AFL GM Notice of Report Form
Name
First Name
Last Name
Phone Number
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Area Code
Phone Number
Date
*
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Month
-
Day
Year
Date
I was officiating as a
Please Select
Field Umpire
Boundary Umpire
Goal Umpire
Emergency Umpire
Venue
*
League
*
Please Select
Goulburn Valley League
Murray Football League
Kyabram District League
Goulburn Murray Junior League
Northern Country Womens League
Grade
*
Please Select
Seniors
Reserves
U/18
U/17
U/16
U/14
Senior Women
Youth Women U/18
Home Team
*
Away Team
*
Home Team sheet
Away Team sheet
Did the player recieve a Yellow or Red Card
Please Select
Yellow Card
Red Card
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Player Reported Club
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Player/official Reported Name
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Player/official Reported Number/role
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Offence
*
Please Select
22.2.2 (a) intentionally or carelessly (i) striking another person.
22.2.2 (a) (ii) kicking another person.
22.2.2 (a) (iii) kneeing another person
22.2.2 (a) intentionally or carelessly(iv) charging an opponent
22.2.2 (a) intentionally or carelessly (v) engaging in rough conduct against an opponent.
22.2.2 (a) intentionally or carelessly (vi) bumping or making forceful contact to an opponent from front on when the player has their head over the ball.
22.2.2 (a) (vii) Head Butting an opponent or making forceful contact to an opponent using the head.
22.2.2 (a) (viii) making unreasonable or unnecessary contact to the eye region of an opponent.
22.2.2 (a) intentionally or carelessly (ix) making unreasonable or unnecessary contact to the face of an opponent.
22.2.2 (a) intentionally or carelessly (x) scratching another person
22.2.2 (a) intentionally or carelessly (xi) tripping another person whether by hand, arm, foot or leg
22.2.2 (b) eye gouging another person.
22.2.2 (c) stomping on another person
22.2.2 (d) intentionally making contact with or striking, an umpire.
22.2.2 (e) attempting to strike an umpire.
22.2.2 (f) spiting at or on an umpire.
22.2.2 (g) behaving in an abuse, insulting, threatening or obscene manner towards or in relation to an umpire.
22.2.2 (h) using abusive, insulting, threatening or obscene language towards or in relation to an umpire.
22.2.2 (i) unreasonable or unnecessary contact with an umpire.
22.2.2 (j) carelessly making contact with an umpire.
22.2.2 (k) disputing a decision of an umpire.
22.2.2 (l) spitting at or on another person.
22.2.2(m) attempting to strike another person.
22.2.2 (n) attempting to kick another person.
22.2.2 (o) Attempting to trip another person whether by hand, arm, foot or leg.
22.2.2 (p) Making unreasonable or unnecessary contact with another player.
22.2.2 (q) engaging in a melee.
22.2.2 (r) instigating a melee.
22.2.2 (s) Wrestling another person.
22.2.2 (t) Pinching another person.
22.2.2 (u) Engaging in an act of staging.
22.2.2 (v) Using abusive, insulting, threatening or obscene language.
22.2.2 (w) use of an obscene gesture.
22.2.2 (x) Engaging in time wasting
22.2.2 (y) Interfering with a player kicking for goal.
22.2.2 (z) Intentionally shaking a goal or behind post.
22.2.2 (aa) failing to leave the playing surface when directed to do so by an umpire.
22.2.2 (bb) Wearing boots, jewellery and equipment prohibited under law 9 of the AFL Laws of the Game.
Quarter
*
Please Select
1
2
3
4
Time
*
Approximate time in the quarter. (Playing time, not real time)
Offended Player/official Club
*
Enter N/A if it is an umpire related charge.
Name of Offended Player/official
*
Enter N/A if it is an umpire related charge.
Offended Player/official Number/Role
*
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Where on the ground did the incident take place
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Describe the incident.
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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
Please Select
Intentional
Careless
Area Struck
Please Select
High/Groin
Body
Impact
Please Select
Severe
High
Medium
Low
Auditory Offence
Comments were
Please Select
THREATENING - displaying an intention to cause bodily harm or causing someone to feel vulnerable or at risk.
HIGH-LEVEL abusive, obscene or Insulting language - includes rude, shocking or offensive language which may abuse, insult or offend any person or group.
LOW-LEVEL abusive, obscene or Insulting language - includes rude, shocking or offensive language which may abuse, insult or offend any person or group.
Comments were directed at
Please Select
an umpire.
Directed at another player or person.
The volume of comments were
Please Select
LOUD - Heard from more than 50m away or heard by spectators.
MEDIUM - Heard from more than 10 metres away, but less that 50 metres away, and/or heard by other players and/or heard by officials.
LOW - language could be heard from no more that 10 metres away, and/or conversational language.
Please write exacley 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.
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Please provide any other details necessary that will assist with this report.
Include anything that was said, describe the contest etc.
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Umpires Signature
Offending teams representative signature
Offending teams representative name
First Name
Last Name
Offended teams representative signature
Offending teams representative name
First Name
Last Name
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