DISCIPLINARY DECISION

DISCIPLINARY DECISION

FOUL PLAY OR MISCONDUCT
MATCH INFORMATION
MATCH-TEAMS*
Match Result (Home Team Score First)*
Ex: Team A (50pts)
MATCH VENUE*
MATCH DATE*
MATCH ORGANIZER*
COMPETITION*
PLAYER/PARTICIPANT INFORMATION
Player/Participant Last Name*
Player/Participant First Name *
# Player/Participant*
Registration (CIPP #)
Player/Participant Birthdate

MonthDayYear
Player/Participant's Team*
PARTICULARS OF OFFENCE
Card/Complaint*

RedYellows (Multiple)CitingOther*
Offense Type*

Foul Play - Reg. 17Misconduct - Reg 20
* IF "OTHER" Please specify
Foul Play Law Section*

9.11 - Reckless/Dangerous conduct9.12 - Physical or verbal abuse9.13 - Dangerous Tackle9.14 - Tackle opponent without the ball9.15 - Hold, push, charge or obstruct an opponent not in possession of the ball9.16 - Failure to grasp player with the ball9.17 - tackle, charge, pull, push or grasp opponent whose feet are off the ground9.18 - Spear/tip tackle9.19 - Dangerous play in scrum9.20 - Dangerous play in ruck or maul9.21 - Retaliation9.25 - Charge or obstruct an opponent who has just kicked the ball9.27 - Conduct that is against the spirit of good sportsmanship9.28 - Failure to respect the authority of the referee
Applicable Law Clarification
Referee Name (if applicable)
Referee's society/ affiliation:
Assistant Referee Name (if applicable)
Assistant Referee's society (if applicable):
Plea*

AdmittedNot Admitted
Summary of Sanction*

Number of weeksNo SanctionOther
HEARING DETAILS
Hearing Date:*
Hearing Venue*
Chair/JO*
Other Members of Disciplinary Committee*
Enter 'none' if JO only
Appearance Player/Participant?*

YESNO
Appearance Player/Participant's Club*

YESYES
Player/Participant's Representative(s)*
DDO and Other Representative(s)*
List of documents/materials*
PROVIDED TO PLAYER/PARTICIPANT IN ADVANCED OF HEARING
SUMMARY OF ESSENTIAL ELEMENTS OF COMPLAINT*

0/10000
ESSENTIAL ELEMENTS OF OTHER EVIDENCE (e.g. medical reports)*

0/10000
SUMMARY OF PLAYER/PARTICIPANT'S EVIDENCE*

0/10000
FINDINGS OF FACT*

0/10000
SANCTIONING PROCESS - Foul Play:

ASSESSMENT OF SERIOUSNESS
Assessment of Intent - R 17.19.2(a)-(b)*

Intentional/deliberateReckless
Assessment of Intent - State Reasons*
Gravity of Player's actions - R 17.19.2(c)
Nature of Actions actions - R 17.19.2(d)
Existence of Provocation - R 17.19.2(e)
Whether Player Retaliated - R 17.19.2(f)
Self-Defense - R 17.19.2(g)
Effect on Victim - R 17.19.2(h)
Effect on Match - R 17.19.2(i)
Vulnerability of Victim - R 17.19.2(j)
Level of Participation/pre-meditation - R 17.19.2(k)
Conduct Completed/attempted - R 17.19.2(l)
Other Features of Player's Conduct - R 17.19.2(m)
Entry Point*

Top End*Mid-rangeLow-end
Sanction*
WEEKS
* If Top End, the JO or Panel should identify, if appropriate, an entry point between Top End and the Maximum sanction and provide the reasons for selecting the entry point, below.

In making this assessment, the JO/Panel should consider World Rugby Regulations 17.19.2(a), 17.19.2(h) and 17.19.2(i)
Reasons for selecting Entry Point above Top End
ADDITIONAL RELEVANT OFF-FIELD AGGRAVATING FACTORS
Player's status as an offender of the Laws of the Game - R 17.19.4(a)
Need for deterrence - R 17.19.4(b)
Any other off-field aggravating factors - R 17.19.4(c)
Number of Additional Weeks*
RELEVANT OFF-FIELD MITIGATING FACTORS
Acknowledgement of guilt
R 17.19.5(a)
Player's disciplinary record
R 17.19.5(b)
Youth and experience
R 17.19.5(c)
Conduct prior to and during hearing
R 17.19.5(d)
Remorse and timing of such
R 17.19.5(e)
Other off-field mitigation
R 17.19.5(f)
Number of weeks deducted*
Summary of reason for number of weeks deducted*
SANCTION

NOTE: PLAYERS ORDERED OFF ARE PROVISIONALLY SUSPENDED PENDING THE HEARING OF THEIR CASE, SUCH SUSPENSION SHOULD BE TAKEN INTO CONSIDERATION WHEN SANCTIONING 0 R 17.14.5(f)
Total Sanction*
WEEKS
Sending off sufficient

Check here
Sanction Commences

MonthDayYear
Date
Sanction concludes

MonthDayYear
Date
Matches/Tournaments included
Costs/Fees
Signature*
Chair/JO of Appeal Panel
Date*

MonthDayYear
Date
NOTE: YOU HAVE 72 HOURS FROM NOTIFICATION OF THE DECISION OF THE CHARMAN/JO TO LODGE AN APPEAL WITH THE APPROPRIATE APPELLATE BODY - WR REG 17.22.2(a)
Should be Empty: