INCIDENT REPORT

SOUTHERN CALIFORNIA RUGBY REFEREES SOCIETY

 

For use by referees and/or coaches, players, spectators, etc.

 

Please use for any incident before, during, or after a match regarding: a) player sent off under Law 10; b) unsafe playing conditions (i.e., no rope barriers, goal post padding missing, no on-site medical attention, improper field markers, unsafe playing surfaces, etc.); c) abusive behavior – coach, player, spectator; or d) any other complaint.

 

Match:   (visitor)            @             (home)

  1st Side                    2nd Side                    3rd Side

Club Men DI  Club Men DII  Club Men DIII  Club Women

Collegiate Men I  Collegiate Men II    Collegiate Women

Youth Boys HS  Youth Girls U-19  Youth Boys U-16  Youth Boys U-14  OB

Location:          Date:   

Individuals involved (include name, position, jersey number, club affiliation, CIPP #, and SCRFU ID # [if appropriate])

(Match Referee: Must submit separate report for each category of "Match Referee Actions."):

 

Details of the incident and your actions, if any, in response:

 

MATCH REFEREE ACTIONS

  Yellow Card: Player

  Red Card: Player – Class I Sendoff  – 8 Days

  Red Card: Player – Class II Sendoff  – 15 Days (Match Referee may recommend more.)

  Red Card: Non-Player Sendoff

  Other: Advisory report of non-play incident

RECOMMENDATIONS

The Disciplinary Committee take no further action.

The Disciplinary Committee consider the following:

      Suspension for the following individuals -- or "N/A" (If Match Referee: In addition to Class II mandated number of days.):

 

      In addition to any suspension, the Disciplinary Committee should consider the following action -- or "N/A":

 

 

 

Name:             Match Referee?   Yes    No

 

Date:          Phone:          E-Mail:    

 

 

SEND THIS REPORT WITHIN 48 HOURS OF THE INCIDENT.