• Gaming Dismissal Report Form

  • Date of game
     - -
    2 digit month, 2 digit day, 4 digit year
  • Kickoff Time

  • 1. Serious Foul Play

    2. Violent Conduct

    3. Biting or spitting at someone

    4. Denying an obvious goal scoring opportunity to an opponent by deliberately handling the ball- Free kick/penalty kick restart

    5. Denying an obvious goal scoring opportunity to an opponent moving towards the player's goal- Free kick restart

    6. Denying an obvious goal scoring opportunity to an opponent moving towards the player's goal- Penalty kick restart (holding, pulling, pushing, no possibility to play the ball)

    7. Using offensive, insulting, abusive language or gestures

    8. Receiving a second caution in the same match- do not complete a Caution Report for either Caution

  • Indicate to whom it was directed:
  • Select if you felt it was
  • Time of Game

  • Description of Incident

    Please include: 

    Directed at a match official?

    Where was the point of contact? (e.g. head, shin, ankle)

    What was used to make contact? (e.g. foot, hand)

    Note where in the facility this occurred

    For dismissal Code 7 (Using offensive, insulting, abusive language or gestures) you must provide the exact words that were spoken. 

    For dismisaal Cofe 8 (Receiving a second caution in the same match- do not complete a Caution Report for either Caution) you must note the details of both cautions. 

     

  • Referee Information
    Rows
  • Should be Empty:
Select theme: