REFEREE/SCOREBENCH REPORT FORM

REFEREE/SCOREBENCH REPORT FORM
Please complete this form to report any incident where you feel that there should be a charge warranted.

Please note that if charges are accepted and a Disciplinary Tribunal is convened, the reporting official, as well as both referees (if the reporting official is not a referee) will be required to attend this Tribunal to give evidence.

This form is for Referees, Supervisors and Scorebench official only.
Details of Reported Person
Persons Name*

First NameLast Name
Team Name*
Club Name*
In what capacity was the reported person acting at the time of the incident?*

PlayerCoachSpectatorOther

Details of Match
Date of the Match*

DayMonthYear
Date
Time of the Match*
The opposing teams at the time of the incident*
Division *
Where did the incident occur?*

Officials Details
Name of Reporting Official*

First NameLast Name
Reporting Official's Email Address*
example@example.com
In what capacity were you involved in the match?*
Name of Referee 1 *

First NameLast Name
Name of Referee 2 (if required)

First NameLast Name
Name of Referee 3 (if required)

First NameLast Name

Description of Events

Please provide as much detail as possible
Details:*
Today's Date

DayMonthYear
Date
Signature of Reporting Official

Clear
Should be Empty:

	A	B
Disputing the decision(s) of a referee (6*)
Unsportsmanlike behaviour (6*)
Breach of Code of Conduct (6*)
Gross breach of a Code of Conduct (6*)
Attempting to trip (10)(52)
Tripping (52)(lifetime)
Making an obscene gesture (10)(20)
Using offensive, abusive, obscene or insulting language (10)(20)
Attempting to strike (10)(52)
Striking (using the fist, hand, head or an object or anther body part) (52*)(life)
Attempting to elbow (10)(52)
Elbowing (52*)(life)
Fighting when 2 or more players are involved (52*)
Attempting to kick (10)(52)
Kicking (52*)(lifetime)
Spitting (52*)(life)
Moving under airborne player (tunnelling) (104*)
Threatening a person or putting a person in fear of impending violence (52)(104)
Coaching, refereeing, playing or performing score bench duties while under suspension (5 per game*)
Deliberately endangering the safety or health of a player, spectator, Official or other person. (ifetime*)
Deliberately endangering the safety or health of a player, spectator, Official or other person in an incident involving blood or a body fluid (lifetime*)
Engaging in conduct bringing the game of basketball or BQ into disrepute (19*)
Failing, when required, to attend Tribunal without proper cause when notified (20*)
Failing to cooperate in or hindering or obstructing an investigation or hearing under these rules (20*)
Assaulting any person (52)(lifetime)
Contempt of Tribunal (20*)
Negligent or reckless or unnecessary physical contact with an official not amounting to striking or assault (52*)
Cheating, tanking, bribery or tampering with intent for any reason including to alter the result of a game (lifetime*)

REFEREE/SCOREBENCH REPORT FORM

Details of Reported Person

Details of Match

Offense(s) With Which the Person is Charged

Officials Details

Description of Events