UW Intramurals
PA Shift Report
Name
*
First Name
Last Name
Date of Shift
*
-
Month
-
Day
Year
Date
Time of Shift
*
Location of Shift
*
Pre-Game Responsibilities
Were there any facility issues you encountered when you arrived or during your shift?
*
Yes
No
If yes, what action was taken?
Did you have all the equipment you needed and was it in proper working order?
*
Yes
No
If no, what was missing or damaged?
Game Responsibilities
Were any officials or PA staff who were late or did not show?
*
Yes
No
Not applicable
If yes, describe the offense, indicate the officials/staff, and describe action taken.
Did any officials perform exceptionally well? Any staff highlights?
Any points of emphasis or areas of improvement for the officiating or PA staff?
Injuries
Were there any injuries?
*
Yes (If yes, fill out an Injury/Accident Report)
No
Protests
Were there any protest filed?
*
Yes (If yes, give Protest Form for participant to fill out, Staff should complete an Incident Report)
No
Conduct
Were there any player ejections?
*
Yes (If yes, give out Ejection - Captain Notice Form, Staff should complete an Incident Report)
No
Any additional team player, or fan conduct concerns?
*
Yes (If yes, Staff should complete an Incident Report)
No
Post Game Responsibilities
Did you review the scoresheet to ensure they were completed properly?
*
Yes
No
Did you put everything away (paperwork, phone, equipment, first aid kit, etc.?
*
Yes
No
Please provide additional comments, recommendations, or concerns about your shift.
*
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