Please write exactly what was said?*
How far from the player were you when the comment was said? In what tone was the comment said? Was there any reaction from other players? What did the reported player say when he was informed he was reported?
Attitude of player/official when informed of the report.*
Please provide any other details necessary that will assist with this report.
Include anything that was said, describe the contest etc.

Umpires Signature

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AFL GM Notice of Report Form

Match Review Request

Reported Player & Offended Player details

Reportable Offence Details

Contact Offences

Auditory Offence