STXCL Incident Report 25.26

STXCL Incident Report 25.26

To report injuries, poor or unsafe field conditions, any unusual incident, or submit a complaint to the STXCL 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 STXCL Soccer Board using the online Incident Report form.
Name*

First NameLast Name
Title*

Director of CoachingClub PresidentReferee
Club Affiliation
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Type of Incident*

EthicsFieldsRefereeSchedule/CommunicationInjuryForfeitProtestSportsmanship- May be used if a team, player, coach, or spectator is involvedOther - 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*

MonthDayYear
Date
Time of Incident*

Hour Minutes

AM/PM Option
Location*
Competition Name*

Eastern ConferenceWestern ConferenceBoys RLGirls 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*

HomeAway
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

Cancelof
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.
Should be Empty: