Match Incident Report Form
If any information is unknown please type 'Unknown' if an answer is required
Your Details
Full Name
*
Role
*
Referee
Assistant Referee
4th Official
Match Assessor/ Mentor
Email
*
example@example.com
Match Details
Competition
*
Senior Men's
Senior Women's
FFA Cup/ Federation Cup
Junior Boys
Junior Girls
Collegiate League
Masters League
AHJSA
Futsal
Summer 7s
Other
Home Team
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Away Team
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Grade/ Age Group
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Division
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Venue
Date and Kick Off Time
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Year
Date
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Minutes
AM
PM
AM/PM Option
Reported Person Details
Person Reported
Role
Player
Coach/Team Official
Club Official
Spectator
Club
Players Shirt Number
Time of Incident
Incident Information
What are you reporting?
*
Red Card
Incident Report
Ground Conditions
Match Abandoned
Other
Was the offence against a Match Official?
*
Yes
No
Red Card
*
R1- Serious Foul Play
R2- Violent Conduct
R3- Spitting
R4- Denying an Obvious Goal Scoring Opportunity by Use of The Hand
R5- Denying an Obvious Goal Scoring Opportunity
R6- Verbal Abuse
R7- Accumulation of 2 Yellow Cards
Did you see the incident clearly
*
Yes
No
Level of Force
*
High Force
Medium Force
Low Force
Further Information
*
Player received medical treatment
Player returned to the game
Player didn't return to the game
Where was the contact on the body?
*
Was the contact made with studs?
*
Yes
No
Further Details of tackle
*
Please describe the tackle, did the player jump in, how many feet were used in the tackle?
Level of Force
*
High
Medium
Low
Offending player made contact with
*
Did the player use; Hand, elbow foot etc
If fist, open or closed hand (Punch or slap)
To the opponents (Head, Neck etc)
*
If a player missed, please put where it was aimed for
Did the strike connect?
*
Yes
No
Further information to the incident
*
Did the spit make contact with someone?
*
Yes
No
Where did the spit make contact?
*
What was said?
*
Please use exact words/ phrases. Do not cut out offensive words.
Did the player commit a further offence after being sent off? (Swearing, violent conduct, refusing to leave the pitch etc)
*
What was the problem with the ground?
*
Weather affected - not safe/suitable
Field of Play not safe/suitable
Markings not acceptable
Other- (Give details below)
When did the incident occur?
*
Pre game
During game
Post game
Reason for abandoned match
*
Home team not in attendance
Away team not in attendance
Weather affected
Spectator interference
Light failure or insufficient for play
Other
Other report options
*
Colour Clash
Match starting late
Report on facilities
Other not listed
Please add any extra information regarding the incident
Please enter any comments/ extra information you wish to add to this report.
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