Match Official Send-Off Report

Match Official Send-Off Report

Match Details

Home Team*

VS

Away Team*

League*

Age Group*

Division*

Ground*

Date & Kick off time*

DayMonthYearHourMinutesAM/PM Option

Player Details

Player Name*

First NameLast Name

Shirt Number*

FFA Number

Club Name*

Offence Details

Send-Off Offence*

R1 - Serious foul playR2 - Violent conductR3 - Spitting at an opponent or any other personR4 - Denying the opposing team a goal or an obvious goal-scoring opportunity by deliberately handling the ball (this does not apply to a goal-keeper within his own penalty area)R5 - Denying an obvious goal-scoring opportunity to an opponent moving towards the player’s goal by an offence punishable by a free kick or a penalty kickR6 - Using offensive, intimidating, insulting or abusive language and/or gesturesR7 - Receiving a second caution in the same match

NOTE: IF NECESSARY, A POST SEND-OFF INCIDENT REQUIRES A SEPARATE INCIDENT REPORT.

Time of offence*

Enter minute of game

Score at time of offence*

Enter score

The Lead-up to the Send-off Incident: Describe where play was; What type of play?; Did anything happen in the Lead-up that made the incident occur?

The send-off was the result of the player’s following actions (Describe the incident): The position of the player; The direction the player was coming from; Describe in detail the type of contact (elbow, fists,head, studs, etc); For an R6 offence say exactly what the player said:

As a result of the offender's actions, what happened to the opponent (Describe in detail): Was the oppoent affected by the offender's actions; Could you see any physical marks (ie, blood, bruising, stud marks); Did they require treatment; Were they able to continue playing; Did they need to come off the field for a period of time; Were they not able to return to the field as a result of the offender's actions:

The Referee's position and view of the incident: How far where you from play?; What angle or view of the incident did you see?; Was your view clear or obstructed?

Post send-off report: Did the player continue to misbehave (further incident) after the Send-off? If so, describe briefly what occured and also submit an incident report (compulsory); Did the player leave the field without further incident?; How was play restarted?

Match Official Details

Role*

Your role at the match

Your name*

First NameLast Name

Your E-mail*

A copy of your submission will emailed to this email account.

Digital Signature*

I certify that the information entered above is true and correct and was entered by myself.

Submission Date*

DayMonthYear

Send Off Reports must be submitted by no later than 6pm on Monday following the match.