TSSA Game Report

USSF Referee Report

Complete and submit this form to the appropriate competition authorities (e.g., local league, tournament director, cup coordinator, etc as directed. If needed, and in addition to the U.S. Soccer Referee Report, the U.S. Soccer Supplemental Referee Report can be used for instances of referee assault, referee abuse, dismissal of team officials, sending-off offenses, serious injuries, game abandonment, or other substantial occurrences.

Home Team:*

Score:*

Away Team:*

Score:*

Game Date:*

Date

Game Number:*

Association/League:*

If other, choose Other and write in name in next box

Other Association or League

Put in other association or league here

Division/Age Group:*

Gender:*

Referee:*

Grade:

Assistant Referee 1:

Grade:

Assistant Referee 2:

Grade:

Fourth Official:

Leave blank if none assigned

Grade:

Cautions/Yellow Cards:

	Name	Pass/ID Number	Team	Misconduct Code

Send Offs/Red Cards:

	Name	Pass/ID Number	Team	Misconduct Codes

USSF ID Number:

Phone Number:

Email Address:

example@example.com

Date:

Date you are submitting form

Assignor:

Choose assignor from dropdown list

Statement:*