PRESCRIBED FORM 21 - ABANDONED MATCH REPORT

PRESCRIBED FORM 21 - NEPEAN F.A. INC. ABANDONED MATCH REPORT
Reporting an abandoned match must be submitted in the first instance by telephone to the Competitions Manager - 0407 123 352

Both the Home and Away Clubs will need to complete this form.

Please see Extra Information Section in this document for who should complete the extra reports required

Weekend Fixture - 9pm on the day of the incident

Mid-Week Fixture - 5pm on the following day of a mid-week fixture.

MATCH DETAILS
Home Team*
Away Team*
Age Group*
Division*
Colour or Name (if applicable)
Date of Match*
Time of Abandonment*
Home Team Score at time of abandonment*
Away Team Score at time of abandonment*
Venue Name & Field #:*
REFEREE DETAILS
Referee First Name*
Referee Surname*
Status Of Referee*
REASON FOR ABANDONMENT

Please select one of the following
Reason for Abandonment*
Provide extra information, as per the above instructions here:
1. EXTRA INFORMATION & INSTRUCTIONS TO COMPLETE SUBMISSION:

PLAYER OR SPECTATOR BEHAVIOUR - a separate & full report must be submitted by the following people from BOTH the home and the away team.

The clubs must submit witness statements from other persons present at the game. The reports are to be submitted to the Association’s office within 72 hours of the incident.

a.       Team manager

b.       Team coach

c.       Team captain

d.       Game marshal

e.       Match Referee & Assistants (NRG will forward official reports. If an unofficial or club referee was used, the club who supplied that referee must co-ordinate the submission of their reports)

f.         Ground Official

2.       PLAYER OR SPECTATOR SERIOUS INJURY - a brief report from the host club should be submitted indicating which player was injured,   whether or not an ambulance was called and at what point in the game the match was abandoned. The club to which the injured player belongs should submit a serious injury/accident report, however, that report does not form part of the abandoned match report process.

3.       REFEREE ABANDONED MATCH DUE TO WEATHER CONDITIONS – No extra reports are necessary

4.       VENUE FAILURE (LIGHTS OR SPRINKLER MALFUNCTION, OR PROBLEM WITH PITCH DISCOVERED AFTER KICK OFF) – home team should submit a brief report on what part of the venue malfunctioned to cause the abandonment.

NB: FINES APPLY FOR FAILURE TO REPORT ABANDONED GAMES
You may also upload extra documents here

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Name of Person Submitting Report*
Position or Role in Club (Must be a club committee member)*
Daytime Contact Phone Number:*
Email Address*
Please click "Print Form" to save a copy or print a copy of your report before sending to us.
Should be Empty:

PRESCRIBED FORM 21 - NEPEAN F.A. INC. ABANDONED MATCH REPORT

Reporting an abandoned match must be submitted in the first instance by telephone to the Competitions Manager - 0407 123 352

Both the Home and Away Clubs will need to complete this form.

Please see Extra Information Section in this document for who should complete the extra reports required

Weekend Fixture - 9pm on the day of the incident

Mid-Week Fixture - 5pm on the following day of a mid-week fixture.

MATCH DETAILS