Eastern Conf STXCL Incident Report 24-25
To report injuries, poor or unsafe field conditions, any unusual incident, or submit a complaint to the USC TX Soccer Board, please complete the following Incident Report Form. Any Director of Coaching, President, or Referee may report injuries, poor or unsafe field conditions, or any unusual incident or submit a complaint to the USC Soccer Board using the online Incident Report form.
Name
*
First Name
Last Name
Title
*
Director of Coaching
Club President
Referee
Club Affiliation
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Type of Incident
*
Ethics
Fields
Referee
Schedule/Communication
Injury
Forfeit
Protest
Sportsmanship- May be used if a team, player, coach, or spectator is involved
Other - Do not use if a team, player, coach, or spectator is involved. Use only if the incident cannot be classified as any other Type of Incident above.
Match Number
*
Date of Incident
*
-
Month
-
Day
Year
Date
Time of Incident
*
Hour Minutes
AM
PM
AM/PM Option
Location
*
Competition Name
*
Eastern Conference
Western Conference
Boys RL
Girls RL
Age Group/Gender
*
Name of Individual/Team Committing Incident *If the name is unknown, then put "unknown"
*
Was the individual/team who committed the incident (a member of) the Home or Visiting team?Type a question
*
Home
Away
Club Affiliation of Individual/Team Committing Incident
*
Team Affiliation of Individual/Name of Team Committing Incident
*
Club Affiliation of Opponent
*
Team Affiliation of Opponent
*
Description of Incident
*
Document Submission
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Is a Response from the PAD Required?
*
I want the PAD to follow up with me and take appropriate action.
I do not want the PAD to follow up with me. This is merely a suggestion or for your information.
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